Med error and im not even a real nurse yet!!!

[kknarfs]

so the other night i made a med error. at our facility the mar is computerized so, we the students before we get on the floor, print all of that information out so we can look stuff up at the hospital pertaining to our patient. the new nurse from some eastern european country i was supposed to be working with was co-working with a more experienced nurse from the unit. we get on the floor at 4:00 so at 4:00 (one or two minuets before) i introduce myself, tell her that i will be doing meds vitals, assessments, all meds that are not iv. i ask her if my patient an 11 month old with a traumatic brain injury if he had gotten his meds yet.

meaning his .5mg of morphine that was due which he is receiving q 3hrs via ng tube.

she said 'no'. only after i passed the med and went to enter it in the computer did i come to discover that she passed the med already (half an hour before i asked and 15 minuets after i printed out the mar) and she thought i was referring to his his 5:00pm med which indeed had not been passed. so because i along with seven other nursing students need our clinical instructor to pass meds with us usually all at the same time, we weren't able to pass it until 5pm (thank god for that). when we go to enter in the computer the he had received his meds it appears that it has already been checked off by someone else an hour and half before that.

i was livid at the nurse but i kept my cool i kept going over in my mind talking/yelling at the nurse who told me that but i never did, my main concern was for my patient. my instructor told me just to monitor him and watch his respirations and hr.

she, my instructor notified the doctor and said it was a communication error because of a language issue.

i know that it is my fault because i am responsible for my patient and i am the one who administered the med. but as a student i want to know what the implications of this are. my instructor just informed me that i need to work with her on a 'clinical learning contract' even though i only have two more clinical days left in the year.

my instructor filled out the incident report while i was watching my patient, (she didn't come back for two more hours because she was busy with other students). i never signed anything, i asked if there was suppose to be something to sign but she said i didn't need to. also she didn't freak out on me and both the new nurse and the more experienced nurse didn't yell at me.

my patient ended up being fine in the end without any problems

but...

what is the process of this/what does it mean?

does this happen to students?

is this on my 'permanent record' sort speaks?

what are the legal implications?

can i get kicked out of school?

what does it do to my grade?

[LVNwannaBE2007]

hey **hugs** it happens to all of us. my 1st med error was in nursing school too.... i was doing clinicals in a LTC facility and gave insulin to teh wrong person....... i didn have to sign all teh paper work and everything but i didnt get kicked out by any means.....

the pt was fine and we just monitored her for a while checking her BS Q15min (she was actually excited because she said she hadnt gotten that kind of attention in a long time)

[pagandeva2000, LPN]

I wouldn't worry about it. Mistakes make us more careful. Also, you followed procedure by telling your clinical instructor, the patient was monitored and thus far, all is well. We are human, and you are in school to learn. Of course, this happens to students as well as experienced nurses. And, we all live through it, and most of us learn to be more careful and diligent in the future. The best lesson of all is that now you know, even with the best of intentions, things can and do go wrong. Huggs to you!

[smk1, LPN]

The answers to what happens depend upon your previous reecord as a student, what your student handbook states and whether the incident occurred because you were outside of your scope of practice. It sounds like you will be fine. There will be an incident noted in your student file I imagine, and so from this point on you will need to be even more careful that you do not make mistakes because multiple incidents will surely cause you to be dismissed from the program. Learn from the incident. Quite frankly it sounds like it isn't truly your error. You asked if the med had been given. You printed your MAR and it wasn't signed as given, it was time to give the med so you gave it. The nurse who gave a med and didn't immediately chart it and then told you she hadn't given the med should be written up. But the situation is what it is. If you were going to get failed over it, you would have heard more from your instructor about it. Good luck

[MistiroseRN]

I can only imagine how scared you were. I am glad that all is well with your patient. I have come close to making a med error but lucky for me my intructor caught it. It will never leave you and you will be very careful because of it. That one time has stuck with me and I am greatful it has. Good luck to you.

[Ginger's Mom, MSN, RN]

As an instructor, I would be concerned with your anger towards the staff nurse. As an instructor, I often get misinformation from the staff, but you have control your anger. As a nurse you have to deal with people ( patients and staff) with accents, you can't use that as an excuse.

Morphine is a narcotic and had to be signed out by your instructor, since you do not have a license it is really her error. She trusted you and didn't double check you, therefore is drafting a learning contract. I think it is the right thing to do , it covers your instructor and you will learn from it.

She didn't have you sign the incident report since your signature was not needed.

[locolorenzo22, BSN, RN]

usually you will have to sign the learning contract....a plan and steps to take before doing meds again.....also, hugs. I think EVERYONE makes a med error in nursing school....You'll probably always be super careful now because of that. We all make mistakes...realize that you should probably always check the MAR before giving meds.....ALL(prn and scheduled) meds.....GL...keep up the good work. Although giving meds to a 11 month old....hmmmm, I think the assignment should be looked at.

[medsurgrnco, BSN, RN]

Unfortunately med errors do happen... Suggest next time being more specific when talking to your nurse ("has the 4:00 morphine med been given ...?"). You can probably also check when getting the med out for the last time it was taken out of the med machine. But shouldn't either your instructor or the nurse have been with you when you gave the med?

[YellowFinchFan]

The most important thing is to learn something from this error. Unfortunately most of us learn "best" from mistakes...When you feel calmer think about how you could change what happened to prevent what happened.

Being very specific with the nurse about what meds you are giving. When dealing with any narcotic (timed dosages) or prn meds never again assume that you and the nurse are 'thinking the same thing'. Assume the nurse may have given all the meds already if you must - but write them down and review them with her. Also...do you use a pycsis machine? They will tell you the last time a 'dose' was removed and by whom (under the med/dosage) I sometimes use this as an additional check on myself....

I'm unclear if the nurse documented she gave the q 3 hour morphine to the baby? Did she document it in the computer? That's another check you can do - look at the MAR and see if things were documented on already.....

Wanting to 'scream' at the nurse is not going to solve anything - when you're a nurse working independently you will see how much you have to manage. Maybe she's learned something from this too - be very specific with nursing students/instructors about what will be given. I know this would be my mantra if this happened on my shift.

No one is perfect, we must strive everyday to be very careful to not make med errors - and it will happen despite your best efforts (I find errors are made when the 'routine' is changed, or you skip a step because you are rushed')

I'm so glad the patient was not harmed....and you learned a valuable lesson - you have to incorporate even more safeguards with med administration.

good luck in school! :typing

[htrn]

First of all {{hugs}} - Any nurse that has been a nurse long enough and is honest with herself has been involved in some sort of medication error. Unfortunately, it happens. Fortunately, most of the time, there are no long term problems and there wern't in your case.

Communication is a huge problem in med errors and you just learned that lesson the hard way. I have learned never to trust a verbal order from a doctor until I have written on the order sheet and read it back to him (as required by JCAHO) and I have also learned to look up any medication I have not personally given myself - even if my co-worker tells me they have already looked it up and everything is "fine". MD handwriting, hand written MARS, look alike/sound alike meds are all potential errors waiting to happen.

Take it as a tough lesson learned and an opportunity to grow. BTW, I am very proud of you for going straight to your instructor and admitting to the error right away. It's a tough thing to do, but the right thing to do. Good Job.

[racing-mom4, BSN, RN]

I too made a med error in school. I was at a facility with computer MARS and the pt had .05 mg of Drug X to be given at 0800. I scanned it and gave it. At 1000 Dr arrives and sees pt. At 1130 staff nurse hands me a bag of meds and says here are so and so's med from pharmacy. I put them in his drawer. At 1200 I go to give his meds and I see Drug X 1mg, in the drawer was a 1mg tab. I scan it, it accepts it and I give it.

Come to find out Drug X was an updated new order from Dr, so techincally I was only to give another .5 to equal the 1mg since I had already given .5 at 0800.

Even though I had been on the floor a few weeks, I was not totally comfortable with this hospitals computer charting, I had a hard time finding my pts charts because either the staff nurses had them, or they were at the ward clerk desk.

My instructor had to write me up and I had to meet with our dean. I felt horrible, terrible. As I had always been an excellent student. I learned that day just because something aka a computer tells you something, to always double check. The safe guards that were in place to prevent the med errors were there, but they didnt catch this. So I learned you can only ultimately trust yourself.

Being a student is hard enough--your worried not only about doing a good clinical job, you also have your school paper work to deal with, the being out of your element to deal with, the multiple personalities that come with the staff nurses to deal with. Mix that in with your nervous and some what overwhelmed.

I had a clinical instructor who was never to be found unless we looked down in the cafeteria or the break room on her cell phone (OK I have a tad bit of hostility still held towards her lol lol) but I still could not blame her. As I was the one who gave the med.

Best of luck---we are human and make mistakes, it is how much we learn from our mistakes is what makes us better nurses.

[TiredMD]

0.5mg morphine via NG tube?

Let's see: The standard initial dose of morphine in a child is 0.1mg/kg IV, which is probably about equivalent to 7mg IV in an adult. A 11mo-old should be about 10kg, which means 0.5mg is half the recommended dose (if given IV). Since an enteric morphine dose has about 1/3 the potency of an IV dose, the dose given to this child is approximately equivalent to a 1mg IV dose in an adult.

Which is . . . well . . . nothing.

Sounds like this med error was probably doing the kid a favor.