med error!!!

[alwayslearning55]

I feel like the biggest failure.

I'm a new grad RN who has been on my own for about 2 months now. I had a 6 week orientation prior to being on my own. I'm on an incredibly busy med-tele floor. And today I made my first error--a HUGE error at that. My patient was to receive a blood transfusion. He was a very sick patient who had 4 channels running with antibiotics, fluids, electrolytes, and blood. I accidentally let the blood transfusion run too long. I can't believe I let this happen. When I looked at the order I thought it was for 4 hours. However, the order was actually for 3 HOURS. And then, around 6:30 right before shift change I was told I had to transfer the patient to a different floor and my charge nurse was very adamant that it needed to be done ASAP. Around that same time I was trying to pass medications and another nurse called to ask if I can switch shifts with her and when I told her it wasn't a good time she got the charge nurse on the phone who kept trying to talk to me about scheduling and me switching shifts with the other nurse. I told her I hadn't even had a chance to sit down all day and chart, let alone look at what my schedule is, and that I would let her know later, but she just kept trying to fix up my schedule. At the same time I had a discharge who had been waiting all day to leave, a patient who needed to be cleaned up, meds to pass, and had to transfer this patient upstairs. I called report and transferred the patient and never turned off the blood. I didn't even know what I had done until the nurse from the other floor called me an hour later and said I had made a huge mistake. Not only was I supposed to have turned off the blood at 6:30, it had run up to 7:50. It ran for 4 HOURS AND 20 MINUTES. I notified my charge nurse right away and called the doctor, and we had to write an incident report. I can't believe I made such a big mistake. I'm crying and so angry at myself for missing something so big. We are so busy on our floor with so many things going on at once, it feels like I'm being pulled in so many directions and I can't keep track of everything. However, there is no excuse. This was MY fault and no one else's. I should have been paying more attention, I shouldn't have let this happen. I don't know what to do. I don't wanna go back to work, I don't want to show my face again.

[alwayslearning55]

I thought you were going to say you forgot to DC a heparin drip or something. THAT's huge.

This, not so much. Unless your patient died from an unmonitored transfusion reaction. THAT's huge.

Just letting the blood go for a few minutes longer than it should... eh. On a scale of zero to ten of patient harm, this is maybe a 3. Probably a 2. OK, a 1 1/2.

Here's what I got from your post that you could have changed:

A) You should learn to put your foot down. If you don't have time to talk, you don't have time to talk. It's OK to hang up on people when they are being ridiculous.

B) You should not have been transferring the patient if you were that busy. Most hospitals have transport that can transfer the patient, unless they are on the monitor with no orders for nurseless transport. At the least, your unsupportive charge should have taken the patient for you.

C) You should have asked for help long before you got that far behind.

D) Learn to say "no." "No, I can't talk now." "No, I can't transfer that patient." "No, I can't interrupt my med pass to talk to you." "No, I can't help the CNA clean this patient up, I have to pass meds." You are the licensee, you do the licensed tasks. The CNA is the unlicensed assistive personnel, they do the unlicensed tasks. If you could do it all yourself, hospitals wouldn't pay for CNAs.

E) You cannot do everything yourself. I have a nurse friend who is a control freak and tries to do it all. She's been disciplined many times for overtime, almost to the point where she's lost her job. Don't be like her. Ask your fellow nurses for help. If they say no, call the charge nurse. If the charge nurse can't help, call your resource nurse. If you don't have resource nurses or they aren't available, call the house supervisor.

I've always said there's no need to drown when you are surrounded by lifesavers. If you don't grab one, that's your own fault.

You will be OK, but you need to stand up for yourself. Chalk it up as a learning moment, and don't EVER let yourself get so busy that you have that problem again. If you are not able to handle the patient load yet, let your manager know. If you have a good manager, they will let you take a smaller assignment until you are more capable, or at least give you pointers on how to manage. If you have a bad manager, don't say anything. They will see it as a sign of weakness and dive right in to prey on you. Find a nurse mentor. There's almost always that one person on the unit who mothers the new grads.

New grads need to be supported for the first year. That's just the way it is. It takes you that long to get used to the critical thinking, the culture of the hospital, and the ins and outs of your specialty. If you are not getting that support, it is not your fault. Hopefully you can talk to your coworkers and management and get things straightened out for yourself.

BTW, you're only stupid if you make a mistake and don't learn from it. I am not happy with your choice of username. Beating yourself up doesn't help anybody.

Now, for blood administration: (Those of you who know what you're doing can skip this part, LOL!)

Most hospital policies are the same. Find yours and print it out so you are familiar with it next time. You fill out a form or put in an e-request with all of the relevant info (patient name/DOB/MR#, blood bank #, blood product needed, ordering physician, location of patient).

Once you get the blood, you have thirty minutes to decide that it is OK to administer or you need to send it back to blood bank. You get your second nurse to verify the unit. Once the bag is spiked, you usually have four hours before the blood expires. Get a set of vitals pre-transfusion. When you have your tubing all set up and connected to the patient, start running your blood. I usually run it at 999 cc/hr until just before it actually goes in the patient. Then I set the secondary for 75 cc/hr for 15 minutes. (Only on pumps that don't have a separate secondary port.) I set the primary for whatever rate is appropriate according the patient age/condition and the IV size. That way I don't have to remember to change it. Your start time is the minute that the blood hits the patient. It's stupid to waste your 15 minutes watching NS going in, so don't start your time when you hit the START button. Wait until the blood is actually going in.

The smaller the gauge, the slower you go. I never run it more than 125 in a #22 to prevent hemolysis reactions. I also never run it over 150 if the patient is over 65 or has CHF or PNA. ARDS sucks.

Stay with the patient for the first 15 minutes to check for s/sx of allergic reactions. I usually take a mobile computer and use that time to chart. Once the 15 minutes is up, get another set of vitals. If the BP goes up or down by 30 points, the HR changes 20 beats from baseline, or the temp goes up or down 3 degrees, you've got a reaction and you need to stop the blood, pronto. Let the doc know, keep NS running at KVO (or your policy's rate) to keep the IV open so you can administer steroids/benadryl/whatever, and send the whole shebang of tubing and blood to blood bank for testing.

If there's no reaction, check on them an hour from the time the blood started and get another set of vitals. Rinse, repeat, until all the blood is gone.

I can't thank you enough for this post. The step by step on how to go about the transfusion with tips and what to do the whole time and if a reaction occurs is SO helpful for me. I want to print this and have it with me at work lol.

Unfortunately, we have one charge nurse who is not helpful and she is the one that was working that day. The other are usually helpful and assist in transfers, meds, etc. if we are behind. But this one does not, she think it's tough love. And I wish so much that we had transporters.

You're right, I try to do a lot on my own because everyone is always so busy and I don't want to bother them, but I need to learn to get help sooner rather than later. And i need to learn to say No and stand up for myself. I'm already starting to see how people take advantage of me because I'm too nice and not assertive enough.

[alwayslearning55]

Thank you to everyone who took the time to read my post and respond. You've all really made me feel so much better and really encouraged me to keep moving forward and keep learning through everything. It's so nice to have so much support from nurses who have been in my shoes and understand what I'm going through.

P.S. I changed my username, you are all right I can't beat myself up.

[melissamabd, DNP, RN]

Hi,

I have been an RN for 36 years and am now a nursing instructor. One thing I tell all students is THEY WILL MAKE MISTAKES.

Humans are not perfect anywhere, let alone in the high stress environment of nursing.

So welcome to the real world of nursing. You are earning badges of honor and courage.

The great thing about a mistake is: it's the best teacher, ever. You will NEVER do this again. You are now wider in many ways. You will be less quick to condemn others and someday, when you are teaching, you will bring wisdom and compassion to your efforts.

I say CONGRATULATIONS to you. You didn't kill anyone, you bravely admitted your experience, and you are reflective about it.

You are on your way to becoming a veteran. Get back in there with your newfound wisdom. We need you.

Oh, and someday you may err again. This is why tests are scored as passing at 65 or greater, not 100%.

Email me if you want to talk about it. Healing takes time... And talking.

[VANurse2010]

A nurse who would report you for 4 hours 20 min. is a GD imbecile.

[Brandidrn]

Not to make light of it but the patient wasn't harmed so take a deep breath u learned from it so let it go we all make mistakes I gave IV to the wrong patient so imagine dealing with that huge boo boo I feel as long as u admit it and take responsibility for it go on the past it gone so good luck!

[cjcsoon2bnp, MSN, RN, NP]

To the OP...

1. Take a deep breath, in and out.

2. Ok now take another.

3. Realize that you're a human being that made a mistake. You identified what the mistake was, the contributing factors and now you know how to avoid it for the future. Take some time to review your institution's policies and procedures on blood product administration.

4. Remember that you're still a good nurse and you care about your patients. Keep your head up, always have an open mind and be ready to learn every day you come into work.

!Chris

[Peacelove889]

I'm so sorry this happened. Mistakes happen all the time and we have to take responsibility when they happen. It can be tough when things are so busy and we miss important things.

Nothing in nursing is perfect and we have to learn from our mistakes. Be proud you're a nurse now and your hard work paid off. :)

Everything will be ok. :)

[Slycooper4u]

We ALL make mistakes. Yor day is unbelievably hectic. I'm an Lpn student who has to repeat a intro to med-surg class. Getting your RN licence is an awesome accomplishment. I was told that mistakes are going to happen, but just try to learn from them. At the end of the day, your still a good nurse.

[jadelpn, LPN, EMT-B]

Thank you so much for your reply. He was supposed to get the whole unit but it was supposed to have been over 3 hours. He didn't have a GI bleed or anything. His Hgb was 7.2. But when the nurse called me and told me I made a huge mistake and that she was going to get in trouble because of me, I just figured this was the biggest mistake I could have ever made, especially because it had to do with blood.

The patient was transferred to a floor where he could get chemo. If we don't transfer our patients promptly the house supervisor usually comes down and gets angry with us because we're holding up 2 rooms and our hospital is so full that we have people in the hallways of the ER.

I agree I will need to be more assertive. It's just a little difficult for me sometimes because I have a very straight forward, blunt charge nurse who is much much older than me and I don't want to seem disrespectful in any way.

As for the cleaning up, our CNA's have 16 patients and so it's very difficult to get ahold of someone to help because they're usually running around just like I am. I do wish we had some more help.

Thank you so much for responding. I'm going to practice being assertive and I'll really try to hang in there and just learn from everything and not let it bring me down.

If she was going to get "spoken to" it would not be because of you. The nurse in question needed to assess, check and verify everything running or everything not running that needs to be. If the blood was to be transfused prior to transfer, then you needed to relay that information when you checked to see if they were ready for the patient. Then you could have asked for direction from your charge regarding increasing the rate.

There is policies in every facility, and some have specific blood transfusion care maps. The care maps talk about premedication, timing and rate. Perhaps this could be a unit idea going forward.

You transferred the patient prior to the 3 hour mark. The rate may have been too slow if the timing was to be 3 hours, but 4 hours is not unheard of. And if you had to premedicate, the blood itself wouldn't go up until around 45 minutes to an hour after that to begin with.

Bottom line, the nurse receiving this patient did not assess well upon transfer and is solely blaming you for that. This part is not your issue. Make sure you document when you premedicate, what your starting rate is, when you increase the rate if tolerating, and review all of this information to the nurse taking the patient. Just for safety's sake, be sure you both look at the number on the bag and re-verify. That way you are both on the same page.