Med error...what to do?

[kh2013]

Okay. I made a med error on Friday...and I don't think I was instructed to document it properly.

I am a new grad with a preceptor. Long story short, patient was in pain and absolutely hysterical, thrashing around in her bed, begging and screaming for me to do something. Her MAR with PRN pain medication was a mile long. The patient, while hysterical, kept changing her mind about what meds she wanted and when. Once she made a decision, I, while flustered, prepared the medications in the unit's Medication Room and from there went into my patient's room and scanned my medications...but did not realize the computer system did not properly scan all of the meds before I administered them. I gave the correct pain medication dose ...but I incidentally gave double the Benadryl IV dose for itching (the one medication that did not scan properly). I tried to scan the med and document the amount I actually gave and not the ordered dose. The computer wouldn't let me and I told my preceptor. We called information systems to ask how to document it, they said just report it to MD and see if I can get an order for one time dosing. I called the MD. MD wasn't worried, came to floor 10-15 mins later for roundings, assessed the patient and cleaned up PRN pain med list and gave me a one time order for Benadryl IV dose I actually administered.

My preceptor told me there was nothing more that needed to be done (I asked about filing an incident report...and the response was along the lines of that the MD provided an order, so it is fine to do without).

I go back to work tomorrow morning. This incident has been eating at me this whole weekend. I will file an incident report tomorrow.

Should I add an addendum to the patient's chart stating, "At 0900 50 mg IV Benadryl given. Discussed with MD."? Or what? Does the one time order after the fact cover me?

I know the timing of this documentation is not ideal, but better late than never, right?

Luckily, the patient had no adverse effects. I am so upset that this occurred, especially during training. And now, with more time to think about it, I hate the fact that it looks like I tried to cover it up. However, I honestly did not mean to come across this way. I told my preceptor and manager what happened as soon as I realized it. I feel awful, and I don't want to cover it up. I will definitely be more careful in the future.

If you have any advice, please share.

Thanks,

One devastated new grad.

[calivianya, BSN, RN]

You covered your butt getting the MD order. If you had given a wrong dose of something harmful, the MD would not have agreed to give you that order.

Honestly, I probably wouldn't even write that one up. I'm with your preceptor on that one.

Additionally - most nurses I know would have intentionally given the full 50mg in the first place, especially to a hysterical patient. Just saying.

[RiskManager]

The RiskManager would like to see an incident report on this, since his interest is piqued by the computer refusing to allow you to enter the administered amount. RiskManager would send the incident report to IT and ask them what gives on this situation. In terms of an addendum to the chart, if the med administration is adequately documented in the chart via the order and the medication administration record, I am not overly concerned over writing an addendum. If it is not documented in the medication administration record due to the computer issues, I would make an addendum documenting that the med was given. Be sure to note this as an addendum made after the fact, however your electronic healthcare record system allows for this.

[TriciaJ, RN]

The only reason to file an incident report is because the barcode scanner malfunctioned. The MD wrote an order to cover the med given. Just make sure the chart reflects the dose the patient actually received, especially since that's what the order reads.

It does not look like you tried to cover anything up. You reported it right away; it got handled. The doctor is not perturbed; the patient is fine. There is no incident. Except for the broken scanner.

[floridaRN38]

I personally would not write up an incident report on it. But if u feel u need to to put your mind at ease. Do it :)

[VANurse2010]

The MD was gracious enough to give you a "get out of jail free" card with the order. Do not be a fool and hang yourself.

[Pangea Reunited, ASN, RN]

I'm going to head down to the police station tonight and demand a ticket for driving five miles over the limit on my way to work. If they tell me everything's OK, I'm going to start screaming, "Cuff me! I'm guilty!"

Seriously, let it go.

[nuangel1, BSN, RN]

Let it go you have an order for dose given and it's charter .move on.

[kaylee.]

As a new grad its definitely easy to get frazzled, especially when the patient is hysterical! I'm not sure the specifics on the scanner malfunction, but just take this as a learning experience to always verify doses, check the screen, and not always trust the technology before you give. If you can get something from this, then there is nothing to feel guilty about. I would let your preceptor take the lead on this one and just keep going.

[Libby1987]

Guilt, performance issues and incident reports don't need to go hand in hand.

PPs: Why avoid the incident report? We prefer to have them.

[Dgamez]

I personally would not write up an incident report on it. But if u feel u need to to put your mind at ease. Do it :)

I agree, I personally wouldn't. I actually did something similar and got the md order and it was ok. But for your peace of mind do what you think will make you feel at ease.

[Leonardo Del Toro, RN]

You are overthinking this whole thing. MD gave you the order, problem solved, end of story. There is no need to file anything. If you insist in doing you are now creating a problem when one didn't exist, and that is not a smart or good critical thinking.