Med error

[Deeninteen]

Hey everyone, i am a new grad that is 1 month off of orientation. Unfortunately I made a major med error today and I was hoping to seek some advice. In short, I didn't administer my patient's AM insulin by accident and I found out that her blood sugars spiked to the 20s by lunch. The patient was asymptomatic and I notified charge and the MD. She was reordered insulin and her blood sugars were still elevated as I left the unit. I filed an incident report and am now wondering if nursing is for me.

After thinking about what happened, I can clearly identify that it was incompetence on my end and not an insulin pen fault. I'm not sure what I was thinking but I didn't administer the insulin when I injected the patient. I'm absolutely embarrassed and more so angry and beating myself up that my stupid mistake caused harm to a patient.

My question now is: should I call my manager to disclose the error? Should I find a way to speak with the family to disclose the error? And finally, what are the chances that I will be fired? Running this through my head, I feel that this is a mistake that should never and has never happened in regards to the new insulin pens. It's made me really question if I am safe and if I should continue with nursing.

[lpnpasta]

So from what you said I'm thinking you applied pressure to the insulin pen to insert the needle but didn't press the button to inject the insulin then realized.

It happens. We're all human. You realized your error, reported it to the doctor, and proper action was taken to correct the incident. Don't doubt yourself, everyone makes mistakes.

Most facilities have you fill out an incident report when a medication error occurs. So yeah, you'd want to tell your unit manager ASAP and fill out the report. At my facility we do call to update the POA when an error occurs.

Also: be careful how you document a medication error in a patient's chart. I've been told not to say there was an error made in the chart. I've just documented what happened, and that you spoke to the doctor and any new orders the doctor gave. Also, I've been told not to mention incident reports in the resident's chart.

[caffeinatednurse, BSN, RN]

I felt the same way after I made my first med error. I was still on orientation when I made mine. An insulin drip had just been discontinued on a pt, and they had been switched to sliding scale. I checked their BG at the beginning of the shift, saw the number and did a little happy dance inside my head because I was sure that their BG fell below the threshold for needing insulin coverage. I was wrong. They required insulin. I didn't realize my mistake until nearly 5 hours later.

The important thing is that you realized you made an error, you reported it, you assessed the pt, you called the MD and that you went about correcting the problem. Whatever policy your facility has in place for medication errors, be sure to follow that.

If you reported it to your charge, then let your charge be the one to decide if it needs to go further. My error ended up landing on my managers desk anyway. I wasn't written up or fired from my job. It was more of a review session - reviewing what happened, why it happened, what can I do to make sure it doesn't happen again, etc.

I was also taught not to mention incident reports when charting in the pt's record, and to simply state the facts (assessment, vitals, contacting the doctor, etc.) without placing blame on anyone.

Look on the bright side...you will never make that same mistake again. You'll always inject the insulin from now on when you insert the needle, just like I will always double check to see if a BG number falls within the range for sliding scale insulin. And one day, you'll have plenty of wisdom to share with new nurses when they make their first mistake and they find themselves questioning if they picked the right career.

If you find that you keep beating yourself up over this mistake, don't be afraid to check out the EAP (Employment Assistance Program) affiliated with your facility. It's usually free, confidential and can be helpful when you find your thoughts stuck in a negative loop as a new RN. If I had used that resource, I probably would have stayed at that job longer than I did.

[kaylee.]

I will add that when you are considering what you learned here, recognize that not all med errors are created equal.

Just to keep it in perspective and apply clinical judgment: there are far worse insulin errors, and consider the potential harm you could cause: sugar in the 200s, u thought u gave the insulin but realized it was not injected. What was the lunch time sugar? This omission is most likely not going to be deleterious.

Were they stable 5 hr later? Or was the sugar elevated but not critical? In this situation I probably would not have even gone through the whole error protocol. You could go in the mar and backchart "not given: pen malfunctioned." Most importantly move on with the lunch sliding scale. However, if they were critical at lunch I would go about correcting this differently, as harm was caused.

If no harm was caused, this is considered a near miss, and technically should get an incident report.

If u are not sure about how to go about it 5 hr later, ask a trusted colleague what you should do. Or ask the charge nurse.

I guess the takeaway for me is, yes take proper protocol for correcting the error, but consider the severity when u are managing this psychologically, don't beat yourself up too much.