Med error

[mommaellis7]

Hello I have been an LPN for 2 years. I've been at my job my whole nursing career so far. Yesterday I received a call from my new DON stating I had made a med error the night before and I would need to come sign a med error form. I began thinking about this as I have never made such a error, never been in trouble at work, ever. I pride myself on doing my very best for my residents. I even serve as a charge nurse a few days per week. It panned out like this...that night I was on the heaviest hall in the building lots of behaviors, very sick people and very very needy families. One family includes several doctors they are very demanding with their loved one, naturally. I spent over an hour back and forth with them over orders got behind during my night pass. During this time I received an order for Coumadin. I followed that order charted wrote TO and reordered new labs everything but transcribing it to the MAR. It was the exact same orders as before. However, we box it off, so you have to rewrite it. I had forgotten to rewrite it in the MAR. So there for I made a med error according to my DON. I asked her why was it considered a med error? She said I gave without orders. But I did have orders, I gave the correct dose. I have clear documentation stating orders but I just forgot to write it in the MAR. Is this truly considered a med error? Should I sign this form? I messed up I own my mistake, but I had right dose, right patient...etc. any advice is greatly appreciated!

[mommaellis7]

I've noticed alot of people looked at my post but no one has commented. I don't want to question my new DON. I am really not sure. Part of me just says do it, the other wants to question. I don't want to make my boss mad but I also don't want it in my file that I gave a med without orders. What happens when I do make a mistake like a med error? Like the wrong dose? It's only a matter of time, it can happen.

[JKL33]

Okay, I'll bite with the caveat that I haven't experienced this so I can only say what I think I would do. I aim for excellence at work. Therefore I expect to be treated with similar regard. I suspect that what I would do is prepare my resignation and then meet with the DON to let her know I won't be signing that. If she is unable or unwilling to consider a more thoughtful response to the situation I would be prepared to leave. I'd rather find a workplace where the give-and-take is balanced more ethically.

[Kooky Korky, BSN, RN]

It sounds like a med error because you didn't write it on the MAR.

Fortunately, you did give the right dose, just that the paperwork was wrong.

If I were your DON, I wouldn't do any more than let you know about the paperwork being wrong and

have you correct it on the MAR. I would not take it further because you did give the right dose.

So where do things stand now?

Am I understanding correctly? The person who gave you a Coumadin order - was he or she the

patient's family member/doctor? Or was the order legitimately from the patient's physician? If you took an

order from a doctor who was a family member and not the pt's doctor, that was wrong.

[RNGummy40]

"I followed that order charted wrote TO and reordered new labs everything but transcribing it to the MAR. It was the exact same orders as before. However, we box it off, so you have to rewrite it. I had forgotten to rewrite it in the MAR. So there for I made a med error according to my DON. I asked her why was it considered a med error? She said I gave without orders. But I did have orders, I gave the correct dose. I have clear documentation stating orders but I just forgot to write it in the MAR. Is this truly considered a med error? Should I sign this form? I messed up I own my mistake, but I had right dose, right patient...etc. any advice is greatly appreciated!"

The med error is not writing it on the MAR. It you got sick and did not show up to work, how would the nurse working that shift know the specific Telephone order you received and be able to verify the order? Documenting it on the MAR allows all nursing staff to see orders received, verify and validate orders, and use 3 checks before administering orders. Orders do expire, or on a paper charting system the number of administration sign offs are limited and forms need to be rewritten. If the order is not on the MAR, errors will happen.

You DON should be explaining why it is an error with more than one sentence. Learning from the mistake is the most important issue.

[JKL33]

You DON should be explaining why it is an error with more than one sentence. Learning from the mistake is the most important issue.

That's most of the problem in my opinion. For starters, the DON is looking to exaggerate this error. Yes, it was a serious omission for the reason you stated but what the DON said was another beast entirely:

She said I gave without orders.

WRONG.

Also, I'm curious what the OP should "learn" from this. This issue really raises my hackles. What is the lesson? Don't run your ass off trying to keep people happy? Park yourself at the desk and not do any other RN duties so that you're ready to "appropriately" take care of a phone order?" There is no new information for her to gain here, she already knows the process of transcribing orders, and presumably she knows it is important since she does it every other time orders change. So then, this is more a case of something that dropped through the HUGE crack that is an RN spread thin. Very thin.

Her "error"/omission is completely circumstantial.

She has a record of excellent patient care and there is NO reason that this can't be handled by letting her know what happened, giving her a verbal warning, and then letting it go unless it is part of a pattern of negligent or absent-minded behavior.

I do not accept that individuals who are at THE bottom of the power structure should be scapegoated for decisions made much higher up in an organization. RNs get held to a zero-strike standard in a setting where staffing is notoriously BAD?? I don't think so.

I'll bet healthcare executives laugh all day long at how easily we RNs will "tsk, tsk" each other while THEY maximize profits by seeing just how far they can stretch a single nurse.

[amoLucia]

DOCUMENTATION error versus med error? Failure to follow P&P?

By any chance, do you already have a target on your back with your NEW DON? Is this an attempt to start a 'paper trail' to precede further FUTURE disciplinary action?

It usually SUPER-pisses off TPTB when the employee refuses to sign an incident report/discpln memo. So proceed cautiously.

You have the right to write anything on that paper, such as ''you acknowledge the episode happened but you see it as a documentation error with potential for further error. But at the time, no pt injury occurred and no med was given erroneously.'' Write something about double checking for future orders or asking for a second person review, etc, etc. Just don't write something that gives them more rope to hang you.

Did the family show up in the DON's office the next morning and this is her response to placating a complaining family?

Maybe you do have to buff up your resume and start a job search. But then, this might just run out its course. If HR comes in on this write-up, then you need to start looking.

Good luck.

[Davey Do]

I have clear documentation stating orders but I just forgot to write it in the MAR. Is this truly considered a med error?

Bottom line:

DOCUMENTATION error

[chiandre]

Legally, if you did not write it, you did not do it. It is your word against your accuser. Originally, there are five rights of medication administration, some institutions have up to ten rights including the right to document. You made a documentation error. Consider this a learning experience. Sign the form.

[ComeTogether, LPN]

I guess they're looking at this as if you skipped the dose, since it wasn't recorded in the MAR because it wasn't transcribed. I always think of med errors as giving the wrong drug, dose or route etc. but it's also a med error to "miss" a dose.

In this case, because it wasn't documented as given, someone else could have transcribed and given the dose.....

I think she is over-reacting, I think a simple teaching moment would have sufficed. Just brush it off, learn from it and move on.

[TriciaJ, RN]

I agree with above posters: this is a documentation error that could lead to subsequent med errors. In most facilities, even near-misses merit incident reports. I don't know how OP's facility works but this action doesn't sound necessarily punitive to me. Sounds like a typical CYA. No one's going to get through a decades-long nursing career without a few incident reports. No matter how conscientious they are.

I would try to make a case for appropriate staffing. Just on principle. Not holding out any hope. Good luck and don't sweat this. **** happens.

[JKL33]

Is this an incident report? Maybe I'm not understanding what it is that is being signed. I've never signed any disciplinary or "error" note of any kind or been placed on a the discipline "ladder" or whatever places call it, ever.

Why would the DON say she gave it without an order if there was nothing indicating that she gave it? How did DON figure out it was given?