Med Error

[Rada]

I got an order to give insulin IV. Dextrose and calcium Gluconate due to a critical K . This order was so odd to me. I never heard anything like it. 

I asked the charge and I said insulin and dextrose are  apposite is this order correct? She said yes, they will balance each other. It was my first time giving IV insulin.

Order said 9 units and I gave 9 ml. It made sense to me at that time since it was IV and not subcutaneous, also it was unit per Kg. We never give insulin per kg.

After I administer the medication and press the accept bottom, I then double sign off popped off . I got the charge and said that I gave the medication. She said, "OK, so you gave 9 units?" At that moment, I realized that I gave 9 ml instead of 9 units.

I reported the error to Dr. and she sent the patient to ICU for close observation. Luckily, the patient survived but the Director insulted me, yelled at me, and told me to report myself to board of nursing. Also, he canceled my contact with that hospital. I am very traumatized and I want to quit nursing for ever. I'm just wondering if this decision is right or not? 

[Davey Do]

This is a great discussion and I wish to applaud Rada for weathering it through, when most would have tucked their tails and run away, never to be seen on this forum again.

Or shouted like a Snowflake, "You COBs are trying to eat me!"

[Medic2RN72, BSN, RN, EMT-P]

6 hours ago, Been there,done that said:

You did not realize that some meds, especially insulin.. require a witness before administering?  

Some hospital systems don't require dual sign off for single admin. My system only require dual sign-off when hanging an insulin drip! 

[Medic2RN72, BSN, RN, EMT-P]

On 1/15/2022 at 1:08 AM, Rada said:

I got an order to give insulin IV , Dextrose and calcium Gluconate due to a critical K . This order was so weirded to me , I never heard about it , I asked the charge and I said insulin and dextrose are  apposite is this order correct? She said yes , they will balance each other. It was my first time giving IV insulin . 

I had one last week in the ED (Hyperk). Dude was a renal patient (missed Dialysis). His orders were Insulin IV, D50, Calcium Gluc, Sodium Bicarb, and Kayexalate. I only had ONE line! (You gotta love those)!! Good ole ED nursing!! 

[NRSKarenRN, BSN, RN]

I was switched to Renal floor after 3 yrs Respiratory unit due to staffing shortage.  First time I encountered K 7.0, also questioned IV insulin to charge nurse.  Some articles to help you .

Diagnosis and treatment of hyperkalemia

Hyperkalemia : Nursing Mgmt and Medical TX

I would write up an outline of incident for your future needs.  Please contact your malpractice carrier for advice.  You will survive this.  I co-signed for blood transfusion --patient without ID bracelet as just transferred to my unit from ICU..... wrong patient and wrong blood type.  Still practicing 43yrs later.

[londonflo]

23 hours ago, Rada said:

At that time I was thinking that this is a new use of insulin and patient is not diabetic, so I excepted totally different process with insulin at this time .

 

On 1/16/2022 at 12:49 PM, londonflo said:

Enroll in a CEU program on metabolic/electrolyte problems and the use of insulin. 

I found a CEU program regarding this: https://www.netce.com/coursecontent.php?courseid=2178

I am going to take it too. Should this ever come up at your hospital assignment or your agency, you can say I took the initiative to learn more about it. Best wishes. 

[vintagegal, BSN, DNP, RN, NP]

Sometimes it is prudent to stop and think before proceeding. I am very surprised this patient did not have a bad outcome, as 900 units of insulin is an insane amount to give, especially via IV.

This is not the end for you, but it may be smart to consult with your Liability Insurance. Also, taking a CEU for insulin admin/ diabetic treatment may help. You will want to show future employers, and possible others if this goes farther, that you are committed to improvement. 
Mistakes happen, it’s what you do about them that makes all the difference.

[JBMmom, MSN, NP]

If anyone is looking for a good hyperkalemia paper, this is one of my favorites: 

Diagnosis and treatment of hyperkalemia

BF Palmer, DJ Clegg - Cleve Clin J Med, 2017

Guess I'm really flying my geek flag by admitting I have a favorite hyperkalemia paper, but you may have picked up on it anyway. ?

[paujos]

I have a fellow nurse who just made a grave med error and luckily the patient is okay. Ironically it cured his bladder issue and was discharged two days later. But, I would not report this to the BON. We do incident reports for any such errors. They are never to be part of the chart. They are not punitive. They are simply to bring attention to the incident. They can use this data for e-learning and to prevent future such mistakes. No intent of harm was made. Don't beat yourself up. This will help you in the future by closely examining medication orders and verifying information. It happens to the best of us. We are under so much pressure right now. The stress is overwhelming. This will make you stronger and an even better nurse. Take care, paujos

[Charlotteee, MSN, RN]

Just a clarification question, I've only seen IV insulin given over a drip. Yours was IV push?

[0.9%NormalSarah, BSN, RN]

1 hour ago, Charlotteee said:

Just a clarification question, I've only seen IV insulin given over a drip. Yours was IV push?

We give IVP insulin in the treatment of hyperkemia as the circulating insulin will carry the excess potassium into the cells. It is standard to give the dextrose first so that you do not drop the blood glucose too much, and typically the insulin dose is between 5 and 10 units only. So draw up the units in an insulin syringe, and then dilute them in a saline flush is what I typically do. Push your D50, flush, and then your insulin.

It’s also helpful to note this is the same reason we give potassium to DKA or HHNK folks on insulin gtts. Insulin carries both glucose and potassium into the cell, leaving circulating potassium levels depleted. If you ever have a patient on an insulin gtt, pay close attention to your potassium levels and be prepared to replace!

[iluvivt, BSN, RN]

I would suggest to you that you increase your knowledge base regarding acid base balance and fluid and electrolytes.I am fully aware of the tough subject matter here but it will serve you and your patients well to have this knowledge.The absolute best book I have ever read and actually enjoyed is by Metheny Fluid and Electrolyte Considerations.They go through the many common disease states that cause these disorders and explain all the treatments and nursing considerations. You will thoroughly understand why this combination of medications was ordered if you.read this book. I would also get to the root cause of your insulin error and correct it. Why did you not have your dosage checked by another RN? Something seemed off to  you and you did not question it further or get more information and why was that? I agree it's good to get emotional support but it's much more important to learn from this error,make some changes to prevent similar ones from occurring and correcting your knowledge deficits. That all takes effort on your part but I suspect you do want suggestions and not just cheerleaders. 

[Rada]

Yes. It was IV push