Med Error

I know a nurse who's doing a travel gig at a major metro hospital.  They way they do meds in their Covid ICU is that you tell a nurse on the outside of the unit what you need, they then hand it in to you.  For insulin, they use communal vials so they hand you the number of units you request.  

She asked the nurse who was passing in meds for 6 units of insulin, the nurse handed her 6 mls of insulin.  She pointed this out to the other nurse who explained that she had never given insulin, ever.  She had been working for a couple of months but had graduated from a nursing program often 'ranked' as a top nursing program and often as the top nursing program in the nation.

9 hours ago, Lunah said:

Not to belabor the point, but it was 100 times the amount, not 900 times the amount. The amount should have been 9 units, and they received 900 units (100 units per mL, 9 mL = 900 units). If they had received 900 times the intended amount, that would have been 8100 units and a very dead patient. Yikes. 

Oops- yes 100 times the amount is what I should have written. My math isn't usually that terrible LOL. 

I felt badly anyway after I posted because I don't think my first paragraph was very helpful but I couldn't edit it again. Mistakes happen all the time- obviously I just made one with 900 vs 100. It's just that in nursing, the stakes can be so high and we so much want to be perfect. I'm still new at being a nurse and find the experience very humbling and at times frightening because of the responsibility. 

OP, my apologies if I came across as too harsh before. I hope that you don't let this stop you from being a nurse- sometimes the worst experiences end up teaching us the most valuable things. 

Not to beat a dead horse but I want to mention the dual sign off again. The reason it’s there is to protect from a potential med error. Personally I won’t sign off someone’s med unless I saw the vial.
I personally like to show them the vial, do the meds and then come find them for the dual sign off so they’re not waiting for you. 

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

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?

Accidents happen. You should not quit nursing and I don't think that the BON will do anything about it. However, next time you have an order you are unfamiliar with, you should request more guidance throughout the process. If you had followed up with your charge nurse before administering and getting the dual sign off message, this could have been avoided. I understand that these days everyone is busy, and as a traveler you're trying to work independently, but everyone needs education from time to time, there's nothing wrong with that. The director should not have been rude to you, though, I'm sorry that happened.

44 minutes ago, JBMmom said:

Accidents happen.

This was not an accident. But I do sympathize with the OP.

Whenever you are thinking you should do something you have never done before (and the OP realized this)....stop and think. Get confirmation on not just the theory but what your actions are going to be.

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A typical vial of insulin contains 10 mL, or 1,000 "units" of insulin.

Frankly, It must have been really hard to get 9 ml out of a 10 ml vial. Sometimes things are packaged to prevent errors.

OP, I am sure you are miserable and I truly do feel for you.  Use this as a teachable time. Enroll in a CEU program on metabolic/electrolyte problems and the use of insulin.  A typical  U-100 vial of insulin contains 10 mL, or 1,000 "units" of insulin. Familiarize your self with the difference between insulin U-100 syringes and milliliter syringes. Should anyone question your knowledge you have shown you are active in in improving it.

I think people are confused about my situation. I am well familiar with insulin syringe and insulin . In this particular case , I told the charge nurse that I am unfamiliar with order . She told me don’t worry insulin and dextrose balance each others and I mentioned 9 ml but she didn’t expect that I am even said ml she heard it unit probably and said yes . 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 . You should draw the insulin with insulin syringe but since you can’t separate the needle from insulin syringe you have to shoot it in a different syringe and then give IV . You should have done it once before to not to get confused.  

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 . Order said 9 units and I gave 9 ml . It was 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 pressed the accept bottom then double sign off popped off . I got the charge and said that I already gave the medication, she said OK , so you gave 9 units ? Then I realized that I gave 9 ml instead if 9 units . I reported the error to Dr and she sent the patient to ICU for close observation. Luckily patient survived but the Director first insulted me and yelled at me and then 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 ? 

You did not realize that some meds, especially insulin.. require a witness before administering? I do not know how you could have used a regular syringe, instead of an insulin syringe. It is a complicated order. In the future if you are not familiar with the process... have another nurse work with you. 

I am not trying to beat you up here, but there were some basic practice errors. I cannot tell you if you should give up nursing, I can tell you NOT to report yourself to the BON. 

This days rarely we use insulin R , insulin pens didn’t need dual sign off. Bedside I was totally distracted from insulin process because I saw a different usage for insulin and different route . 

27 minutes ago, Rada said:

She told me don’t worry insulin and dextrose balance each others and I mentioned 9 ml but she didn’t expect that I am even said ml she heard it unit probably and said yes . 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 .

I know that things are busy these days, but if you were not familiar with the order and biological processes associated, you should have clarified further. Even though the order was related to the patient's high potassium and not blood sugar control, you are aware of the relationship between insulin and blood sugar and dextrose. If you think about the process, you were probably ordered 25 or 50g of dextrose with the insulin. When you did the math and converted units of insulin to mL and realized you were going to administer 900 units of insulin, did you think that 25 or 50g of dextrose would counteract the effects of that dose in the body? Even if the patient isn't diabetic, that much insulin is going to completely tank their blood sugar and could induce a diabetic coma. Again, I realize that this was not done with intent, but being unfamiliar with an order doesn't mean your critical thinking should be ignored. 

18 hours ago, Rada said:

This days rarely we use insulin R , insulin pens didn’t need dual sign off. Bedside I was totally distracted from insulin process because I saw a different usage for insulin and different route . 

"This days rarely we use insulin R , insulin pens didn’t need dual sign off." You were not using an insulin pen.

"I was totally distracted from insulin process because I saw a different usage for insulin and different route ".  Nobody cares if you were distracted. Nurses are distracted all of the time and still act prudently.

The bottom line is... you messed up.. big time.

2 hours ago, Rada said:

Bedside I was totally distracted from insulin process because I saw a different usage for insulin and different route . 

I had a lot of empathy for you but now I am having second thoughts. You didn't know what you were doing. No excuses.

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I asked the charge and I said insulin and dextrose are  apposite is this order correct? She said yes , they will balance each other.

 Like we would give Salt and a diuretic to "balance' each other out? But what about the REAL problem with the patient? Instead the patient ended up in ICU getting an accucheck every hour at the least. 

Learn from this. Get a drug handbook (you must have had one when you were in school). The drug handbook does say you "Must draw up U-100 Insulin with a U-100 syringe. "  I still can't figure out how you were able to draw up 9 ml out of a 10 ml vial without meeting a lot of resistance or thinking 'this is really hard'. 

3 hours ago, Rada said:

You should draw the insulin with insulin syringe but since you can’t separate the needle from insulin syringe you have to shoot it in a different syringe and then give IV . You should have done it once before to not to get confused.

Who are you talking to?