Med Error

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! 

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!! 

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. 

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.

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. ?

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

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

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!

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. 

Yes. It was IV push 

I'm so sorry that this happened to  you (and your patient).  We all make mistakes.  I don't think you mentioned how long you've been in nursing, but I do know that the clinical experiences and new RN orientations have been suboptimal during this pandemic; if you are newer to the field, this definitely wouldn't have helped.

It does sound like you did the right thing in following up right away once you realized your mistake, which enabled the patient to get to the right level of care and offer the best odds given the situation. 

Sometimes things learned the hard way are the ones best remembered.  In the future, I would advise that any time you give something with which you are unfamiliar (especially IV), check with your charge regarding administration policies (or check the policies yourself if he / she / they are busy), double or triple check the dosage and instructions yourself (before, during, and after drawing it up), then click accept on the MAR to see if it flags for a double check before administering. 

I've been a nurse for quite a while now, but when I'm floated to another unit and see a med I've never given, I still always question the rules surrounding administration... some meds, for instance, require ACLS certification to administer (which I'm not) and would require charge to administer despite the lack of flagged double check.

Anyhow, please don't see this as a reason to give up on all the work you have put into your career. Keep your head up!