Medication Error

[CMA-RN29]

Hey everyone,

I am not a nurse yet, I am in school for my RN. I made a medication error and now I feel like I should never be a nurse. Does anyone else feel this way? The patient was not harmed because of it and I honestly just didn't go over my 6 rights well enough. I now how the 6 rights written on my badge so I will always do it but it was a dumb mistake and I feel terrible. My job does not take lightly to this either. I really just question my ability to be an RN after this. I love school and do well and love my job and patients. Am I the only one to make a mistake?

[OyWithThePoodles, RN]

With most vaccines you have to chart the lot number and expiration date (and even manufacturer sometimes), this would be a good time to take a quick glance to make sure you have the right vaccine. I know I caught wrong vaccines in the wrong place several times because the lot numbers weren't what I was expecting.

After entering lot number after lot number you know which vaccines start with what letters/numbers, so when charting one that wasn't the norm, I knew something was off.

[klone, MSN, RN]

JKL, I typically love what you post, but must disagree here.

When I worked in a doctors office, there was absolutely NO difference in the tasks that I performed and the ones the MA's performed. The only reason they even hired me as an RN was because they had planned on giving IV fluids in office, which never happened, which is why I left for a hospital.

Just sayin', the only difference between me and the MA's, was my pay.

Also, as another poster asked, the doctor would order the immunization and we would draw it up and give it, no verification by anyone.

I remember once I accidentally forgot to mix the powder and solution for a vaccine and just gave the solution. I felt horrible. The only harm I did was the patient had to get another vaccine, but still. I cried and cried lol

Then your clinic was grossly out of scope for what the MAs were doing, or they were grossly under-utilizing you.

I worked clinic for 4 years. Things I did that the MAs could not do:

Take a thorough H&P

Provide in-depth patient education

See my own patients for contraception counseling, STI counseling, pregnancy counseling

Physical assessments

Non-stress test administration and intepretation

Telephone and in-person triage

Calling patients to report abnormal lab results, explain what said results mean, and discuss necessary follow-up care

Dosage calculation, admixing and administration of reconstituted medications

IV therapy

[Susie2310]

JKL, I typically love what you post, but must disagree here.

When I worked in a doctors office, there was absolutely NO difference in the tasks that I performed and the ones the MA's performed. The only reason they even hired me as an RN was because they had planned on giving IV fluids in office, which never happened, which is why I left for a hospital.

Just sayin', the only difference between me and the MA's, was my pay.

While there may have been NO difference in tasks where you were employed, there is certainly a difference in legal scope of practice between you, the RN, and the MA. Also, you, as a licensed nurse, are held to a higher standard of practice. The MA, as an unlicensed care giver, is practicing under the supervision of a physician.

[Susie2310]

Also, as another poster asked, the doctor would order the immunization and we would draw it up and give it, no verification by anyone.

I remember once I accidentally forgot to mix the powder and solution for a vaccine and just gave the solution. I felt horrible. The only harm I did was the patient had to get another vaccine, but still. I cried and cried lol

It's good to know what goes on.

I will definitely make sure that next time I receive a vaccination in a PCP office I confirm ahead of time with my doctor exactly what medication they have ordered, and when I arrive for the vaccination I will tell the MA I would like to see for myself both the doctor's order and the medication they are about to give before they administer it.

[OyWithThePoodles, RN]

Then your clinic was grossly out of scope for what the MAs were doing, or they were grossly under-utilizing you.

I worked clinic for 4 years. Things I did that the MAs could not do:

Take a thorough H&P

Provide in-depth patient education

See my own patients for contraception counseling, STI counseling, pregnancy counseling

Physical assessments

Non-stress test administration and intepretation

Telephone and in-person triage

Calling patients to report abnormal lab results, explain what said results mean, and discuss necessary follow-up care

Dosage calculation, admixing and administration of reconstituted medications

IV therapy

This was a peds office, no IV therapy, the only medications given were nebs, and fever reducers, phone calls were what the doctor told us to say to the parents. Physical assessments were done by the doctor. I checked vitals, swabbed for flu/strep, performed fingerstick CBC's or blood draws if needed. Removed stitches, irrigated ears. Things like that. I was hired for IV therapy but they never started it, which is why I left, because I was under-utilized.

While there may have been NO difference in tasks where you were employed, there is certainly a difference in legal scope of practice between you, the RN, and the MA. Also, you, as a licensed nurse, are held to a higher standard of practice. The MA, as an unlicensed care giver, is practicing under the supervision of a physician.

Yes, I know there is a legal difference, I wasn't inferring otherwise. OP had said in that practice, there was little difference between her duties and the RN duties, which is quite possible. (No snark intended)

[OyWithThePoodles, RN]

It's good to know what goes on.

I will definitely make sure that next time I receive a vaccination in a PCP office I confirm ahead of time with my doctor exactly what medication they have ordered, and when I arrive for the vaccination I will tell the MA I would like to see for myself both the doctor's order and the medication they are about to give before they administer it.

Just know that most of the time, vaccines come in a vial and are drawn up into a syringe. There are exceptions of course. If I was giving multiple vaccines I would write the name of the vaccine on the syringe.

[klone, MSN, RN]

Just know that most of the time, vaccines come in a vial and are drawn up into a syringe. There are exceptions of course. If I was giving multiple vaccines I would write the name of the vaccine on the syringe.

Actually, in most practices now (particularly pediatric) they come in single-dose syringes. No drawing up necessary. They have eliminated thimerosal from pediatric vaccines, and thimerosal was used as a preservative in multi-use vials.

[Sour Lemon]

As is the case for adults. Every vaccine I've given and received since becoming a nurse (about 7-8 years ago) has come in its own single dose vial.

[gpsrn, MSN, RN]

Medication errors are serious. Use this experience to help you prevent errors in the future. Like others have stated, we all have made them.

[TriciaJ, RN]

A very good practice, good for you. I do the same - - it's not that uncommon to find that a wrong vial has made its way into a particular cubby. When I thought about that I forced myself to develop the habit of conscientiously reading the label as I'm removing something from the med dispenser.

I was taught to look at every medication 3 times: first before pulling it, second after pulling it, and third just before it goes into the patient. That is a corner I never cut.

[MunoRN, RN]

Medical assistant can admin meds and vaccines. I know I messed up but I do have an associates degree for medical assisting. They don't have to verify anything. And I don't work in a Pcp office either. Basically the only difference between my RN and I is that an RN can give narcotics and start iv's.

Not to downplay your mistake, but what you would be doing as a nurse is actually very different since as a nurse you will be administering medications, as an MA you are giving medications under the direct supervision of a nurse, physician, or other LIP. The medication error in your example was the fault of the licensed person who was supposed to confirm you were giving the correct medication, dose, etc.

Keep in mind that in regulatory terms, "administering" does not simply mean the act of physically giving or injecting a medication, it refers to the complete process of evaluating the appropriateness of the medication, verifying the dose is appropriate, etc.

[kbrn2002, ADN, RN]

Everybody makes makes at least one mistake. I'm not at all trying to sound mean when I say it's not a bad thing to have gotten your mistake out of the way. Now that you know how easy it is to make an error you will be much more careful going forward.