Medication error

First of all...breathe. I wish I could offer you more than this but there really isn't any way to determine that you, specifically, caused this patient to code. It sounds like he was de-compensating so he might have coded anyway with or without the med error. We just don't know. But right now I don't think that is what you should be focusing on. There is a clear chain of events that led up to this unfortunate situation. Are you a new nurse? I ask only because it will help me determine how to approach this.

Stable patients get drugs, unstable patients get electricity. Sounds like this patient should have been cardioverted, perhaps?

Regardless, OP, please see if your employer has an Employee Assistance Program (EAP) if you need some help working through this. Or is there a hospital chaplain? No matter their (or your) denomination, I have found that they are typically great listeners in these types of situations. Take care.

3 hours ago, Ginger's Mom said:

A patient this ill needed a physician to see the patient, second the pharmacy should have questioned the order, it was a chain of errors you were just the last link.

The last link, we’ll sort of. Let me preface this by saying that I am in no way saying the OP caused the code but as I mentioned earlier there is a chain of events that led up to the incident. First, this is a very new grad with, at most, 7 weeks of experience. Orientation should still be underway and I’m mystified why she was not being supervised while pushing drugs (lopressor) on a patient who wasn’t particularly stable. Second, no nurse no matter how experienced should be left on their own to handle this type of situation. The charge nurse should have been aware AND available. Third, is there no rapid response system in place? Calling/paging a doctor for a patient that is becoming unstable is a recipe for disaster when time is of the essence. What’s worse is it takes you away from your patient. Four, taking verbal orders is extremely risky, especially in an emergency situation. The TJC frowns on them and this scenario is exactly why. Fifth, generic vs trade name. Our facility uses the generic name exclusively. Although there are a few that sound alike by and large they do not and this decreases the risk of errors being made. We saw this in the Versed/Vecuronium disaster thread.

While it’s true that the patient could very well have coded if everything went perfectly there is also a chance that it might have been avoided had any part of this particular series of events been handled differently. The bottom line is that this is a classic case of a system break down. While the OP bears some responsibility, which she has very professionally accepted, she most certainly should not be blamed for a system that sounds like a setup for failure in the first place.

To the OP, talk about a baptism by fire! I truly feel for you but this is no reason for you to quit nursing! You were only a very small part of what happened. I highly doubt the patient got enough Nicardipine at the point that he coded for it to have caused it. That being said the transcription error is a big one that will likely stay with you for the rest of your career but that’s actually a good thing. This error, early on, will shape you into being an even better nurse if you let it. An experience like this should and hopefully will make you extra careful when it comes to administering medications, especially potentially dangerous ones. You’ve also now learned the pitfalls of verbal orders which will likely change your practice. Another important lesson is learning that you have a right and a responsibility to have support in new or unstable situation. A “right” in that your peers should be available to you and a “responsibility” in that you need to be able to recognize if you are in a situation that you need help. I feel like being aware of what my less experienced coworkers are dealing with in their assignments is a necessary and kind thing for me to be doing as a senior nurse. It is my hope that this experience will allow you to better advocate for yourself and your patients. You should never have been put in this position in the first place but you also need to not be afraid to say “I need help now”. Most of us have been in your shoes at some point in our careers. You are not alone. You are not a bad nurse. I agree with a previous poster, please seek out whatever help you have available to you. This is also something you shouldn’t be dealing with on your own. Be gentle with yourself. We are here for you.