4 medication errors in 11 months

[tdupuis]

Hello I am new to allnurses and I just wanted to share my story mostly because I still feel incredibly terrible about this and feel the need to discuss.

I started working in a fairly acute care hospital in June 2010. I have had 4 medication errors since I have started and I am just terrified of losing my job.

#1 Drew up and mixed a patient's IV medication that was due at 0600 on a night shift. I had put it in the patient's drawer (we have med carts) as instructed by my mentor (I was doing a new grad initiative) as we needed to attend to another patient at that moment. All the while looking after this other patient I completely forgot to give the patient the medication and the morning staff found the IV bag when they went to give the patient's morning meds.

#2 Missed a dose of a patient's antibiotics. Patient was a transfer from the ICU and on receiving report the reporting RN mentioned that they had not had a chance to give the patient their antibiotic. After report I went about my business and completely forgot that this patient still needed to receive their antibiotic.

#3 Went in to give a patient their evening medication and forgot to remove their Nitro patch. Whether is was found by another nurse on the next shift or the next morning when the nurse went to apply the new patch I'm not sure but either way still a HUGE no no.

#4 Gave a patient their antibiotic IV instead of PO. Patient had previously been on an IV dose of this antibiotic but had been changed to PO. At our hospital we do not get new MARs printed everyday, we use the same one for a week so when a medication is changed the old order is crossed out in red and the new order written below. This particular medication route change I believe was on the same page and either I overlooked the route or had been looking at the wrong order (it is difficult to distinguish new/old orders even with the red marking because medication administration times, new drs orders for meds, etc. are also written on the MARs in red ink).

I take full responsibility for all these errors as I was at fault and they were not 'system' errors. Thankfully none of these errors had a harmful effect on any of the patients. Incident reports were written up for all these errors and I was approached by management about #1 and #3 only regarding how to not let it happen again. The other two have not been discussed. I have never been approached regarding a reprimand nor a probationary period but I still feel like I am very close to losing my job. Every shift I come in to work I am fearful of receiving an email/phone call regarding termination/another med error. I am also very concerned that in only 11 months I have managed to make 4 medication errors. It worries me on a regular basis and although I tried to look at the positives (noone was harmed and I took these as a learning experience) I still managed to make the same mistake twice (dose omission). I'm not sure what I'm doing wrong or what else I can do to ensure I do not make further mistakes?

I am most fearful of making a mistake on a day shift during 0800 medication rounds as we need to share the medication cart between two nurses, one gets it first for their patients, the other gets it after. I already feel so rushed in the morning with patient meals, pt requests, needing to get patients to their daily inpatient appointments and having to get through my medication pass in a timely manner so that the other nurse can do hers as well.

Not sure what else I can do other than continue to take my time (as I know medication administration isn't the time to rush), ensure to do my 7 rights, and writting down any meds that remain to be given to a patient we get from a transfer etc. I now check all my patient's medication drawers to ensure I have given everyone their meds. I have also learnt to bring a baggie (for patches) or write down anything that may not be 'giving' patients a medication but removing patches etc. so as to not forget to do these once I am in the patient's room. I continue to lose sleep over these errors which unfortunately may lead to drowsiness/lack of sleep and may ultimately lead to further medication errors. I'm not sure how to get out of this cycle. If anyone has any suggestions for me it would be greatly appreciated.

[NottaSpringChik, BSN, RN]

I am new nurse too and for a while I also thought any moment I would be called in and let go. Thankfully, things finally smoothed out for me, but I have dreams in which I am late giving meds or something similar. One of my nursing instructors told me that all the years she was nurse she dreamt it was Noon and she hadn't given 0800 meds. The dreams stopped when she was working as a professor and started again when she took some work as a staff nurse.

I would talk to your supervisors about how they think you are doing. I think the good thing you are doing is #1 taking responsibility and #2 making changes to your practice to help prevent errors.

I had that problem when I first started and even in clinicals, but now I am amazed at how much better I am at remembering things since I am into the routine. At first it was real issue for me though and I was really worried I couldn't be a nurse, as I have always been a bit absent minded. But I think, with practice, I am amazed, things are coming much easier now.

[Nurzelady]

I think that the fact that you are making an earnest effort to do your best everyday and that you genuinely care is great in itself. Trust me you are not the first to make mistakes as a nurse. There are nurses who have been working for years and still make medication errors. And the fact that its been 11 months and you're still there, shows that you're definitely doing something right! And lets say you end up deciding to leave this job, you now have that golden one year experience to get you any other job of your choice! Don't beat yourself up. You're doing a great job. You're a good nurse!

[SNIXRN]

Do you have a report sheet that can help you become more organized? How early do you go in before your shift to review your patient's info? I find it helpful to show up 45 mins early to review my patients' kardexes, meds, etc. It also helps me pay attention to detail and I am more prepared and have a better understanding of my patient.

[NotReady4PrimeTime, RN]

how early do you go in before your shift to review your patient's info? i find it helpful to show up 45 mins early to review my patients' kardexes, meds, etc. it also helps me pay attention to detail and i am more prepared and have a better understanding of my patient.

why should you have to do that?? if you're working 8 hour shifts that's nearly 4 hours of unpaid overtime you're gifting to you employer every week!

if you're having to do that on a routine basis that facility has far more serious porblems than the occasional late med.

[SNIXRN]

As a new grad I take a lot of pride in being a nurse at Mayo Clinic and it's not a matter of problems with the hospital, it's a matter of higher standards that the hospital holds me to and that I hold myself to. This field is not for someone who is looking just for a paycheck. I care about my patients and their health and safety come first. I put their health and wellbeing ahead of petty concerns for not being paid for 45 mins.

[rn/writer, RN]

As a new grad I take a lot of pride in being a nurse at Mayo Clinic and it's not a matter of problems with the hospital, it's a matter of higher standards that the hospital holds me to and that I hold myself to. This field is not for someone who is looking just for a paycheck. I care about my patients and their health and safety come first. I put their health and wellbeing ahead of petty concerns for not being paid for 45 mins.

Wanting to be paid properly for the time you put in is not "looking just for a paycheck." Nor does it mean that nurses who don't want to give away half of a day's pay every week don't care about their patients.

Putting in 45 unpaid minutes once in awhile is not a deal-breaker, but to do it every shift? That is not petty. And it can have the detrimental effect of encouraging employers to expect the nursing staff to compensate for insufficient staffing.

Please, do not equate this new nurse's time management challenges with a lack of standards or concern for her patients. If she didn't care, she wouldn't be asking us for help.

To the OP, I have found that writing everything on my "brain sheet" is the biggest help in getting it all done. By the end of my shift, that piece of paper looks like it's covered with hieroglyphics, but those little notes have saved my bacon many, many times.

"ABX 0600 3842" is enough to remind you to give antibiotics to the patient in room 3842 at 0600. I also remind myself to order breakfast for a non-English speaking patient, call a doc, look up a lab that was just drawn, order a social service consult--you get the idea.

It's just too easy to have one urgent task crowd another one right out of your head. Writing it all down and checking your sheet frequently can jog your memory and give you piece of mind when you leave that, yes, you did hang that amp and call the doc.

Try not to dwell on past mistakes. Learn from them, but don't get so caught up in worrying about them that you make new ones.

I hope you can relax (in a good way) and move forward with a little more confidence.

[SNIXRN]

Hey again. I definitely agree that a report sheet/brain sheet is essential for organization. Also, to address coming in early - I work three 12 HR shifts, I usually come in 45 mins early my first day of three so I can drink my coffee, look up my patients' history, labs, meds, side effects, and any diseases/disorders that I am unfamiliar with. I have only been a nurse for four months so I still have limited knowledge and would like to start the day being more prepared.

[tdupuis]

Thank you for all the support and feedback! It has made me feel much better :)

I guess what spiked my worry/concern was seeing posts by others about being fired about 2-3 medication errors and just got me wondering if that's what I was in for as well.

Unfortunately we do not have kardex's in our hospital - I wish we did! We do have 'report boards'. The way my medical and med/surg floors work is that the floors are seperated into 'quads'. For each 'quad' on my floor the RN gets 5 patients and the RPN gets 6. Anyways on these boards we have pt, room, MD, diagnosis, past medical history (if the previous shift has felt so inclined to write this in - some don't) and then three sections one for days, evenings, nights, where we write down things like IVs, catheters/I&O, vital signs, some assessments, pain, etc. but they do not give a full picture of how to care for a given patient the way a kardex would. The information that would be found on a kardex is in our computer system, we have computer charting. Our computer system is the slightest bit on the slower side and having to go into each patient and look up different things does take time - much more than being able to flip through a kardex binder in my experience!

We also do not find out our assignment until we receive report as we split the patients up between myself and the RPN on my quad based on their acuity that day. Therefore it makes coming in to do research, looking things up almost impossible. I do come in about 20 minutes early just to get myself settled and look up common info: allergies, activity level, diet, etc. on all 11 patients in my quad only because I take over all patients while the RPN is on break and vice-versa. This makes organizing my day a slight bit harder, however sometimes I can if patients have remained the same and I know that, for example the patients I had yesterday are still the most acute in my quad, I can expect they will be assigned to me.

I have been using some sort of report sheet to go off of but still manage to miss things. I have spent some time devising some new report/organization sheets and I have looked up examples and gained ideas from co-workers about what sorts of things to include on this sheet - thanks for this suggestion though!

I must say I do agree with that we should have to, nor be expected to come in early on our own time to get ourselves organized as employers may begin to rely on this. I understand that nursing and the health care field in general is a different class of working environment however I think about the big picture, what other jobs/careers expect their employees to come in early to get organized in order to get the job done? I have only started coming in early since January, I was on a new grad initiative previously, because I know I am on my own now and I need to develop trial-and-error what works best for me. I am also hoping that as I build my knowledge base and organization skills I won't have to come in so early to organize myself.

I had much better shifts the last couple of days and I will continue to utilize my 'brain sheets' to better organize myself, however I find I sometimes even forget to write something down haha.

[evolvingrn, BSN, RN]

hang in there. most of your medication errors can be solved with a little re-organization. as another person mentioned your 'brain-sheet/assignment' sheet should have all the med times listed. mine has all 24 hours written across the bottome of each pt's 'area' i circle in red the time that meds are due on my shift. i think cross it out in black when i have given it (and only after i have given it, not just drawn it up) Looking at each mar is the first thing i do at the beginning of each shift.

[icemanof92]

I'll honestly tell you in my opinion that any of these errors could really be system related, especially #4. While you are correct in taking responsibility, think about what we are taught in school about new provisions being put in place to prevent errors. We seek to decrease reliance on memory and have safeguards in place to prevent errors. Let's be real here. Nurses are overworked and stretched to their absolute limits. An EMR system that updates orders in real time and that highlights in a bright color orders that are overdue is a great safeguard against errors. Perhaps this is my perspective because I'm young and this is all I've ever known, but I can not see how working without such a system can possibly be safe.

[THELIVINGWORST, ASN, RN]

Is this in Canada or the states? I was under the impression that CMS requires all facilities to transfer all pt information to EMR? These errors are exactly why EMR is a good idea. These errors could've been avoided if your facility took advantage of EMR.