Medication Incident reports, and feeling punched in the gut

[esokitty]

I would appreciate some advice here, as I am a new nurse, and I am ruffling feathers at my first job.

At our facility, we are supposed to fill out "medication incident reports" when we discover a med error has been made. We are encouraged to report our own errors, as well as those of our coworkers. When you find a coworker's error, you initiate the paperwork, sign it as the nurse discovering the error, then hand it to a supervisor for processing. The paper you filled out is then forwarded to the responsible nurse to write an action plan to not repeat the error. Your name stays visible on the paper.

I have been written up by others a few times - for using undated glucose test solution, for an honest to goodness med error. Each time it bothered me. Although I felt one of the issues was picayune and insignificant never did I become upset with the person who wrote me up.

Not too long ago, while running the worst med pass in the building, I discovered that there were three separate bottles of expired eye drop solution which had been used for 3-5 days past their clearly marked expiration dates. I asked my supervisor (who was standing right next to me when I discovered the expired drops, swore, and spent 20 minutes hunting down new ones) what to do, and she indicated that I should fill out medication incident reports for each day the drops were administered past the "do not use after" day. This involved 3 nurses total, one of whom was the nurse who wrote up my previous med error.

The next time I saw her, she was very cold to me. We had previously been friendly and joking. I felt terrible. I said to her, "sorry about that incident report, the supervisor saw the whole thing and told me I should fill those out." She was curt and cold, and we've not been friendly again since.

Tonight, I found an envelope in my mailbox addressed to me and marked confidential. Another nurse (who was not even one of the ones who had made the error) had hand written a note, pointing out an error I had made. She wrote, "Now I could write this up as you don't hesitate - but I decided to talk to you instead, and perhaps you'll give a second thought sometime to someone else. Please destroy this." Oddly, the letter was a photocopy.

I don't know what to do. I really feel stabbed in the gut. I don't mean to be a tattle tale. I feel like if she had chosen to fill out an incident report about the issue, I would have actually taken it as a learning experience, and made damn sure to not repeat the error in the future. I almost wish she had. But instead I got this strange, photocopied, passive aggressive message...

Should I speak with this nurse, to explain the situation? Does it even warrant an explanation? Should I have just kept the whole thing to myself? Is it part of my job description to rat out my coworkers? Is it an ethical issue? An error was made - even if it was insignificant seeming. Had state survey been in, it would have been a problem.

What am I even asking for here? I guess I just wonder what you all would do... Maybe what I should do moving forward. I suppose there is no mending fences here. I don't like not getting along with my co-workers. Help!

[swirlo]

I would not work for a place like that. Put in your two weeks and find somewhere more peaceful where it isn't dog eat dog.

[HouTx, BSN, MSN, EdD]

First of all, that photocopied note is nothing but a (slightly) veiled threat. Obviously, there is an original copy somewhere just waiting to surface. If I were you, I would go ahead and report the error that is referenced in that message, along with an explanation of how you became aware of it. This would eliminate any charge of hypocrisy "she's quick to report others, but not herself"

This is not "dog eat dog". Your organization appears to be following a process that has been shown to be absolutely essential for creating and maintaining a 'culture of safety' and quality. Human errors will always happen - because we're human. If they are analyzed as they occur (rather than just covering them up), each one becomes a learning opportunity for the individuals involved as well as the organization. Of course, this is only effective if the organization is also committed to a "Just Culture" philosophy in which there is no punitive action for true human errors and mistakes.

Your actions did not "rat out" your coworkers. You discovered a process breakdown (failure to note expired drugs) that could have harmed a patient. The individuals involved were probably completely unaware that this had happened... if not, it would have been a deliberate action (which should be handled in a much harsher way) rather than a mistake. It is regrettable that they have reacted so negatively by lashing out at you rather than analyzing how their actions may have contributed to this process breakdown but you can't control their reactions. Just keep on doing the right things to protect patient safety.

[Esme12, ASN, BSN, RN]

I agree with HouTx report yourself about the error you made as pointed out by this other nurse....... but I would be sure to note that it was not only found by this other nurse, how she decided to notified you.

You aren't at work to make friends...you can be friendly....but it isn't necessary for them to be friends. Separate the two.

The real purpose of incident reports is to not to get people in trouble (however many places use them as such) but as a learning tool to improve/correct the system or yourself.

I wish you the best.