Medication Mistake

[buttercup_rn]

This is my first job as a new grad RN. It's a home health job. My client gets all her meds through her tube feeding (she has many meds) and I decided to prepare all the meds in advance for the next nurse coming on.

The next nurse (day) dispassionately stated, "I can't give those meds. It's against policy. You never give meds that another nurse has drawn up." It wasn't until after she said this that it made perfect sense. I was thinking that I was doing her a favor.

I wasn't able to give the meds myself because it was my time to leave. She didn't want to throw them away. She said she would ask the parent to give those meds for the evening if she chose, or she could choose to dispose of them herself. Now I just feel like an idiot, and as though I should have known this. It didn't dawn on me until the other nurse mentioned it that it was wrong.

I did call the clinical supervisor right away to discuss the matter, who said basically take it as a learning experience. but the day nurse acted as though she'd never made a mistake.

Has anyone ever done anything like this?

[MimiLPN]

It's normal as a new nurse to make simple mistakes that you probably had learned somewhere along the line. The fact is that the things we learn in nursing school don't always sink in until we can practice them, and something like preparing meds for another nurse is for sure something we've all been told not to do, but without practice you can easily get caught up in the moment and act based on your instinct to help your fellow nurse. I think all nurses have their share of mistake-stories that they have accumulated throughout their years and if they don't they are probably lying.

PS- I've noticed that being a newby is something that seasoned nurses readily forget they have been. I guess time really does heal all wounds haha!

[SweetPEI]

IMHP, you should be grateful your mistake was a simple one that could be chalked up to a learning experience. As far as stating that the other nurse acted as if she never made mistakes, the focus is on you, not her. It could have been that she was in utter surprise that you would do that, especially if her license is at stake. Scenario: lets say you were an addict and you replaced some of the patients pills (narcs) with some random ones. What if those "random" pills caused some sort of reaction, and it was found out there were some other drugs beside what was supposed to be given. Who would be responsible? The other nurse. Again, this was just an example, be it extreme... So, although she may have come off harsh, it may have been because she was thinking about her license. Hopefully you can charge it to her head and not her heart. Hope it gets better for you!

[caliotter3]

It is normal to have one's good intentions derided by a coworker. She did the right thing but could have been more gracious about it.

[merlee]

Nice thought, but something we cannot do for each other. The 'rule' is 'the nurse who pours the meds gives the meds'. You might find other ways to help - making certain all supplies are readily available, clean linens, etc.

No harm done, a lesson learned.

Best wishes!

[Meriwhen, ASN, BSN, MSN, RN]

It's a mistake most of us have made as new grads :) Just trying to be helpful, we think...but the nurse is right. You really can't trust the meds that another nurse has pulled because mistakes can--and do--happen, even to the best of nurses.

If they were still sealed in their unit-dose packs, then prepping the meds for the next nurse isn't such a bad thing--they're still sealed and labelled so there is no question as to what the pill within is, and the oncoming nurse can (should!) verify the meds before opening the packs. But if they were kept in bottles--which being home health I suspect is the case--then pulling should not be done.

Live and learn :) You're not a bad nurse at all, it's a common mistake.

[BuckyBadgerRN, ASN, RN]

This is my first job as a new grad RN. It's a home health job. My client gets all her meds through her tube feeding (she has many meds) and I decided to prepare all the meds in advance for the next nurse coming on. The next nurse (day) dispassionately stated, "I can't give those meds. It's against policy. You never give meds that another nurse has drawn up." It wasn't until after she said this that it made perfect sense. I was thinking that I was doing her a favor. I wasn't able to give the meds myself because it was my time to leave. She didn't want to throw them away. She said she would ask the parent to give those meds for the evening if she chose, or she could choose to dispose of them herself. Now I just feel like an idiot, and as though I should have known this. It didn't dawn on me until the other nurse mentioned it that it was wrong. I did call the clinical supervisor right away to discuss the matter, who said basically take it as a learning experience. but the day nurse acted as though she'd never made a mistake. Has anyone ever done anything like this?

Um, no, I've never done anything like this. It's something we learned in nursing school. How was this not covered during your education?

[buttercup_rn]

Thanks, MimiLPN, I think this is what happened. I was focused on helping the next shift, and wasn't considering the fact that it was wrong. ColleenRN: actually, no it wasn't covered in nursing school specifically, but it is one of those things I should have used my critical thinking for, and didn't....which is why I feel like a idiot now...am almost wishing I could find another area of nursing that involves less med giving.

[LoveCali]

Yeah, don't give a nurse an unlabeled med to give to a patient, and never take an unlabeled med from a nurse. Since you did all the prep with the meds you should have given them, and I'm sure the oncoming nurse would have appreciated it, but don't worry about it. Chalk it up as one of those great learning experiences we all want, the ones where nobody gets hurt.

[mikeicurn, ASN, RN]

As others have said, no harm done. It could have been a lot worse. Don't take it personal, although your coworker may have not been the most gracious about it, she taught you something. Take the lesson and move on. When you have the opportunity to help a new grad along and teach them the same thing, remember this and do it in a different manner.

[LilacHeart]

I'm just starting school (LPN, plans to continue to RN later), but am a CMA. When I was in school for medical assisting (community college), it was emphatically stressed to never, ever administer any medication that you did not draw up/pour out yourself. There is no way to check your "rights" for one thing. You can't know that it is the right medication, right dosage, right time, etc., etc., etc. I'm surprised that you weren't taught this in school. Shame on them to put you in such a position!

I would have reacted the same as the nurse following your shift (as in refusing to give the meds), but there was no call for her to be rude about it.

Well, at least now you know and it is something you'll definitely not do again. Take it as a learning experience and try to let the bad feelings go.

[RkfdNurse1]

I returned to work from my weekend off. One of the patients was allowed out on an overnight pass and her meds were put into an envelope for the next days administration for family to give. The patient came back early with the extra meds intact. I was told to just use what another nurse had packaged up for her. I didn't feel right doing it since I didn't see the packaging they came from. I opened the envelope to compare them to the ones in the packaging, and they were poured wrong!! The other nurse had omitted 2 AM meds and had instead put 2 PM meds in the envelope. I threw them all away, and started fresh!! I will never pour for another nurse, nor will I accept another nurses pour!!!