Missed Med

[Losingfaith]

I can't describe how horrible I've been feeling for the past 24 hours.

Yesterday, I got a call from the day RN I had given a pt to regarding a missed insulin dose. The glucose in the AM was over 400 and he was scheduled to receive 11u of lispro per the sliding scale. I called on-call since it was only 6 am and primary sx wasn't there yet to double check if additional insulin should be administered and/or if the pt's tube-feedings should be turned off for a hour or two until his glucose improved. The on-call told me not to administer any additional insulin and not to turn off the tube-feeding. I did as he said. About 630 I saw an order from the primary sx increasing the patients sliding scale to 21u. I checked with a more senior RN whether I should give the additional 10u or leave it to the day RN to give after re-checking the glucose after 2 hours. She advised me to hold the additional 10u and it could be given later if needed.

I gave report to the day RN and told her about the changes to the order and she could give the additional units if needed later and despite what the MD said, I turned off the tube-feeding before I left (to be turned back on after an hour).

The mistake is, I saw the order for the change in lispro but missed seeing a NOW dose of Lantus. All day the pt's glucose remained high and the MD's were ****** I hadn't given the dose. I know this missed med is a med error and I'm very scared of the consequences (possibly losing my job?)

A year ago, right off of orientation I made a med error as well. I had 2 pt's in the same room. One in a-fib on a Cardizem gtt and during the night my patient in the second bed went into uncontrolled a-fib. Long story short, I thought I had been told bed 1 was in uncontrolled a-fib, alerted the MD, took vitals and pushed IV cardizem before realizing it was bed 2 who needed to be tx.

I care about my patients. I care about not just being a good nurse, but the best nurse I can possibly be. I was a strong student and always received the praises from my instructors. But in 18 months I've made 2 errors. I acknowledge my mistakes, but I can't shake the feeling that I'm a bad RN.

I want to scream, cry and quit. I feel like this job has no room for error so maybe if I can't be 100% I shouldn't be there at all....

[nurse2033, MSN, RN]

Give yourself a little slack. We have all made meds errors and it sucks. We all feel the same way after but here fortunately no real patient harm occurred. Your risk of losing your job depends on your employer. A good one will make sure you understand the cause to avoid it in the future. It sounds like the glucose was high all day under the care of other nurses. This was a typical breakdown in communication. You are not a bad RN. This is a tough job and this is one reason why. Dust yourself off and keep going.

[chevyv, BSN, RN]

I hate making med errors! That is the number one thing that always, no matter how tiny, makes me feel that I'm incompetent. I second guess myself and tell myself all kinds of things that make me feel worse. Hang in there! I always make sure I learn from my mistakes and go from there. We are not perfect. We are always a work in progress.

[pajoopie1]

I agree with the other posters...

We are all human. EVERYBODY makes mistakes. The nurse (or any other professional) that looks down on or talks bad about people who make mistakes is a liar and hypocrite. You are human. You will mess up. We all do it.

We have lots of checks in place to try to prevent errors. But even the best of the best still make mistakes.

I highly doubt you'll be fired, especially since you were honest about the errors. Do you have a mentor you can trust or a kind manager? Maybe you can ask for a little one on one to help you review your practice. Could you have a more effective report sheet? Would a double check of all orders at the end of your shift before you clock out help you make sure you didn't miss anything?

And as much as we all hate the extra red tape, always do your med checks! Accuracy matters and you'll save time (and heartbreak) by slowing down and clearing your head right before administering a med. And always, always check the arm band of the patient. I'm not saying this to make you feel bad. Don't feel bad. You only proved that you are human. I have hung antibiotics on the wrong patient before. Of the two patients I mixed up, one was black and one was white and they weren't in the same room! Since then, I ALWAYS do at least two med checks (a lot of our patients are on contact isolation so you can't do a third bedside check) and I ALWAYS compare the bag of abx or whatever else it is to the patient's arm band. Oh, and I've also failed at least twice to split a med that was a 1/2 tab and gave the pt a double dose. Oh, and I have a good friend who gave a patient A WHOLE BOTTLE OF NITRO instead of one tab q5 minutes up to 3 doses! Thankfully none of these resulted in patient harm. And you have to think, of the number of errors that you realize, how many go unnoticed or unreported?

There is always a chance of error, just remember to slow down and think before you act. Does the pt need this med? Is this med appropriate? Do I know what it does? Are their vital signs appropriate for this med?

I also like to pause every even hour to review my report sheet, flip through my MARS, check my orders, and view the latest set of VS (we have e-charting). I even count on my fingers to make sure that I've checked on or thought about all five of my patients. [i'm paranoid I'll go a whole shift forgetting one of my patients!]It might feel like you don't have time for this... but you do. And it will save you a whole lot of time and heart break in the end. It will help you plan ahead and be more efficient.

No need to cry, quit, or give up. Just focus on the things that you can change and improve to minimize errors.

Keep your head up!

Lindsay

[Orange Tree]

The first error sounds super-scary. Thank goodness it's in the past and you've learned from it. I can't believe they called you at home about the Lantus. In the grand scheme of things, I would be upset, but not too upset, about that one. Rest assured that the nurse who called you at home has made medication errors, too.....so have the MDs who were "******" about the missing dose.

Hang in there!

[Isabelle49]

Don't feel so bad. Only a 'real' nurse who is doing her job makes a mistake, where others are perfect (they know how to cover their tracks).

[LvANrse80, ASN, BSN, CNA, LPN, RN]

PLEASE CHEER-UP!!!!! NO NURSE ANYWHERE IS PERFECT, IF HE/SHE SAY THEY ARE THEY'RE LYING,I THINK EVERY NURSE HAS MADE A MISTAKE SOMEWHERE, EVEN IF IT WAS MINOR OR SIMPLE.( NOT TRYING TO OFFEND ANYONE) THANK GOD YOUR PATIENTS ARE SAFE! NURSING CHANGES FROM MINUTE TO MINUTE, PAT YOURSELF ON THE BACK FOR BEING HONEST AND ABLE TO ADMIT YOU MADE A MISTAKE, JUST TAKE THIS AS AN LEARNING EXPERIENCE, MANY NURSES DON'T EVEN DO THAT. NURSING IS A DEMANDING FIELD AND REQUIRES STRONG PEOPLE WITH BIG HEARTS!! A PERSON LIKE YOU.

[cherryblossom88]

I once had a Levadopa in one med cup and a Lortab in another and gave them to the wrong patients! My heart sank in my chest when I realized what I had done. :uhoh21:. Everything was okay thank goodness. Everyone makes mistakes ...so I wouldn't worry. Learn from your mistakes, it will make you better at your job. :)

[Losingfaith]

Thanks for all the support!

I know I'm human and make mistakes. In my head I'm logical, but my heart and gut can only ache right now. It's comforting to know despite all the "perfect nurses" out there, there are still a good number of us who can be honest and support each other.

[pajoopie1]

Glad we helped. Keep your chin up. You'll do great!

The fact that you care so much about your error PROVES without a doubt that you are, and will be, a great nurse!

[cav5]

I have to agree. I had an instructor one time who told me if the nurse said she didn't make a med error it was 1 of 3 things. The 1st. is that the nurse NEVER gives meds. The 2nd is that she is lying. The 3rd is that she is too stupid to know she had made a med error. You aren't any of these things. We all have those heart stopping moments when whe messed up-all of us. When I made a major error in drip rate (nobody got hurt thank God) all the nurses banded around me because I felt horrible-I almost quit that night-they said it was the hallmark of a good nurse to take ownership and learn from their mistakes. I think you did that and you care, that is the hallmark of a good nurse. Take care!

[tiroka03, LPN]

I made a mistake once and didn't 1/2 a med. I did file papers on it. It was exremely scarey.

What makes me upset, is that we are put in a pressure cooker, things being tossed at us faster than we can catch them. All while we are dilengiently passing meds, doing tx, calling doctors and families. It's only by the grace of God that more mistakes aren't made. What makes me upset is that we are penalized for being honest. If you fess up and say anything, you have to face a firing scrud of self righteous, frightened, spineless thugs who have only their behinds to protect. Kind of makes you want to run and hide - doesn't it.