Mistake on orientation..please help

[MommyRN89]

I am in my 7th week of orientation at my new job in ICU. I have a few years of experience but not in ICU. The other day as I was leaving, I gave a med that had been ordered that day, Tylenol Q8. Since it was a new order, the times for which it had been scheduled after the first dose were not moved for 8 hours from the first dose. So I tried to re-time them. However, I didn't notice that the rest of the times for administration had not been adjusted as well. When I gave report to the night nurse, I let her know about the new med but not the timing. The next morning, she tells me that I caused her to make a med error. Due to the fact that I moved only the first dose and not the others, she gave 2 doses Q6 instead of Q8. She said she filed a report about the incident. I felt horribly and have been kicking myself since..my preceptor brushed it off like it wasn't a big deal and said "it's only Tylenol and the patient wasn't harmed" but I am not the kind of person to make these kinds of mistakes and accept them. I can't imagine causing a patient harm as that is the opposite of my reason for becoming a nurse. I strive for excellence especially when it comes to my job.. I hate that that happened while I was orientation too. I have obviously learned from this but I can't seem to move past it. I don't want to lose my new job either..any advice is greatly appreciated..

[lrobinson5]

I guess her reasoning was that I shouldn't have changed the timing without letting her know so she knew what to look for. According to her, I set her up for failure by retiming a dose that made the rest of the doses' timing incorrect on the MAR..

No, she is shifting blame on to you to try and cover up HER medication error. She has working eyes and a brain, she was just in a rush and/or not paying attention, which is not your fault. You would be surprised how many people blindly follow what the MAR time says, which is a VERY bad habit. Enoxaparin often will double dose someone because they receive a loading dose in the ED and a different daily recurring dose to follow up the day after. Sometimes it doesn't show up the day after, but instead shows up for that day. Antibiotics are sometimes given late, or they change the dose but the start time is way too early on the MAR and is a med error waiting to happen. Like it would be nice in the future to re-time it as a courtesy, but by no means was this your fault!

[WestCoastSunRN, MSN, CNS]

Actually this should be written up -- for education purposes, not punitive. It's true that it would have been great for you to give her a heads up about the dosing --- also you could have asked pharmacy to appropriately schedule all future doses on MAR based on the initial dose.

But it seems like this makes a case for basic education about the 5-8 rights we are supposed to know about medication administration. We never get an excuse not to check each time we give a med -- to use our brain. Mindlessly following a MAR and giving meds is easy to do, but a dangerous habit. What if it had been a beta blocker?

OP -- it's a learning event for BOTH of you -- but technically the med error was made by your co-worker and it involved her not doing her job in safe med administration.

Your co-worker might be surprised when the raised eyebrows are directed her way.

[Ruby Vee, BSN]

Thank you for the words of encouragement..I guess her reasoning was that I shouldn't have changed the timing without letting her know so she knew what to look for. According to her, I set her up for failure by retiming a dose that made the rest of the doses' timing incorrect on the MAR..

So the patient got four doses in a 24 hour period rather than three doses -- probably not a huge deal. It reflects well on you (especially as an orientee) that you're taking your part in this seriously. If I were your preceptor, I would want to see you taking it seriously. But in the greater scheme of things, your preceptor is right. It's not that big of a deal. The other nurse is blaming you for HER mistake -- it was just as much on HER to make sure that the times were correct as it is on YOU.

[psu_213, BSN, RN]

Actually this should be written up -- for education purposes, not punitive. It's true that it would have been great for you to give her a heads up about the dosing --- also you could have asked pharmacy to appropriately schedule all future doses on MAR based on the initial dose.

To the OP--are you using an eMAR. If so, after you rescheduled the med, it should have rescheduled the subsequent doses since it was ordered q8h (as opposed to TID). If the eMAR did not reschedule subsequent doses, this needs to be investigated, which is why an incident report is appropriate. It doesn't mean you did anything wrong--I do not think you did--but it is an issue with your eMAR that needs to be looked at by the powers that be.

[Rocknurse, MSN, APRN, NP]

Ha...she just reported herself since she was the one that made the med error!

[notTHATjersey]

I agree with the others that this is on HER, not you! As a nurse, we have to check all the "rights" before giving a med: right patient, right drug, right dose, right route, right TIME, right documentation... We are supposed to do this with every administration. Every preceptor I have had has double checked the timing/frequency of the meds they are to give on their shift against the previous doses given on the prior shift to make sure the timing intervals on the eMAR are correct, because technology is NOT infallible.

She is blaming YOU for HER laziness and failure to administer medication properly. She needs an in-service training or workshop on medication administration and a good talking-to about ethics and professionalism.

Don't stress yourself. People forget to mention things in report sometimes. That is why it is important for ALL nurses to take a minute or two to review the chart and eMAR after getting report. It's just a good habit to develop. Instead of beating yourself up, learn from HER mistake so YOU can be a better nurse =)

[mtmkjr, BSN]

If eMAR... isn't there a pop-up if a med is given too close to previous dose?

[Kyrshamarks, BSN, RN]

No matter what time you put in the computer for administration or did not put in, the other nurse is the one who gave the drug and slipped one othe basic checks. RIGHT TIME. Not you. The mistake is all on her not you at all. I dont know how many times I hve seen pharmacy enter wrong times for drugs despite the order. They never never het in trouble for it, the nurse to dmins it at the wrong schedule gets in trouble. Same situation here

[hppygr8ful, ASN, RN, EMT-I]

Thank you for the words of encouragement..I guess her reasoning was that I shouldn't have changed the timing without letting her know so she knew what to look for. According to her, I set her up for failure by retiming a dose that made the rest of the doses' timing incorrect on the MAR..

Sounds like she is a bit of a drama queen and practicing aggressive CYA. You made a mistake. It didn't harm anyone and it won't be the last mistake you will make. Don't get me wrong all med errors and mistakes can have serious consequences but this one will likely result in what is called a Med Variance in my facility. You will receive some counseling on the Variance and how it could have been prevented and that will be it. Learn from this and move on.

Good luck with your new career

Hppy

[nursel56]

Thank you guys for being so encouraging. I found out more details about the report she filed. She stated that I moved the next dose to 9pm. I initially gave it at 12pm so next dose should have been around 8pm. I unfortunately can't remember if that is when I moved it to and since she gave it at 9 I can't see when it was moved too. And then the computer had the next dose timed for 3am so that's when she gave it. Yes the order still said Q8 so technically it should have been given at 5am. But this is how she's saying I caused the error..I just feel so bad. I'm new to this job and I already feel like I've made an enemy ������

Rather than saying you made an enemy, perhaps look at it as her giving you an early heads up as to what kind of person you're dealing with. I recommend you not behave in any way that gives her the impression you did something wrong. Keep your dealings with her strictly business, so to speak, and keep alert for more sabotaging behaviors from your coworker.

Best wishes!

[Have Nurse, ADN, RN]

I'm sorry, maybe I'm not understanding clearly but I don't see how YOU made HER make a med error. Would it have been nice if you to fix all the times? Yes. Should you have let her know about the time situation in report? Sure. But in my opinion, if the MAR lists the correct time that the last dose was given and the order states Q8, then that's on her for not doing some simple math to ensure the correct time of the next dose.

I feel like some nurses are relying too much on the computer and not using their own judgement. Maybe I'm just jaded but I always take report with a grain of salt and verify everything myself as needed throughout the shift.

Don't take it personally and continue to focus on your orientation. That nurse needs to take responsibility for her actions. Congrats on the new job!

I agree. In the Pharmacology of my nurses training, we were taught to triple check everything, including times because anyone including Pharmacy and a computer, can make mistakes. Let it roll off your back, friend. You won't let it happen again. We all have been on the receiving end of someone else's mistake.

[amzyRN]

Even though you didn't tell her about the timing, it's her responsibility to check prior to giving the med, so that error is on her technically. When a nurse is giving meds, especially things that might impair liver function or be toxic (Tylenol for example) it's important to check to see when the last dose was given and the amount of if that has been given in 24 hours. In the future, you should tell the next nurse that you didn't re-time them, or send a note to pharmacy and have them do it. I think if they call you in about it, you'll both be equally scrutinized but ultimately the responsibility is on the nurse giving the medication.

When I worked on the floor and giving scheduled meds, I'd always check when the last dose was given. I think my first preceptor taught me that so I got in the habit of doing it each time I was giving a time-sensitive med.