Multiple vaccine errors.

[lrkelso95]

I feel like the most inept, useless nurse to ever exist.

Today I made my 3rd med error ever. I've been an LPN for one year. My past two errors were incorrect dosages of flu vaccines, which is bad, but not particularly harmful. Today, I was supposed to give a child a meningitis shot and instead gave him MMR.

I don't like making excuses. All I can say is that I'm mentally at the end of my rope with this job. I'm the only support staff for a doctor who sees 25 patients daily. That doesn't include calling patients for test results, scheduling appointments, and everything else that comes up in between. He's a very demanding doctor, and the patient load is simply too much for one person. I get overwhelmed and mixed up, and inevitably do something wrong.

I haven't been written up yet, but an incident report has been filed. Everyone in my life says I shouldn't beat myself up over it, because errors are bound to happen when someone is as stressed as I am. But these are people's lives we're talking about, not a typo in an email. I just feel awful, like I shouldn't even be a nurse if I can't get my head screwed on straight. What should I do?

[sevensonnets]

If you follow the five rights of med administration every single time you will never go wrong.

[Lovethenurse2b25, ASN, BSN, CNA, LPN, RN]

The only thing you can do now is learn from your mistake. Now matter how demanding my job is I always try to take my time. Think about your professional nursing license and what may happen if a mistake leads to an adverse event. Everyone makes mistakes. And use the medication rights...

Right dose, Right route, Right reason, Right patient, Right Medication, Right time, Right response, Right Documentation

[FolksBtrippin, BSN, RN]

Don't beat yourself up, but do solve the problem.

Why did this happen? Are you frequently interrupted? Always doing 10 things at once?

Medication administration needs to be prioritized over most of the other things you do in an office.

Set some boundaries with the doctor if you need to.

When you are administering a vaccine do not stop to pick up the phone or check something else. It's your responsibility to stay on track.

I check vial meds twice. Once when I get them out of the fridge and a second time when I draw them up into the syringe.

You need habits and practices that will stop this from happening again. The 6 rights (or 7 or 8 or whatever) are the bottom line, but not being interrupted is also important. Not rushing through med admin is also important.

[JKL33]

13 hours ago, lrkelso95 said:

I'm the only support staff for a doctor who sees 25 patients daily. That doesn't include calling patients for test results, scheduling appointments, and everything else that comes up in between. He's a very demanding doctor, and the patient load is simply too much for one person.

One way or another people need to come to an understanding; probably not just the doctor but the practice administrator or whomever is your direct supervisor.

In situations like this, until you can either work through improvements or get out altogether, the only thing you can do is be very conscientious where it matters most, and deal with the fall-outs of moving some things farther down the priority list. You have to be okay with the fact that something has to be deprioritized, you have no choice. You can't have your focus divided in such a way that you are too frazzled to make sure you have the right vial in your hand or check the 5Rs.

Think it through. Is there any portion of your tasks that could reasonably be reassigned, or that rightfully should be reassigned? What responsibilities are extra and are taking this situation beyond the breaking point? Discuss your error with your supervisor, take responsibility for it. State that you need to be able to prioritize for safety. Suggest that xyz task(s) be reassigned.

That's all you can do if you want to take the chance of doing it. Be prepared that employers (seemingly) usually prefer to off-load responsibility and accountability onto employees regardless of the work load. It's easier for them to focus only on an obvious wrong (not reading the vial) than unrealistic expectations that contribute to errors.

[Sour Lemon]

I've made a few errors under pressure while being rushed. I eventually came to realize that faster is not better if you're not giving the correct medication, in the correct dose, to the correct patient, etc. Slow down and take your time to make sure everything is accurate, even when it feels like the sky is falling.

I agree with the person who suggested setting boundaries. Most of us work for someone else, and we obviously have to be conscious of that, but we also have to take what we need to do our jobs safely.

[amoLucia]

OP - breathe! Just to say, stop beating yourself up so badly. Obviously, you are deeply concerned re the med errors. And rightly so. Those 3 errors in 1 year are signally something very disturbingly wrong. I don't think you're the 'most inept, useless nurse ...' . But you do have a problem.

It seems you're OVERWHELMED in your job. It's sounds like a tough job for anyone, but ... the buck stops with you as YOU are the one making the mistakes.

Sorry to say this, but I feel you're at that CRITICAL POINT where you need to immed talk with your employer re your work environment (AS YOU DESCRIBE IT). Unless things are to drastically change (which I doubt will), then you should SERIOUSLY consider resigning and finding other employment.

You are correct that another error may likely occur again, and with possibly more serious outcomes.

But give yourself some credit - you did successfully complete your LPN program (all nsg programs are hard), and you successfully NCLEXed for your license. Importantly, you demonstrate the foresight to see the seriousness of this situation for your pts, foremost. And you've analyzed some root cause contributing factors.

If you were to continue in your job as it currently exists, I see you becoming increasingly frazzled, more self-negative, and MOST SERIOUSLY, have increasing difficulty to practice safely. And that's your goal - to practice safely.

Take care for your pts and yourself. Good luck.

And BTW, while your family and friends are trying to be supportive of you in their own ways, you are correctly recognizing the full seriousness of this dilemma to respond in a safe, responsible & conscientious manner.

[Nunya, BSN]

I worked in a military clinic where I gave vaccines to all civilians, including the many many kids. One thing that helped was figuring out what was needed in the room prior to the parent and kid coming in. And other staff knew if I was in the main treatment room and the door was closed they didn't disturb me unnecessarily. And there was no phone in that room. I also, as much as possible, did my documentation in their vaccine book prior to giving the vaccine. That was a double check as I looked at the vaccine not only when pulling out of the refrigerator but when writing down the name, dose, number and manufacturer.

[pedsnurseIJAG]

I worked in a peds office with 8 doctors, doing everything you are doing. I was stressed and made some dumb, but luckily not harmful mistakes with vaccines. I now work in a clinic where there's one nice doctor and no stress. And I haven't made any mistakes at all. The environment where you work does wonders.

[Katie82, RN]

No excuses please. Three med errors in a one year period is something to stop and think about. Why was there an error with the flu vaccine, does your doc buy multidose supply to save money? I have never seen anything but single dose, and I have literally given thousands of flu shots. The incorrect vaccine was a kinda big deal. This should be a wake-up call. If this job is too much for you, and as I read your post, I can think it would be too much for anyone, you need to say so and find another job. This does not constitute a failure on your part, this doc is literally asking you to do too much. You are putting your license on the line here. Get additional help or get out.

[Bloop41, BSN, RN]

I used to work as an MA in a busy peds practice and I organized my vaccines by putting each in a kidney dish w all the needed supplies + a Post-it w the child's name, DOB + and provider name. Whenever someone was coming in for a well child visit, I would pull whatever was indicated for their age/etc, get it set up, and complete my first med check (6 R's!!) before I went and roomed them. Then, once I had finished vitals, I could go back to the lab and start drawing everything up (second check of the 6 R's). Then of course, I would do the third check with the parent and child in the exam room.

Granted, this worked well because the clinic bought single use vials or pre-filled syringes; not multidose ones. But still-- DRILL yourself on making sure you check those 6 R's at least twice before you even get into the exam room. There's a reason they harp on it so much in nursing school.

[Kooky Korky, BSN, RN]

Your doctor is a cheap jerk.

Or he is unaware of the pressure your job holds.

You need to speak up. If you can't or choose not to, get out.

Good luck.