Need Advice on Accused Medication Error

[Shannon Dull Dunlevy]

So, here is the situation. I started a DuoNeb treatment on my patient WITH my professor/instructor. Once the treatment was started we left the room and documented the treatment. I checked in on patient about 7 minutes and and everything was fine. At around 15 minutes I checked on the patient and noticed that someone had taken the face mask off the patient and turned the nebulizer machine off. When my instructor came back I reported that someone had turned the machine off. My instructor went into the room alone and reported to me that she had re-initiated treatment because there was still some DuoNeb in the reservoir. I was written up as having made a medical error because I did not personally take it upon myself to start the treatment again. My rationale behind not starting the treatment by myself is:

I wasn't sure who stopped the treatment in the first place. It could have been my instructor for all I knew.

I wasn't sure WHY the treatment was stopped. The patient may have been observed having adverse reactions for all I knew.

I do not feel that I as a student, working under another's license, should make the clinical judgement to restart the treatment on my own accord.

What do you all think is the best move here. I have a remediation meeting in a couple days.

I feel like the persons who made the medication error was #1, the person prematurely stopped the treatment and didn't document or notify anyone, and #2, my instructor who restarted treatment without knowing who stopped it in the first place and why.

[adamg]

Did you ask the patient who stopped the treatment and look at patient chart prior going to instructor? I dont know what type of setting you were in or if you have a patient who could do stuff themselves

[Shannon Dull Dunlevy]

Patient is A&O x's 1 with impaired mobility. So patient could not communicate about who stopped the treatment. Patient would not be able to take this off themselves nor turn the machine off. The charting system is very basic and leaves barely any room for commentary under med administration, and if it does someplace, I am unaware, as I am first year, first semester. I know that I am 100% not allowed to document a medication administration unless in the presence of my instructor.

[NICU Guy, BSN, RN]

11 hours ago, Shannon Dull Dunlevy said:

I was written up as having made a medical error because I did not personally take it upon myself to start the treatment again.

This is a recurring topic on this message board: Clinical instructors expecting first semester nursing students to have the knowledge and clinical judgement of an experienced nurse.

You did what you were suppose to do, ask your instructor. 15 minutes is long enough for a breathing treatment (Pulmicort may take a little longer). What probably happened was that another nurse was walking by the room and heard the nebulizer making the sputtering sound and turned it off.

Your instructor should have told you to ask around before restarting it. There could have been a reason why someone turned it off early. I wouldn't have restarted it until I found out why it was turned off.

[Rionoir, ADN, RN]

If you go into that meeting accusing your instructor of having made a med error things are not going to turn out well for you.

[Orion81RN]

99.9% of the time I would say to apologize for your error and state what you learned. Basically just tell them what they want to hear so you can move on and graduate. HOWEVER....this is absurd, and there is nothing I can think of that you can say in your meeting along the lines of, "I see where I messed up here. In the future yada yada..." No. You are absolutely correct. The patient's own nurse herself could have turned off the machine for a variety of reasons for all you OR the instructor knew, such as an adverse reaction. Going to your instructor was absolutely the most appropriate thing to do.

First of all, your instructor was in the wrong for leaving the patient period. NCLEX world you stay with the patient the entire treatment time and assess. As a student you have the time to do so. In the real world it is the norm to leave and come back. But that is usually not policy. So there's that.

As a student, damned if you do, damned if you don't. If you had turned it back on yourself, you could have gotten in trouble for administering a med solo. That is a huge no no for which I myself got a write up for even though my instructor told me to.

The only advice I can give is to not go in the meeting in any accusatory or overly defensive manner. Just state your case in facts. Leave feelings out of it...and the fact that they are dead wrong. Tell them you want to learn from this but for them to please guide you with the takeaway as you knew school policy states that you are not to administer meds alone.

[Shannon Dull Dunlevy]

7 hours ago, Rionoir said:

If you go into that meeting accusing your instructor of having made a med error things are not going to turn out well for you.

I 100% agree with you there. I'm definitely not going to use that approach LOL.

[JKL33]

This is not official advice, this is what I would do.

I'm with @Orion81RN.

It seems there is no limit to the stupidity and pure hatefulness students are subject to now (much like nurses).

This is utterly ridiculous.

I'll tell you what likely happened: Someone came in and turned it off because it was mostly done, although the sides of the chamber probably could have been tapped to get another 30"-1 minute out of it. After it sat there (off) and the condensation settled, your instructor came around and picked the thing up and saw a couple more drops of medication that could theoretically be nebulized.

I am assuming this instructor wrote you up. I have no words, I can't even type what I'm thinking because I try to be nicer than that.

I would go in polite. Look ever-so-very-slightly confused, state plainly that you went in, found it off, and decided that the safe thing to do would be to talk to your instructor about it. I would NOT go into self-deprecation mode. I would hold the line that it would not have been appropriate for you to restart it without consultation. At the very most, I would consider admitting that if this happened again you might immediately call your instructor for advice. That is the absolute most I would concede.

If there are going to be significant consequences....personally I would spend money to wreak whatever havoc is possible (lawyer).

There is no nurse in their right mind who would have expected you as a student to find this situation and just shrug and turn it back on.

[JKL33]

Your instructor (assuming s/he is the one who wrote you up) has significant emotional problems.

As well as exceedingly poor nursing judgment.

?

[BlueShoes12, BSN, RN]

You were absolutely in the right. Prepare a written statement in advance detailing the experience, timing and your rationale. Do not directly accuse your instructor of making a medication error, however. Just address the actions that you took.

I'm not a nursing instructor, but I frequently precept nursing students from the local college, and under no circumstances are they to administer medication or change settings on an IV pump without a supervising RN present. RTs manage the DuoNebs, but it still applies in that case!

[Kooky Korky, BSN, RN]

18 hours ago, Rionoir said:

If you go into that meeting accusing your instructor of having made a med error things are not going to turn out well for you.

I agree. However, the pt should not have been left alone during this treatment, IMO.

The Instructor is in the wrong and is putting it on the student. The student, who is a first semester student, should have been told by her so-called teacher, to stay with the pt, who is only O x 1. What if the pt had begun coughing, vomiting, aspirating, whatever during the tx? Does this pt feed herself? Can she use the call bell?

But - the student should probably suck it up, take the heat, quietly defer to the Instructor, as Rionoir advices. Let the Instructor save face.

Student should make private notes about this, keep it quietly at home, discuss it with absolutely no one else. If anyone else jumps on her (school or facility Admin) or wants to do any more than write her up as they already have, then I guess she can reconsider her course of action at that point.

Hopefully this will quietly pass.

Maybe some "keeping the ears open" will reveal who turned it off and why. I would not verbally investigate.

Best wishes.

[Shan, RN]

I would like to politely ask them, "If you were the patient, would you have wanted a student administering a medication on their own judgement that a licensed nurse had turned off?"