New Grad Med Error in ED

[Newgradacutern]

I am freaking out and need some perspective.

I am new grad nurse, day 2 on the unit in ED. I did my pregrad in the ED at another hospital that was really tight for resources, which meant I learned a lot of really bad habits and shortcuts that I realize are not best practice.

Anyways- Our patient got an order for 20meq/L KCl in 1 L D5W. I went and grabbed the bag, and a practice I picked up from the previous hospital was to hang KCl by calculating gtt/min instead of using the infusion pump since we just didn’t have any on the unit. Unfortunately, this stuck in my brain due to the number of times I did it that way, and I did it for this patient.

The nurse I was shadowing was not there when I hung the bag, and to my luck it was the charge nurse that caught my error, within minutes of me hanging it. She briefly told me it was a really big mistake, that I could lose my license over it. She then filed an incident report and emailed the manager without offering any follow up, education, or to even hear why I made the mistake.

I overheard her gossiping about the incident in the break room, stating she is worried for the future of nursing after dealing with so many new grads. I am distraught over the consequences of this, and fearful of not only being labeled as incompetent but also losing my job, and my license over this. I have no idea what to do with myself I am a wreck.

Thankfully the patient is fine, she only received about 75 mls before the pump was added. Any perspective on being a new grad and dealing with making errors and mistakes would be welcomed, and any insight on the types of consequences that are likely as my brain just keeps going to being fired/losing my license. 

[heron, ASN, RN]

Calm down - your charge nurse is having drama for the sake of her own ego. Yes, if your current facility requires any kcl to be run on a pump, then a correction is appropriate. However 20meq is a pretty tiny dose - but unless your liter was set to run in less than an hour, unlikely to cause harm. Back in the day, the general standard was to run any kcl at 20meq/hr or less. You didn’t mention how fast you set the rate, but unless you were bolusing at 1L/hr or faster, it seems safe to me. If that guideline hasn’t changed, then charge is FOS. Med error - technically yes, if a pump was mandated and you didn’t use one. Career-ending/license-shredding catastrophe?  Not hardly.

Members with more recent acute experience should have more up to date info on this - but I don’t think you should get into a tizzy over it.

 

[nurse2033, MSN, RN]

I would say this is a good lesson. As as nurse you want the patient to have what they need. But, your employer did not provide the tools you need (all too common). Next time, don't hang the infusion without a pump. Immediately notify the physician, and your charge nurse. Enter an incident report. If the physician orders you to hang it without a pump, just chart it and be sure of your drop count.

If you get any further flack for this, ask if a root cause analysis was done and what was the result. It's a normal impulse to workaround all the barriers that exists for you to do your job, but if we don't hold the hospital accountable, nothing will change. Good luck.

[HiddenAngels]

I agree with everyone, and this is a prime example of nurses eat their young, dang I’m sorry this happened to you but don’t sweat too much.  Good thing is this is a good learning experience (scared the crap out of you didn’t it) and now you will never do that again.. so don’t worry.  Bad thing is that drama queen petty nurse behavior is everywhere and you have to see it for what it is, some people really miss high school… Always be scanning and use the pump and even then check your drug, volume, and rates. You’ll be alright. The RCA here is basically because you didn’t scan the bag. It happens.. and you’ll be alright.

[MaxAttack, BSN, RN]

Did I miss something? Where was the error? You calculated the drop rate instead of putting it on a pump? If anything the incident report should be for the psychotic toxic charge nurse. A simple "hey we put those on pumps" would have sufficed. 

[2BS Nurse, BSN]

"I overheard her gossiping about the incident in the break room, stating she is worried for the future of nursing after dealing with so many new grads."

Totally inappropriate. She should not be charge if she doesn't have the maturity to handle the situation properly. So many big egos out there!

[Crystal-Wings, LVN]

I would suppose it depends on where you work and what your facility does for med errors as far as education goes.

[MD married to RN]

Just for clarification, did you hang D5W and a separate 20 meq K rider OR was the bag pre-mixed? If it was all premixed in one bag and you calculated the drops to give over roughly an hour, you are good. I wish more nurses knew how to hang meds without fancy pumps, especially figuring out drops and end up with ucg/kg/hr. When the power goes out or the pumps suffer catastrophic software failure, you will be very valuable.

MORE IMPORTANTLY get to know the dangerous drugs on your unit:

• Insulin
• Potassium
• Paralytics--vecuronium, rocuronium, pancuronium--watch
• Other pushed cations--Mag, Ca, hypertonic Na
• Sedative and Narcotic and Presedex--especially if given to the elderly, those with sleep apnea, or if mixing agents
• Please chime in allnurses members

Related, can someone tell me why Narcan & Norcuron AND Roxanol & Rocuronium sound close? (Rox and Roc--potential oops)

 

[Crystal-Wings, LVN]

She sounds like a drama queen/do-gooder who couldn’t be bothered to offer any kind of follow up teaching for the error, and instead just wrote you up. I hate working with people like that because quite frankly our job is already stressful enough. Who needs the extra bs from a *** like that?

[SandraCVRN]

As a new grad at a new facility you NEED to think of the NCLEX world and try to forget the bad habits from somewhere else. Sounds like they used a different dosage of fluids. You always need to check name, dose & strength (mg/ml) etc. They can be different from day to day now with supply chain issues. Try not to let the remarks stick (you did make a mistake) learn from it and move on. Show them you are willing to learn. If it was me I’d say something to her, not necessarily about the remark but ….. they didn’t have pumps at ** I won’t let it happen again blah blah blah. 
Good luck ? 

[lhasa1956]

I hate moments like that. Make sure that you have a reference point of emotional support OUTSIDE of work. Especially since the workplace is so stressed, to be resilient you have to pay attention to the much bigger picture because the view in the workplace is very very narrow. 

[delrionurse]

 

On 4/3/2022 at 3:22 PM, MD married to RN said:

When the power goes out or the pumps suffer catastrophic software failure, you will be very valuable.

 If you don't use the skill everyday, you forget it. Half the time facilities don't even have the supplies needed.