New grad, Med error

[Nickc58]

So I’m a new grad still on orientation. Long story short I was taking care of a pretty critical patient the other night. I was taking frequent verbal orders from the provider. The patient was vomiting frequently and had prn zofran ordered. The provider wanted me to give a dose so I went into the Pyxis and began to pull the zofran, 4mg. As I was in the process of removing the vial, the provider came into the Pyxis room and told me to give 8 of zofran. Not thinking this through, I pulled an extra vial. I drew up 8mg of zofran and gave it IVP to the pt. When I went to scan the vials after I had given it, I saw the order had been put in for 8mg IVPB. I was then told that I shouldn’t have given it IVP as anything over 4mg should be diluted. I am not placing blame on the provider, ultimately it was my fault for not following the correct administration process. I was confused by the provider and the multiple verbal orders, but it was still on me. I reported this immediately to my charge nurse. My question is, what should I expect to come of this? While I’ve heard of nurses being terminated for less than this, I hope to take this as a learning experience and not lose my job over this. There wasn’t any patient harm, and I’m extremely torn up about this. I just need some words of wisdom. Thank you!

[canadianedmurse]

On 11/4/2019 at 10:26 PM, mmc51264 said:

We have med admin instructions on our MAR that tell us how it is to be given. How can you have med admin protocols decided by nurse preference? What about meds you are not familiar with? What about a new nurse? I work with residents and they know nothing about administering meds.

OP, every nurse makes mistakes, if they tell you they don't, they are lying. Learn from it and go on ?

Interesting perspective. We administer the drugs so it is our responsibility to responsibly administer them. We have administration guides in every med room and pharmacy has a webpage with parental manuals. You'd be surprised. I rarely need to look now

[Guest219794]

23 hours ago, Nickc58 said:

So I’m a new grad still on orientation. Long story short I was taking care of a pretty critical patient the other night. I was taking frequent verbal orders from the provider. The patient was vomiting frequently and had prn zofran ordered. The provider wanted me to give a dose so I went into the Pyxis and began to pull the zofran, 4mg. As I was in the process of removing the vial, the provider came into the Pyxis room and told me to give 8 of zofran. Not thinking this through, I pulled an extra vial. I drew up 8mg of zofran and gave it IVP to the pt. When I went to scan the vials after I had given it, I saw the order had been put in for 8mg IVPB. I was then told that I shouldn’t have given it IVP as anything over 4mg should be diluted. I am not placing blame on the provider, ultimately it was my fault for not following the correct administration process. I was confused by the provider and the multiple verbal orders, but it was still on me. I reported this immediately to my charge nurse. My question is, what should I expect to come of this? While I’ve heard of nurses being terminated for less than this, I hope to take this as a learning experience and not lose my job over this. There wasn’t any patient harm, and I’m extremely torn up about this. I just need some words of wisdom. Thank you!

I am curious- told by whom?

Be aware that much of what you will learn as a new nurse is nursing mythology handed down by word of mouth. Your hospital may, in fact, have a written policy on this, but maybe not.

I give a lot of Zofran. Easily in the top three meds I administer in the ER. I have never done an infusion. I am know this is a valid way to administer the drug, but I have never seen an order for it.

[Lunah, MSN, RN]

OP, just a trick for the future — while you are prepping antiemetics, if a patient can keep it together enough, have him or her hold an alcohol prep pad under his/her nose and inhale. The smell will sometimes hold that nausea at bay. Doesn't always work, especially if they are already actively vomiting. I have given lots of Zofran IVP too, I don't recall ever giving it IVPB except as part of a 24-hour drip concoction we used to make for people with intractable vomiting (it had Zofran, Reglan, and Zantac and worked like a charm!).

Anyway, lesson learned. Check your unit policy about verbal orders, too — if it turns out you are not supposed to take them (outside of a code/very emergent situation), then providers should know darn well they aren't supposed to give them. What kind of unit do you work on?

[Nickc58]

48 minutes ago, hherrn said:

I am curious- told by whom?

Be aware that much of what you will learn as a new nurse is nursing mythology handed down by word of mouth. Your hospital may, in fact, have a written policy on this, but maybe not.

I give a lot of Zofran. Easily in the top three meds I administer in the ER. I have never done an infusion. I am know this is a valid way to administer the drug, but I have never seen an order for it.

My charge called pharmacy and that’s what they said

[beekee]

4 hours ago, Nickc58 said:

My charge called pharmacy and that’s what they said

I bet the charge would have given it IVP too. I’ve never done Zofran IVPB either.

[mmc51264, BSN, MSN, RN]

Quote

interesting perspective. We administer the drugs so it is our responsibilty to responsibly administer them. We have administration guides in every med room and pharmacy has a webpage with parental manuals. You'd be suprised. I rarely need to look now

And if it isn't a med you give all the time? What if a pt needs special admin instructions?

We have specific policies at our facilities. For example, no timed-released medication can be altered to give, such as potassium, even though the manufacturer says that it can be dissolved in water an given.

We have pharmacists for a reason. I have heard of medications being weight-based and the medication dosed for lbs, not kg.

Not every nurse knows how to give every medication correctly. Rather than having to go look for a resource, our instructions are in the MAR. EPIC-based so it is very user friendly.

[murseman24, MSN, CRNA]

You're fine. There are a million different POSSIBLE interactions with some medications. This one is no where near the top of the list in relation to potential harm to the patient. Now IVP a loading dose of precedex or amiodarone and you may cause an issue.

[Lunah, MSN, RN]

I have personally seen a patient go into Torsades after a dose of Zofran, so it's not always a benign med! But that is a rare thing, I believe. It was crazy!

[Guest219794]

On 11/5/2019 at 9:20 PM, Pixie.RN said:

I have personally seen a patient go into Torsades after a dose of Zofran, so it's not always a benign med! But that is a rare thing, I believe. It was crazy!

Curious- Was this a monitored PT with a normal QTC?

I have heard of places that require monitoring for IV zofran. We give it out like candy.

[Lunah, MSN, RN]

1 hour ago, hherrn said:

Curious- Was this a monitored PT with a normal QTC?

I have heard of places that require monitoring for IV zofran. We give it out like candy.

I am not sure, to be honest — it wasn't my patient. I just helped with the short flurry of activity that ensued! But yes, I had a physician who wrote monitor orders with every dose of Zofran while the others gave it out like candy.

[AlwaysLearning247, BSN]

You’re not going to get fired over this. You learned something new! I came across this a few years ago, but I’ve only ever given 4mg IVP. When I used our medication administration book I read anything over 4mg you dilute and infuse over 15 mins. I always dilute in 50ml bag of NS and infuse over 15 mins (many IV pumps already have the concentration and time of zofran programmed too). I’ve heard of multiple nurses pushing 8mg and nothing happened to their patients. However, zofran can increase QTC, causing arrhythmias. We are all human and are bound to make small mistakes from time to time. This is how we learn. Good luck!