New Grad Mistake!

[CaligirlRN75]

First of all, I apologize if I put this in the wrong thread, I'm not familiar with the site just yet. Second, HELLO guys!

So I'm in my new job and 3rd day of being solo, I committed a mistake. So I work in an adolescent unit and one of the patients had a really bad EPS as in her neck was stiffening and she cannot move her tongue. I called the doctor (since the Nurse who was responsible for the pt was super busy) and he told me to GIVE BENADRYL IM 5O MG Now and "make it BID." So I repeated everything he said. I gave the "now" shot and put in an order for Benadryl 50 mg IM BID. Long story short, my charge nurse confirmed the order and it was wrong. The doctor insisted it should be Benadryl 50 mg BID PO! Nothing was given and everything was fixed but I felt really bad. I felt my knees weaken and my whole body just cannot process. I called the Dr. and apologized and ask for a feedback so I won't do thesame mistake again. He was really cool about it and so was my charge nurse. But I feel like crap. I feel miserable. I can't sleep, can't eat. Can u imagine if I gave the order BID IM and it was PO??!!!!!! OMG. i wanna die.

[NRSKarenRN, BSN, RN]

Moved to our First Year After Nursing Licensure forum for support.

Ouch...you've learned a valuable lesson. The fact that you took responsibility for incident and prompt followup is commendable for doing the right thing. When repeating orders back to the doctor, for any drug route other than PO, I raise the infection in my voice on route and repeat route at end order.

I then think order over to see if it makes sense: Benadryl 50 MG IM BID??? How many times do you see an IM injection BID other than antibiotic, fertility over several days? Rethinking often has the internal nursing lightbulb go off: this order needs to be questioned again....even if you expect flack from practitioner. It's how we keep patients safe.

Just like time heals all wounds, you will be able to put this event into a nursing memory box and move forward.

[pinkiepieRN]

I'm not saying you shouldn't have caught it (and good on you for doing so!) but I think any nurse looking at that order would think twice before giving a standing dose of Benadryl IM, especially if this is an otherwise cooperative/compliant patient. Know what I mean?

[Meriwhen, ASN, BSN, MSN, RN]

Generally, medications shouldn't be given IM if they don't have to be, especially scheduled medication. Sometimes the initial dose may be given IM if it's needed to work faster or there's other factors (e.g., vomiting, full stomach) that would render PO medication unfeasible. But to see an order for routinely scheduled IM med should raise a little flag in your mind.

Since you're talking EPS and IM injections, it's a safe guess that you're in psych. Dolcebellaluna has an excellent point: if the patient is cooperative there is really no need for IM injections (except if those other factors (vomiting, etc.) are present). When possible, the patient should always be offered the option of taking a medication PO.

As far as med errors go, this one isn't too bad. The patient wasn't harmed and you took full responsibility for it. So you can beat yourself up for the rest of the night if you like, but after that stop beating yourself up and learn from it.

You're going to be OK.

[KATRN78]

If the patient was unable to move tongue, could she swallow? Did doctor mean to say give it im now and po bid?

[BSNbeauty, BSN, RN]

This is why I HATE verbal orders. I understand that it was urgent in this case but right after I gave the Benadryl IM and settled the patient I would have taken him the chart to write the order.....

I've repeated back verbal orders that came out to be incorrect because the doctor simply said "mmm um, that is correct" without really giving a hoot about me repeating back the VO.

OP it was a lesson learned, no harm done.

[applewhitern, BSN, RN]

Since you said the patient's neck was stiffening and she could not move her tongue, I would not have questioned this order.

[Nurseadam]

look, everyone makes mistakes. But not sleeping over an order of Benadryl is extreme.. So what if you gave the order IM? If the doctor was cool, he'll say it's fine, and change his order for IM now and PO Next dose.. It's not a big deal.. I would've given it IM, EPS isn't something to mess with and PO takes a long time to enter the blood stream.. Relax and stop your knees from shaking.. it's going to be okay, you new grads are so cute

[Morainey, BSN, RN]

Don't beat yourself up about it too much. Don't be scared to repeat verbal orders back to docs, either, CYA and all that.

[LandD_RN_chica]

I mad a mistake in triage the other day. I had a patient actively vomiting and the NP told me she ordered zofran 4mg. Since the patient was actively vomiting I assumed it would be iv and gave it iv and it was ordered po. She had an allergic reaction at the site. Just hives and I had to give her Benedryl. My manager talked to me about the situation and I had to do an incident report. I am not a new grad but I'm new to giving meds. I was in the or for two years and anesthesia handled every med. it happens. Don't be upset. Mistakes are how you learn. No one died. You and I will always be sure that we check the mar and read orders back before we give meds and we won't make a mistake again. Don't beat urself up. Things happen.

[KATRN78]

I did some googling and apparently benadryl IM is common practice for acute dystonia/drug induced dystonic reaction. Then followed by benadryl po later.

[nurseprnRN, BSN, RN]

The doc likely would have prescribed the first dose IM (difficulty swallowing) and then PO afterwards if you had asked him about that. Next time you'll know to ask him to give a more appropriate prescription because you have had this experience... and perhaps he'll know it better too.