New nurse, Second Medication error, Scared

scibruin · Jan 7, 2011

I wish I had better advice. I just wanted to give you some encouragement. Keep your head up and really be thorough with your work from now on. It's a hard lesson learned. I wish you the best and be a diligent nurse from this day forward. You made it through school you can make it through anything!

Davey Do · Jan 7, 2011

Kaysonrose:

Welcome to the Real World where mistakes are made every day.

I appreciate your concern, and being a Monument to Trial and Error, can identify with your plight. I've made numerous Medication Errors in my 27 year career with little to no negative Patient Reaction. The Important Thing was that the Errors were Caught and Rectified. And isn't that the reason we have checks, such as MARS reconciliation?

Let's look at the Reality of the Situation: Two medication errors were made where the Correct Dose of a Correct medication were given the Correct Route to the Correct Patient but Not at the Correct Time. The Patients probably did not suffer due to this Error.

In the Institution where I work, Medication Variances are rated on a Scale. A Slight Variance would be the type that you experienced. A Medication was not administered at the time it was ordered. From there, the variances do exactly that- they vary. For example, the Wrong Medication to the Wrong Patient. Ouch! The Outcome varies again, according to the Patient's raction: No Reaction all the way to Death.

A Fair Approach to your Error would be Counselling by an Adminisrative Official and nothing more.

You did what you needed to do: Own up to the Responsibility and acted Accordingly. That's what counts and I admire you for that.

I hope it all works out for you, Kaysonrose.

Dave

Ruby Vee, BSN · Jan 7, 2011

everyone makes mistakes -- even med errors. believe me, i understand. i've made some whoppers. (i once hung a heparin drip instead of lidocaine and failed to notice the mistake until the patient peed pink.) it seems as though you've made the same mistake twice, though. you missed a med. have you figured out why you missed those meds? figured out how you're going to avoid doing the same thing again? do you understand the potential ramifications of the medication errors you made? have you communicated the above to your boss?

i find it easier to forgive someone a mistake when they recognize their mistake and the possible outcomes, seem horrified at their mistake, and then learn from it to avoid repeating it in the future. maybe that's what your boss is trying to tell you.

here's the thing: you're a new nurse. stick it out in this job and in a year or two you'll be an experienced nurse. keep changing jobs and you'll still be a new nurse, only you'll have a well-deserved reputation as a job hopper and will find it difficult to keep finding new jobs. figure out why you made your mistakes and how to keep it from happening again. and then make sure your manager knows you've done so and how horrible you feel about the possible harm done to your patients.

mtowers2 · Jan 7, 2011

Considering your job seems to be on the line I here I know it is hard but please try not beat yourself up to much over it. I am a new nurse as well and I see how easy it is to make a med error. My only suggestion is to try to be as thorough as possible and check all MARS before you leave for the day. Bottom line everyone makes mistakes including nurses. In the long run there is no failure. You win or you learn. Either one is okay!

I wish you the best. Keep your head up and don't be to hard on yourself.

Meghan

kids · Jan 7, 2011

it seems as though you've made the same mistake twice, though. you missed a med. have you figured out why you missed those meds? figured out how you're going to avoid doing the same thing again? do you understand the potential ramifications of the medication errors you made? have you communicated the above to your boss?

ditto ruby.

both errors are an error by omission, there is a problem with your process, figure out what it is and correct it.

personally, i never, never leave a shift without double checking every page of the mar.

eaRNed · Jan 7, 2011

I know at my hospital we do a comprehensive check of the chart orders for at least the past 24 hours once per shift. I don't know if this is an actual policy but it is certainly a good practice. That being said, I am also a young, new nurse and I have certainly missed my fair share of orders. Thankfully, I have no med-errors to my name but mistakes happen. We work long hours and we get tired and distracted (although these are never acceptable excuses!). We just have to learn from them and take the time to ensure we don't make the same mistakes twice (or in your case, three times ). Also, I have been pulled to our ICU/CCU many many times already and they not only check their charts once per shift but take the time to go over all orders, no matter how mundane, with the nurse receiving the patient in addition to shift report. I hope this helps. Good luck!

GM2RN · Jan 7, 2011

Ditto Ruby.
Both errors are an error by omission, there is a problem with your process, figure out what it is and correct it.
Personally, I never, NEVER leave a shift without double checking every page of the MAR.

OP...While this is a good policy, it may not be enough to double check the MAR before leaving at the end of your shift. If you missed an AM med, for example, and didn't catch it until just before the end of the shift, it will still result in an error. It won't matter that you were the one to catch it instead of another nurse because too much time would have passed since the med should have been given.

You need to get in the habit of being more careful to check the MAR the first time through, even if it means slowing down a bit. You should be checking the MAR three times before giving meds anyway, and one of them should be at the bedside. In your case, I would also recommend to double check it again as soon as meds are done to make sure none were missed.

CodyRN · Jan 7, 2011

Well, I would like to add that the stress of being a new nurse, learning, knowing people are watching you and looking for mistakes, can make people make errors they otherwise would not make. This added pressure is only going to make it worse. Somebody I spoke with compared nursing to driving. She said that drivers that are reckless and uncaring cause accidents. And drivers that were TOO careful, drove too slow, afraid to merge, too anxious, etc. also cause accidents. You have to find a way to relieve some of the pressure and stress so that you can do your job confidently. Easier said than done, I admit. But I also agree with the other nurses that posted...both errors were minor, you learned from them. Move on, forget the whole "third strike and you're out." Even if you did get fired, and I understand how traumatic that would be for anybody because we try so hard, but even if you did....there are going to be other jobs and other managers that will be able to see these errors in the context of a new nurse learning her job. There's so much to learn and your mind is constantly being pulled in a million directions, so take a deep breath and remember that tomorrow is a new day.

suetje · Jan 7, 2011

Perhaps you could set up a little plan to make sure you don't miss things: for example, every day you 1) check all orders, 2) compare the orders to the ordered meds, and 3) double check that all your meds are given by the end of shift (electronic charting makes it easier to spot any missed meds.) I also would recommend you talk with your Manager and tell them you'd like any assistance, such as a Preceptor checking your meds with you, or after you , or even before you complete the shift so things can be followed up on right away. This would show you have a good faith effort to make your practice better, and hopefully show you are taking corrective action to avoid termination. Termination without assistance to rectify the problem is crazy! Maybe the institution is at fault too for not helping you do better!

Cessna172 · Jan 7, 2011

Here is a method I use to make sure I don't miss meds. I take a blank sheet of paper and write my room number, then going over my mar, I start with the earliest med listed, for example 0900. Write the time and the meds that are due at that time, and so on for the rest of the meds and times you will be responsible for.

0900 xanax

1000 kdur, diflucan, asa

1200 accu check __________ (put the results on the line), Reg insulin _____

cipro, clonidine

1400 xxx, xxx, xxx

and so on

I usually use the little scratch sheets we have laying at the nursing station, that are cut from whole sheets, so it's 1/4 a sheet of paper, and is small enough to not get in the way on my clipboard. Do this for each patient. I know, it takes a few minutes, but once you have your system down, it goes quickly. Simply discard these sheets in the shred bin at shift end. Cross out each med you give, circle any that were refused or not given for whatever reason, and scratch out any that are d/c'd. Write in any new meds ordered for your shift.

This is my system, it has served me well, but I am sure there are tons of different methods that may help you avoid that problem. The problem with some hospitals is the doctor can order meds and never inform you, thus you have to check the computer often. I have been fortunate, the docs go over their orders with the nurse to make sure we understand their writing. (paper charting)

Kaysonrose · Jan 8, 2011

Wow thanks guys for all the support! I'm new to this site and you guys make me feel like I'm not alone in this situation. I will defintely be more thorough with my medications. I just don't really like the fact that the unit secretary can take my MAR at any time and write down an order without telling me. Of course it's not an excuse for making mistakes but maybe there's a better system to reduce med errors.

I will definitely check the chart with the MAR every chance I get in between the chaos that goes on at work. Again thanks for all the advice and support!

Kaysonrose