Jump to content

New nurse, Second Medication error, Scared

Hi I'm a new RN and I was recently hired at an acute setting in October 2010. In the past three months, I have made two medication errors and my DON told me the third one will be up for termination? After hearing this, I've been absolutely scared.:crying2: I mean this is my first RN job and already I'm making medication errors.

First Drug Error: I didn't see the order for potassium and so the night nurse ended up giving it to the patient (4 hours late) but of course I was written up for that. :down:

Second Drug Error: I forgot to give coumadin 2mg for maintenance (written by the pharmacy per protocol) and again I was written up for it. :down:

I admit that I made the mistakes. I was just crushed because just when I thought I had been thorough with my work that day, I get a call from my DON telling me about the error. I'm feeling so frustrated with myself.

I don't want to lose my job. I'm new and I'm learning. I don't even know if they'll put me on probation or not or if there is such thing with medication errors. Will they terminate me if I somehow make another error after a year?

I don't know if I should start looking for another job. But lesson learned, I am NOT leaving that hospital without looking at the MAR and the Chart thoroughly from now on. I'm just feeling so traumatized because I now know I can't afford to make another mistake and so I have this pressure on my shoulders. Now I'm thinking, are they going to automatically terminate me if I make another error? :confused: Any advice to ease my stress?

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

Has 41 years experience. Specializes in Psych, CD, HH, Admin, LTC, OR, ER, Med Surge.

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

Has 40 years experience. Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

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

Has 1 years experience. Specializes in LTC.

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

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

Has 2 years experience. Specializes in Pre-Op, Med-Surg, Oncology.

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!

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.

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.

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

Has 12 years experience. Specializes in ICU & LTAC as RN. FNP.

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)

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

NocturneNrse

Has 6 years experience. Specializes in Med/Surg/Tele/SNF-LTC/Supervisory.

Ok, you missed the order for the K. Can you think of a reason that new order was missed? Are there "alerts" in place so the nurses can clearly SEE that a new order has been written? Perhaps there needs to be some changes to the "new order" protocol to prevent other nurses from missing them as well. You made a mistake - you're NEW, perhaps it's JUST NOT YOUR FAULT - the system may be faulty as well... glad you owned up to it though, because that shows integrtiy.

You also missed the 2mg of Coumadin per Pharmacy Protocol.... OK, is that protocol CLEARLY displayed for the nurse to see? Where I used to work, there were loads of protocols.. but many were in such area's that noone would ever find them, or would even suspect they exist!!! Perhaps - you could take some time and look over all of the protocols for your hospital - just skim over them to see they exist, so you will get that "OH YEAH" in your brain when your patient is on that medication, etc etc... Also - your integrity shines through loud and clear with your willingness and accepting of your mistake.

My advice.. When getting report, ask "I'm new, is there anything that I should know about this patient? Any new orders, protocols that I might not see?" Hopefully you'll have a helpful nurse handing off to you. Also, SLOW DOWN.. I know you're probably crazy busy, and want to show that you can hustle like the rest of them.. but it does take time. And always bring that MAR with you when giving a med - that is how I made my med error.

And finally.... :hug: hugs to you.. it's hard, and we support you!!

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.

Just an idea.... can your unit secretary stick one of those fluorescent sticky note things to the MAR so it's sticking out of the top to alert nurses that there is a new order? Does your hospital have any plans for electronic MAR? I've found that it's near impossible to miss a med using the EMAR. The doctors enter all orders into the computer, then the orders pop up as one color in the 2 hour window that they are due (1 hr before, 1 hr after), and then pop up red when they are overdue.

HI, I am a new night nurse of 2 months. Though I don't have all the details about what went wrong, but I supposedly did my 24 hour chart check and didn't catch a certain drug that pharmacy accidentally posted on the mar. The drug then was given to the patient for 3 days before another nurse realized the medication was not actually ordered by the M.D.. When the M.D. found out, he went to the director and demanded something to be done immediately to rectify the situation. The drug was solu-medrol. I take responsibility for this, not sure how it happened, but it happened. The Good, the bad and the ugly....what are everyone's opinions on this? I meet Monday to find out if I still have a job.

FancypantsRN

Specializes in Cardiovascular, ER.

bullygirlie - so all the nurses that gave that med are in jeopardy of losing their jobs? really?

FancypantsRN

Specializes in Cardiovascular, ER.

med errors happen. i have made a couple myself. i have almost made many (especially when i worked at places with the paper MARs).

i just try to question why the patient is on the meds. if i can't figure out why i am pulling the med, i try and find it in the chart. this has saved me from a couple of med errors. it's hard to do when you are super busy and i haven't done that every time, so perhaps i have made more errors than i know.

it's even harder to catch when the doc puts the order in the wrong chart (happens), the us enters it wrong, the pharmacy verifies it incorrectly, or even verifies the wrong med on the wrong patient.

it's tough sometimes to catch a break. we do the best we can with the systems we have. we just make note to self, and try not to make the same error in the future. just like our priorities and to do list is ever changing, so is the way we look at our own processes for doing things.

HI, thanks for replying. It's all 100 percent my fault for the patient getting the drug???? I failed to realize there was no M.D. order for it and Pharmacy posted it onto the wrong MAR. I should have caught it and the other nurses just gave it, relying on my 24 hour chart check. I am going to ask to see the chart tomorrow in my conference as I don't know what the specific details are. I walked into a bunch of rumors and found out my boss is going to talk to me about it second hand. That sucks!!!! I must have not crossed it off the Mar during my 24 hour chart check and the day nurses gave it for 3 days afterward. Then the last nurse caught it and notified my boss. The M.D. was furious. I guess it is 100 percent my fault alone. What do you think? I feel terrible and I am very meticulous when it comes to my meds. I fear med errors the most. I also told my work I was swamped and sinking with all the admissions and discharges they give to me every shift. I am brand new and the season nurses don't get half the admissions I do. I do take responsibility for my actions and inactions and I will own up to my errors. The pharmacy should have some accountability as well though. I think I am getting fired.

FancypantsRN

Specializes in Cardiovascular, ER.

well i think getting fired would be kind of harsh. i am not sure of the details - but if they call you in, i would just explain to them that you take responsibility for the mistake and you have learned a valuable lesson from it. you would think with all they put into you being a nurse on their floor that they would not can you for this. i would just not given them excuses, if it were me, about the admissions and dc's. that will even out in time - really it will. a lot of charge nurses think that new people on the floor should pay their dues (as wrong as that is to a new nurse). when i was new, i got all the heavy patients. i was promised a "slow easy group" until i got adjusted. ha! no way, all confused, combative and high acuity for me : )

yes, pharmacy does share in the error. med errors are not usually just one persons fault, sometimes it is a system error and they don't get corrected unless risk management gets involved and so on.

You are not solely responsible for this error. It's a systems error. It was initially pharmacy's error. The med was given for 3 days. That means it got missed on three 24 hour chart checks, right? Were you responsible for all three of those checks? No nurses on other shifts that gave the med questioned the order? Don't let management put this all on you.

×

By using the site you agree to our Privacy, Cookies, and Terms of Service Policies.

OK