New RN, 2 med errors in 2 days!

[asteroidcat]

I just want to share how I'm feeling right now about having 2 med errors in just 2 days, and I have only been working at my first job for less than a month! It's been 2 days now since the error and I am still afraid of the phone call that might come from the DON firing me or something.

The 2 med errors I committed involved the drug Levetiracetam (prophylaxis for epilepsy) and albuterol and ipratropium (nebs). For both meds, I gave the wrong dose. For the levetiracetam, I only gave one pill instead of two and for the nebs, I only gave albuterol and not ipratropium. I monitored the patients and both have not displayed any adverse reactions and vital signs were stable.

It was a busy day for our facility and I am basically still an orientee. There were 3 nurses (including me) and 14 patients plus the ER. One of the nurses went to the ER and I was with another nurse and we took 7 patients each. I admit that I was quite overwhelmed with the number because the most # of pts I've taken care of is 6. Not to mention that it was the weekend so there was no one in the pharmacy and no RT (I'm working in a small, rural hospital) so we do the med refills and administration of nebs. I do not exactly know HOW it happened, but I misread the MAR both times even after double-checking it and when I was comparing the MD's orders with the MAR, I was horrified to realize that I have made TWO med errors! I can still feel the chill down my spine and I am still very scared. The nurse that was with me told me that the important thing was I caught the error in time and I filed a report for it and that both patients are stable and have not shown any adverse symptoms. Both patients were non-critical but I can't help but think of what the outcome of my error would be for me and my patients. Will it eventually affect them in a few days? Will it affect my nursing license? I'm so confused.

[PinkyToe]

I've only been a nurse for a year, but I've made med errors too. How long have you been working? The best thing to do is watch the patient and make sure he/she is fine- then make a commitment to be more careful next time. I would tell the manager of my mistake. Any nurse, including the don, knows the feeling of making a medication error. You had a lot to take care of with 7 patients. Please realize that you are not a bad nurse for this and that it happens to most, if not all, nurses at some point. You should not lose your license or your job over this.

[turnforthenurse, MSN, NP]

At our facility, albuterol and ipratropium are given together, called DuoNeb - the standard is "1 unit each." You did not overdose anyone, which is good, and best of all your patients were both okay. Please realize that EVERYONE makes mistakes and nurses who say they have never made a mistake in their 20 years of nursing is lying. Use this as a learning experience and as PinkyToe said, don't think you are a bad nurse over this!

[suanna]

Hears hoping your streak of errors is a short one! EVERYONE makes med errors- this skill will improve just like all the others with time. You know you made the errors- you accept responsibility for you actions and you are making the effort to improve- what else can you do. In 20 years you will look back on this post and laugh.

[clfrn]

I feel so bad for you. I have been an RN for 1 1/2 years and although I have not made an med error yet I have come very close and it scared the heck out of me. I would say the same thing that the nurse on the floor told you. The patients had no adverse effect and the dosages you gave were under and not over. Please don't be so hard on yourself. I understand how over whelmed you can be. Unforunately there will be other errors in your life and no nurse out there can say that over their entire career they have not had an error. Mine will come. My preceptor, made a med error while training me. She got in a hurry and said she would hang a med for me and hung the wrong med on the patient. Fortunately she walked out of the room and grabbed the other med to hang and saw that she had hung the wrong med and stopped it immediately so as you can see it happens. Don't beat yourself up. As long as you learn from your errors and no one gets hurt its all good. :heartbeat

[NeoPediRN]

1) Keppra is a drug that builds a therapeutic level (allegedly, but that's a whole other story!)...if you accidentally gave your patient a 1/2 dose there is a slim to none chance their level will drop so critically they'd seize.

2) Atrovent is meant to be given in combination with another neb. For the most part, it doesn't have the rapid acting effect of a short term beta 2 like albuterol. If you had to mess up on these two, it's better that you forgot the atrovent and not the albuterol :)

Your patients shouldn't experience any detrimental side effects from either episode. Relax and exhale. Know 2 things: 7 patients is frazzling for anyone, and if you have to pass meds on them all at once, take a break halfway through and do something that doesn't involve staring at the MAR for 5 minutes or so. Do a quick assessment, stretch and take some deep breaths, do whatever it takes to clear your mind. Things start blurring together when you're passing upwwards of 40 meds at once.

[Double-Helix, BSN, RN]

Like others have said, the med errors will most likely not hurt the patients. It's good that you recognize the errors and want to learn from them. In reading you post, the one thing that stood out was when you said:

I do not exactly know HOW it happened, but I misread the MAR both times even after double-checking it and when I was comparing the MD's orders with the MAR, I was horrified to realize that I have made TWO med errors!

You should really be comparing the order to the MAR before you give any medications. That's the Three Check procedure.

1. Compare the physician's order with the MAR to make sure that the med, dose, route, and frequency were transcribed correctly.

2. Check the medication that you pulled with the MAR when you are pulling the medication.

3. Check the medication with the MAR again right before you give the med to the patient. Pay special attention to the name of the medication and the dose.

[xtxrn, ASN, RN]

You know what you did- the patients were ok....you learned from it- that's not a catastrophe (though it feels horrible). You are not a bad nurse- you're just new. And it sounds like kind of a cluster with everybody going to different departments, and having to do RT along with nursing (though LTC does that routinely).

You're going to do ok- and be ok :)