Nurse went "ballistic" over her medication error.......

[WriteStuff]

Hi all,

Just want to talk about why it is some Nurses (not all for sure), go absolutely "ballistic" when another Nurse has to make out a medication error report when an error is found.

Last weekend I found an error in a pre-op med that was to be given four times a day, for two days, prior to this resident's surgery on Monday morning. (The day shift Nurse did not give the med on her shift, for two days.)

I contacted the Doctor, who stated, "not a big deal, just get two doses in before the resident leaves for the hospital on Monday morning. We did.

But, I realized that this was an error that needed to be documented according to policy and procedure, so followed through on the right thing to do.

When the Nurse involved saw the report she went absolutely ballistic!! Started making all kinds of claims, accusations, and went into a tangled scenario as to why "this just cannot be so."

She's one of these Nurses and persons who can "do no wrong" and has been at the facility for 100 years now.

But I have seen this same "reaction" by other Nurses during my lengthy tenure in this profession. What is that all about anyway???

Any of you experience the same with your peers?

Wondering, in Minnesota.

[WriteStuff]

Good question!

It was passed on shift-to-shift. Nurse involved said: (while going ballistic)............"There was no med sheet."

(Our pre-op, and one-time order med sheets are printed out separately and put on the Mar)

There was a med sheet and it was printed out six days prior to the date the pre-op med was to be given, because the resident had visited the Dr. that day and came back with pre-op orders. The Charge Nurse had taken the order off, printed the Med sheet, and signed and dated it in red ink and placed it on the mar.

This is why Occurrence reports feel so punitive at times. We are forced to look at the "why" it was missed and sometimes it means that we screwed up royally.

[fiestynurse]

You know what healingtouch, maybe we should all start supporting each other in this manner and stop filling out these reports on every little minor error. Doctors don't fill these out on every little thing that goes wrong. Until the punitive climate changes, maybe we should be more discriminate about when we fill these out. Grouchy is right!

[Mijourney]

Hi fiesty. Thanks for correcting me about quality management. Sometimes I have alot of typos in my post that I don't catch such as not instead of the intended now.

Can you recommend a website that we can refer to on incident or occurence reports? Is this information that the ANA includes in their website?

[willie2001]

I wrote myself up the other day for a medication error. I gave my patient 80mg of Lasix po at 0800. our normal time for administering AM meds. For some reason, this patient's lasix was scheduled to be given an 0600 and had already had it. My brain was on automatic, and I gave it again:rolleyes: The time was a deviation from our normal routine, but I should have been more careful. The patient suffered no harmful effects. I told the doc of my error and he said that it probably wasn't all that bad of a thing because the patient has pneumonia with bilateral pleural effusions. He diuresed 1500 cc. after the double dose!

[Norbert Holz]

I have made mistakes and was fired or put on the do not use list for the humanity of imperfection.

We truly are disposable!

[P_RN, ADN, RN]

One point I beg to differ. Doctors may not write each other up, but more times than I can count I have seen such (STOOPID) orders such as......and I am NOT kidding here.

"INCIDENT REPORT STAT about ice bag with nothing but warm water in it"

"INCIDENT REPORT about patient not having his chosen breakfast delivered....."

And I still believe it's "tit for tat" as far as WHO gets written up.