Covered Up a Narcotic Med Error

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Specializes in ER, Paeds, Gen Surg.

I feel for you girl. One lie - led to another, and as well you involved a co-worker. I graduated from nursing school in 1982. I have made med errors. Thankfully none of them had adverse effects on the patient. I can't recall the errors now, but I know I reported them to the nurse in charge promptly, and completed an incident report. I think I was directed to meet with the DON for one of the errors, but otherwise, no fall out. Listen. We are all human. And I think you got bad advice from the senior nurse you consulted. As for the family being angry - that's something you can't control. And - you have no idea of the family dynamics associated with the gentleman and the patient. You are a fairly new nurse. I have no doubt this incident will be one you learn so much from. Come clean with all of it - deal with it - move on. Best of luck to you! As for getting a PRN order from the Doc to cover the medication - that's not proper practice for the nurse, or the Doc.

Specializes in ICU; Telephone Triage Nurse.

Sometimes we make mistakes and become terrified. That fear can pave the way for behavior we later regret. In hindsight this is obvious, but at the time when the whine of panic is loudly drowning out all rational thought bad choices can be made.

I'm far from perfect, therefore I would never cast a stone anyone else's way. The important thing to remember here is coming clean and cooperating fully with whatever the investigation asks of you.

This is not a total loss in terms of life a lesson if you learn something from this series of mistakes. No one is immune from errors, and you wouldn't be the first to try to hide one out of fear.

Specializes in 15 years in ICU, 22 years in PACU.

OK, you know you made a mistake. Actually two of them (the "crime" and the "cover-up"). You are now prepared to go through the punishment.

The rest will have to just play itself out. Occurrence report, meeting with DON, possible report to BON or State if the facility has been sloppy about narcotics in the past. Stick to the facts. Don't embellish or blame. Suck it up. Unless they try to blame YOU for a host of sloppy practices in the past or throw YOU under the bus because a family member is getting lawsuit happy. Then you will need a lawyer familiar with BON disciplinary actions and your life will be Hell for a few months/years.

Take responsibility for what YOU did and try to stop there. You are not the worst nurse ever, nor are you a particular hazard to the entire World! I hope they don't blow this out of proportion and make it a Federal case. The healthcare profession is supposed to be using these incidents to improve practice rather than punish.

Question that came to mind though is, Why would your "senior nurse friend" advise you not to tell the DON? Has she been burnt by the DON for something minor? Has your workplace been a Hell Hole that would throw good nurses under the bus to cover for their poor practices?

I am curious about the MD involvement. I have heard of nurses giving a PRN type medication due to symptoms and then asking for an order to "cover it." Thi is obviosly not correct practice, but I know it happens. If a medication is given incorrectly, is it common to seek an order to "fix" it? I completely understand alerting the MD for medical reasons, but giving a order seems really shady. Could this be what the family is reacting so strongly too? In the hospital record, was there even a way to chart the medication as given without an order generating it on the EMR?

In ltc this is quite common, and even in hospital care I have seen doctors write orders for a one time dose, I don't think it is so much shady as I don't think the md is really clued in to the med error aspect and is just trying to be helpful.

If a medication is given incorrectly, is it common to seek an order to "fix" it?

Yes. I had seen this many times at my former LTAC. We did not have scanners and our narcotics were in a locked cabinet with paper charting. It was not unusual to grab the wrong but similar narcotic: Percocet versus Norco, etc. We would then get an MD order to balance everything out for pharmacy oversight. If there wasn't an easy fix or we gave an entirely inappropriate med, or there was potential for harm, then we would call family/MD/DON.

Family upset? What family? Our patients were the forgotten. DON upset? Our DON had too much on her plate to worry about something that we already mitigated paperwork-wise.

I know this sounds terrible but we really did provide the best care we could, compassionately, while overworked and chronically understaffed.

I myself made an error like this one working on a medicine floor. I reported it to the nurse in charge, the GP on call wrote a one time order for the med. I monitored vitals and was honest to the incoming nurse for night shift. I did however document that a medication was given in error and filled out an incident report on myself explaining what had happened and what I would change in future. You know what happened? Nothing. Because I was honest and mistakes happens. Honesty is always the best policy. I understand that under panic we make rash decisions, the best you can do now it be honest in all mistakes going forward and of course follow through with your 7 rights (not 5) right patient, time, route, dose, documentation, right technique, & the right to refuse. Good luck! We make mistakes and we are human.

Specializes in Addictions, psych, corrections, transfers.

I had a great nurse instructor tell me when she was a manager, that when it came to mistakes and a person was truthful, then it is seen as a learning opportunity and possibly leads to more training. If they make a mistake and they lie, then that person would be fired because you can train out mistakes and but you can't train ethics or morals. I think you learned that lesson.

Specializes in ER.

Ouch. It's too bad the medical culture discourages self reporting of incidents like this. People are scared of losing their license and their jobs, so things like this get covered up. Hang in there.

Specializes in NICU.

!.Speak with union rep who will be with you when they write you up,you do not have to sign,the rep can request a copy.State only the facts, do not take the same patient.Do not discuss/apologize to irate husband, he is over dramatic,.anything you say can be used against you so ...shut the f up.

It will be in your record for a couple of years.

Do not discuss with anyone else!

Specializes in Clinical Research, Outpt Women's Health.

I hope they will be understanding. I sense that you have punished yourself enough. Lesson learned and I hope they allow you to just go on.

I had a similar experience as a new grad; nearly identical patients something along the lines of both total right hips. I was cut slack being very inexperienced and no one asked my to withhold information. The patient had attitude of 'no harm, no foul'. It was something along the lines of one had morphine, the other demerol. I did freak out a bit, my 1st order of business was to check the patient for allergies and, of course, check the patient.

This was over 20 years ago and it was not quite such a litigious society.

Also everyone did not live in fear of the BON, I made more than one mistake as a new grad but I really do not recall even taking the BON into account.

I did not tell the patient as a supervisor wanted to handle that. It was not that difficult to make those types of mistakes as a sleep-deprived newbie. I believe that sleep deprivation is not nearly taken into account as much as is should be, we had the 5 rights but it was not impressed as much and I didn't want to turn on all the lights and have the patient go thru name/DOB but I sure did after that. Do they not have bar-coding? As much as I think they want to turn us into robots I am a firm believer in bar coding. The only mistakes I saw new grads make when I last worked acute care was not bar coding the patient. The moment you stated that you were expected to withhold information I saw a red flag of you being thrown under the bus. I hope you forgive yourself, we have all made mistakes and we are all human.

Specializes in New Grad 2020.

I agree I don't think the husband is out of line. Mistakes happen we all do dumb things I'm easy going but if it was me the cover up from more than one person wouldn't go over real well. I'd be very angry. If it is true what the husband says and his wife is really doing worse (really worse not hyperbole or exaggeration) after the fact that particular person would not want to run into me. That's not cool

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