fellow nurse, small error...what to do?

  1. Today at work, i was assessing a pt's skin and noticed an approx 3-4cm bruise with raised, palpable hematoma at her deltoid. I asked, "what happened here?" and she said, "the other nurse gave me that really painful shot for my diarrhea right there." This pt is on SQ, SUBQ!!! sandostatitin for a high-output fistula q8h. From what I inferred, the "other nurse" had given this med IM. It is very clearly, and has always been, ordered as a subq medication (and is never given IM, as far as I know). If I assume correctly, and I recognize that assuming is a bad thing, this is a med error--WRONG ROUTE.

    My dilemma is this: Should I address this with my fellow RN directly, or write up a med error report that will involve the DON and powers-that-be and become part of the pt's medical record? I am sure this caused minimal harm to the pt and hopefully the hematoma will resolve without complication. The pt also, technically, received this medication, although the absorption may be different... arghhh. The nurse is very sweet and I don't doubt her safety, in general. I also don't want to bring it up to other nurses on the floor for fear of being gossippy or undermining...
    Any suggestions would be appreciated.
  2. Visit BigMar profile page

    About BigMar

    Joined: Jan '09; Posts: 5; Likes: 7
    staff RN; from US
    Specialty: 6 year(s) of experience in med-surg, LTC


  3. by   sunidol
    Unless you %100 *know * she gave it IM I don't think you should do anything other than possibly ask her... Ask her if she gave it IM or mention to her that it is admin subq-

  4. by   BigMar
    yeah, i guess asking her what happened would be the next step. i just don't want to seem like a know it all and i don't want to step on her toes. she has many, many years more experience that i.
  5. by   judeamaria
    I think it's better if you inform your unit manager and she'll take over from there.
  6. by   Pepperlady
    Quote from BigMar
    yeah, i guess asking her what happened would be the next step. i just don't want to seem like a know it all and i don't want to step on her toes. she has many, many years more experience that i.
    Goodness, you don't even know what happened but you want to take it to the nurse manager?? I say ask her about it and then mention that it is a subcutaneous injection and not IM.

    I don't understand the mentality of reporting every little thing to the nurse manager and writing fellow nurses up. I do understand the mentality of pulling a fellow nurse aside and in a non-threatening manner telling her.
  7. by   Tweety
    Good question.

    When these kinds of things come up, I alway think of the worst case scnerio. What if the bruise turned a little necroctic, an abcess formed and things deteriorated from there. He's going to remember a nurse gave him the injection in his arm and perhaps remember telling you.

    Any kind of abnormallity or change in condition must be reported somehow. I know you want to be the "nice nurse" and not "rock the boat" or be a tattle tale, but you also want to cover your butt.

    I know this sounds rather like I'm being a drama queen and paranoid. But 17 years of nursing a few lawsuits and a few depositions later have taught me one thing, and it's mantra of nurses everywhere "cover your butt".
  8. by   Whispera
    I think you should mention it to your fellow nurse. It's a patient comfort thing and also a med error if true. You're being patient advocate if you mention it.
  9. by   CathyLew
    I wouldnt' go to the nurse manager. A SQ injection can leave a bruise as well. Its not 100% indication that the shot was given IM. You don't know what size needle she used. You could always print off the drug instructions and leave them with the MAR.
  10. by   Whispera
    Deltoid isn't the usual site for a SQ injection. I think the med WAS probably given IM. If you suspect this, you have to do something, but speaking with the other nurse is going to the source rather than hitting her with a sledgehammer (which reporting to the manager would be). If you were absolutely certain, you'd need to do an incident report and or med error report (whichever your agency uses). Just because you do one of those doesn't mean the other nurse is confronted or yelled at or fired. It just informs the boss and leaves it in his or her hands to followup. Not reporting an error you're certain of doesn't keep the patients safe. If someone does some things once, he or she might do them again. Maybe the nurse in question doens't understand SQ or realize the med in question is SQ?
  11. by   MS._Jen_RN
    I've seen more than one truly subcut injection leave a hematoma/ecchymosis. The only thing that would lead me to thnk it might have been IM is the location. I'd ask the other nurse about it. You can give subcut in the back of the arm as well.
  12. by   steelcityrn
    A incident report should have been filled out. Patient states.....description of trauma ect....then you submit it to the right person and shut your mouth, your job is done. Your protected and thats for mng to take care of. NEVER ASSUME ANYTHING!!
  13. by   FlyingScot
    How about pulling her aside, explaining your concerns, confirm whether it was administered the wrong way and let HER take the high road in filling out an incident report/med error report on herself. That way you BOTH look like professionals.
  14. by   BroadwayRN
    Granted the deltoid area is a not the first choice or a place I think of for a SQ, I always go to the underside of the upper arm with a SQ, unless it's ordered abdominal, etc. If the patient is large or has fleshy arms it's very possible to give a SQ injection in the deltoid area. What injection would be for diarrhea? That's a new one on me.

    I would ask the nurse who gave the injection if she had seen the area it left and let her take it from there. If she does absolutely nothing then tell the nurse manager. You do have to CYA when all is said and done.