New nurse still on orientation and first med error?

  1. Let me just start off by saying im extremely cautious about giving meds and checking and double checking them because I dont want to make a med error but on my last shift a patient got up and requested her "warm pack" (that she already had in room)be warmed up and a cna working (who is also very new) warmed it for her i thought nothing of it and charted a nurses note on my patient including the note about the "warm pack" she received. My orientator read this and said does she have an order for a "warm pack"? when it dawned on me OMG u do need an MD order for heat. well the patient didnt have an order (huge lesson learned for me and the cna and no harm done to patient). my orientator helped me modify my note to remove the "warm pack" part. I said what if I didnt take it out of note?? she told me i would have been written up!! well im obviously terrified of that and especially any harm to be done to patient and feel like a honest person and always hear stories of risk management control in hospitals..and how they are there to not reprimand but try and prevent future errors so being an honest person I feel bad for leaving that out and im sure patient will be asking for another "warm pack" on next shift and say oh i got one last shift...ANYWAYS just want to know from other experienced nurses who maybe made an error like u really get written up if no harm done to patient and first type of error. hope this is my LAST error but just in case...
  2. Visit sleepdeprived1 profile page

    About sleepdeprived1

    Joined: Nov '10; Posts: 48; Likes: 6


  3. by   Esme12
    If you make a mistake it is still a mistake whether or not the patient is harmed. Technically, the reporting of errors is to be a learning experience and not a punitive one. Patients can be severely burned by "hot Packs" even though it seems so benign. If you patient was a diabetic with neuropathy and numbness receiving pain meds.....fell asleep on a hot pack they didn't know was too hot and got badly burned, got a staph infection that would not heal or turned into a flesh eating are liable.

    Think carefully before doing ANYTHING. Ask questions. You will make's whether you learn form the that make the difference. good luck
  4. by   amoLucia
    I don't know how I missed this post before... Found it interesting. As Esme pointed out, a mistake is a mistake is a mistake. Hopefully, you've learned an important lesson. But to take this a step forward... did you and your preceptor obtain an MD order for the warm pack? If this was an intervention that was more comforting instead of or in addtion to pain medication, this may be appropriate for her pain mgt care plan. But without the order first, it was a treatment error nontheless.

    One other issue, was a CNA permitted to provide its application?? Is it within her job description/scope of practice to do so? At minimum, you needed to go behind her to check. The risk of injury is at issue as Esme comments. I realize this is a lot for newbies to consider but this is the state of nursing and healthcare today. You just have to be super cautious - it does get better with time.
  5. by   tyvin
    Yes you do get written up for Tx errors such as that...I hope you went ahead and got an order. Check the docs standing orders as well.
  6. by   deyo321
    I would have gotten the order. You had to call the MD any to report error right?
  7. by   wooh
    We do warm packs without orders all the time at my facility. But at my last job, it would have been a huge to do. My current job, nurses are expected to not be idiots and to not give them when contraindicated. My last job, nurses were assumed to be an idiots and had to get an order to breathe near the patients.
  8. by   Dixielee
    Am I the only one who thinks the biggest problem is that your preceptor wanted you to modify (falsify) the record by removing reference to the warm pack? That bothers me more than the error itself.

    Yes, you should have gotten an order for it after the fact, since you didn't have one before the fact, but falsifying the record is NOT a good idea. Perhaps I missed something here.

    OP, no this will not be your last error. We all make them for a variety of reasons, the key is to learn from it.
  9. by   Kittypower123
    Medication errors need to handled in such a way as to reduce the risk of another happening. When a write-up is automatically the result of one med error, nurses are afraid to report errors and things do not change or improve. According to an article available on Medscape at Medscape: Medscape Access, "Implementation of a nonpunitive medication error reporting and tracking system is necessary in all healthcare organizations. Such a reporting system promotes the reporting of errors as an important patient-centered responsibility of the caregiver. Data collected is used to drive ongoing improvements in the medication system within the organization and among individuals." A single med error should not result in a write-up. Instead, an investigation of the situation should occur with a goal of reducing the risk of a med error, not punishing the individual who made a mistake (as with any "rule" there are exeptions - including a pattern of mistakes, or a gross error where even the basic procedures were not followed).

    That being said, we do have a responsibility to our patients. The same article mentioned above also says, " Individuals must perceive themselves and their actions as part of the overall process and must realize that systems will help them provide safer patient care. Just as an organization must develop systems and processes to reduce risk for errors, so must individual caregivers. Individual actions, behaviors, and work processes should be evaluated for potential deficiencies and redesigned." Patient care is team effort, everyone needs to be working together for the care and safety of the patient. Sometimes, write-ups are a necessary part of that effort, but not always. Whether or not a write-up as given, learn from your mistakes.
  10. by   Galaxy1
    your preceptor should have made you put a line through your note and initial it. there is no such thing as nursing judement. you need an order to do things. although you will see nurses do things without orders and get orders later. i would rather have an order for anything because no one is going to back you up.
  11. by   Galaxy1
    this story makes me not want to reposition or fluff up a pillow without an order.
  12. by   Galaxy1
    anyway some experienced nurse probably gave this patient a warm pack but if it did cause a problem you will be the only one to fall.
  13. by   Galaxy1
    and also dont trust any nurses. you dont need their trust. just do your work and you should be fine. if you need help then ask someone is fine and the right thing to do.but trusting that this one or that one will do this or that...forget about it. dont let trust cause you to lose your license.
  14. by   nurseprnRN
    "there is no such thing as nursing judement. you need an order to do things." (sic)

    you do not need an order for everything you do for a patient. there most certainly is such a thing as nursing judgment, and you'd better be able to demonstrate it. this is one reason nursing students leave their programs: they think all they have to do is "follow doctor's orders" and they're all set. alas for them, the autonomy that registered nurses bring to the practice of nursing is not going away anytime soon.

    as to the warm pack, you cannot falsify the record by eliminating mention of it once you've charted it. you can draw a line through it and mark it "error" and initial that, but then the assumption would be that you charted it on a wrong patient and this one didn't really get the warm pack. then if there's some problem later, the question arises, "why did you cross that out?" better to leave it in, call the physician, get an order for it, and write it all down in the occurrence report (or whatever you call them).

    if there wasn't an order for it, i see no reason why a prudent nurse couldn't assess the patient for safety (alertness, risk factors for injury, etc.) and apply a warm (not hot) pack (to intact skin with normal circulation and sensation) for comfort, and check the area frequently until it gets cool. personally, absent patient risk factors for injury, i think the physician is gonna laugh him/herself silly when you call about a dang warm pack. this is the sort of thing that gives nursing a reputation for lack of judgment.