Made a Med Error in Clinical.. :(

Here.I.Stand, BSN, RN · Apr 17, 2014

You need to force yourself to focus, first of all. I know poor sleep doesn't make it easy, but it happens in real life, and it's an obstacle that needs to be overcome. Look at medical residents, how interrupted or nonexistent their sleep is for days, and yet they still have to be able to think critically.

If you don't understand something like w/ the sliding scale insulin, please ask! There's no shame in asking for help, and med errors w/ insulin can be very serious.

When you do your reflection, I'd think long and hard about what you can do action wise to improve. Don't say anything that could come off as an excuse, such as not sleeping well...yes, I know this is a factor that does make work difficult, but it could be taken as an excuse. You want to make it clear that you take this very seriously. Some ideas that I can think off the top of my head are if you feel yourself getting tired or having trouble focusing, take 5 min. to go outside for some air, do some deep breathing in a quiet place, meditate, whatever works for you. Google online resources for medication safety. For situations like the FeSO4 possibly being in the pt's room, you can make a little dot on the MAR (if it's paper) or list the meds on a sticky note that you still have to pull, once you've pulled the ones from where most of them are.

I know a couple of people personally who've failed clinical. I hope it works out for you this time, but like I said think very long and hard about what you will do differently going forward, and show your instructor how seriously you take the issues you've had. Hugs!

kringkring5144 · Apr 17, 2014

Hi thanks for the support.

What were the reasons these people failed clinicals?

I did mention not sleeping well, but I did admit I need to improve on medication administration and specifically pointed it out. and Tryingto make see her see I realized my mistake!

kringkring5144 · Apr 18, 2014

Ive been getting satisfactory on my papers, showing her im improving with looking up medication.

She never mentioned failing but keeps questioning my thought process since I mentioned two weeks before I was showing her I was incompetent.

I never heard anyone failing out of clinical at my school and heard people that should have failed still passed. One my older friends in Nursing School at my school was told that she should have stayed in X-ray school and practically made her cry and has also done a med error in the past.

I know I made errors at my last clinical day that was not safe and I am just praying that the teacher gives me grace for this. After all, I was told I'm only learning.

Been there,done that, ASN, RN · Apr 18, 2014

Where are you going to nursing school???

You are under the instructor's license and guidance. The bottom line is you are a STUDENT.

1.) Apparently this was a narcotic. I have a gazillion years experience and can still forget to make a count whenever I pull a narc, it will be found sooner or later, meh.

2.) Do you have access to reference material during clinical? The different insulins and their administration is very confusing. Your instructor needs to be made aware this is a problem area for you .. and TEACH you their administration.

3.) As far as the ferrous sulfate, you push a LOT of pills, can't remember each and every one. That's why we scan them! Seems to me you prevented an error instead of making one.

The instructor needs to be more worried about his/her performance than yours. Instructor is not giving you what you need to succeed, I think you're being picked on.

kringkring5144 · Apr 18, 2014

I go to Mennonite college of nursing at Illinois State University. Well it wasn't narcotics. It was just some meds had more mg than what was ordered and I wasn't counting them. Yea idk for sure what to do next until I hear back from her

akulahawkRN, ADN, RN, EMT-P · Apr 18, 2014

At some point, we all make med errors. The question that remains is how bad are the errors! Sometimes it's a little too much, sometimes it's just not enough med. Scanning the meds does help reduce errors but that doesn't eliminate them. If you're supposed to give half a pill, you scan the med, enter in the correct dose so that the system thinks you're giving the right dose, and if you forget to use your pill splitter right then, you can inadvertently give the full pill instead of the 1/2 you were supposed to. That's a med error! You might not even realize that you made that error and the system might not either. Another "med error" is finding out that a med is needed and not available. It's not your error, usually, but it's still not supposed to happen. The problem becomes yours when you fail to do something about it. Those kinds of problems can throw off your whole plan for the day and make you run around like the proverbial headless chicken trying to catch back up.

Insulin Sliding Scale is, at first, a difficult concept to grasp. Everyone needs insulin so their body's cells can uptake carbs as a fuel source. The question is how they get the insulin. Most people's bodies produce sufficient insulin to meet the need, even during times of high stress like illness. Some people need help with their insulin. What gets confusing at first is that you can have several patients that are type I diabetics, so they all need insulin, they're all about the same height, weight, and even body fat percentage, yet they have a different insulin scale! Another thing to remember is that people that are NPO and aren't getting any other supplemental nutrition will be on one scale, there'll yet be another scale for them being on continuous NGT feeds, and perhaps another for TPN, and another if they're taking regular meals. You have to know which one the patient is on, what their blood sugar levels are throughout the day, and therefore how much (if any) insulin the patient needs.

What really drives me batty is when the patient needs long-acting insulin, a nutritional insulin , and correctional insulin... yet I somehow have figured it out and haven't made insulin errors. It doesn't mean that it's easy, just takes a while to wrap your head around it.

kringkring5144 · Apr 20, 2014

Yeah I really need to look over all the insulin sliding scales.

I felt like she was not pleased with my last careplan. I put 5 bowel movement on someone who was one day post op. She was not pleased.

loriangel14, RN · Apr 20, 2014

A good friend of mine failed a clinical because she made med errors. you really need to get a handle on administering safely before you move on. it's very critical that you are paying attention to how much of something you are giving. What part of the sliding scale did you not understand?

Here.I.Stand, BSN, RN · Apr 20, 2014

So you diagnosed this pt as risk for altered bowel function? One day postop, that sounds reasonable to me. It's likely not going to be your top-prioritized nursing dx, but as an item on a careplan it would be appropriate. :up:

The gal in my class who failed clinical, I'm not 100% clear on. She and I were NOT friends lol (we were fine until she dented my car door in the parking lot and I chose to file an auto ins. claim. Imagine that.) What I'd heard from a classmate was "Her pt. had tubefeeding and she didn't know what to do." I'm not sure if the instructors felt that she should be beyond asking (which I think is dumb. You don't intimidate people from asking questions) or if she did something dangerous like trying to feed it through an NG before the pt had x-ray confirmation of placement. Or if there were other issues leading up to this.

The other was a student PN who I was precepting, who made a potential med error while the instructor was observing. I think she took regular ASA out when the pt was ordered EC ASA. I told her to check the ASA bottle again to make sure she had the right one; shortly after, her instructor sat her down in the report room and told her she was not passing. I don't know if this had been an ongoing issue for her, if she had been warned in previous clinicals already, or what.

Have you followed up w/ your instructor yet?

kringkring5144 · Apr 20, 2014

Yeah this was the last day of clinical and the only time I had a med error.

I was really bad at it. The sliding scale was for a Humalog insulin; I didn't know I had to go one sliding scale versus another one that didn't have one.

kringkring5144 · Apr 20, 2014

Yes, I followed with up her.

She said will evaluate me this upcoming Wednesday.

Im nervous for my life.

Everyone tells me she seems pretty nice and will only sit me down to make sure I know what I am doing

Other reasons why I probably wont pass is

2 weeks before this she sat me down told me I was not competent and had 2 weeks. She never mentioned failing me since she rambled on about the next 2 semesters and ways I can improve on

The next clinical I felt I did better

I just screwed up on the last day with the medications.

Reasons Ill pass:

Shes is nice and believes in improvement

She has not failed people in clinical for the past semesters

She never mentioned failing me.

She only said she was concerned..

She is trying to evaluate me on my thought process for my final evaluation-so she knows what I need to improve.

This is what I am praying for.