Medication Error(s) & Termination

[amalay, MSN, RN]

Hi, I'm a pediatric nurse practitioner that recently started a new job at a school-based health center and I'm about 5 months into the job. The clinic that I "took over" from previous NPs was always missing basic things like gloves, white copy paper, and cabinets were filled to the brim with expired point-of-care tests (ie: rapid strep kits, ua/culture tubes), needles, medications, etc. I have been trying very hard to get this clinic back up to par, and made a full Excel sheet of inventory and expiration dates for all meds and lab supplies.

The other day I found that our "private stock" (non VFC or federally funded vaccines) had plenty of expired vaccines, so I pulled them out of the fridge and freezer(s) to be thrown away. The vaccine had been expired since 5/2016 and I started my position in 12/2016. So why the vaccine was still even there was beyond me. What were the previous MA's and NP's doing?? However, my medical assistant had inadvertently placed the expired MMR back into the freezer AND onto the VFC shelf.

I didn't know this until I had jumped in to help with giving vaccines on a busy, under-staffed afternoon (I only had that one MA with me) and gave the expired MMR vaccine to an infant because STUPID me missed the double check on the vials before drawing them up. Usually I re-verify all vaccines, but since I had just done all the inventory just 4 hours earlier and knew there shouldn't be any more expired vaccines in the freezer, I didn't recheck. Which is still my own fault.

Not only this mistake though, an incident report regarding vaccine errors has been filed 4 times in the past 5 months for my clinic. First I had ordered an extra flu shot on an 18-year old because I missed that he had already gotten the flu shot this season (we have to look on our EMR and on a paper copies of vaccine records to piece it together, because they don't enter all vaccines into the EMR at this place). The second time, one of my medical assistants had given an incorrect vaccine because they went off a verbal order of mine but had grabbed a wrong vaccine and gave it WITHOUT looking at the order in the computer OR verifying the vaccine with me. The third time one of my newer medical assistants discovered she stuck herself with a needle after giving vaccines and had to go through the entire needlestick injury report/protocol.

But as the NP at the clinic, I feel responsible for all of the issues that has happened-- and I'm afraid that in the end, that is what my clinic manager and administrators will see too and fire me. My clinic manager was supposed to have come in to do an in-service with our clinic after the 2nd vaccine error but it never happened because she "got too busy". In your experience, do you think I can be terminated ("3 strikes you're out")?

[RiskManager]

Can you be terminated? Absolutely. Are you likely to be terminated because of this? Probably not. RiskManager would however be paying you and your staff a visit to talk about proper medication administration and how meds should be managed. Were I in your shoes, I would be asking the clinic manager and/or administration for some assistance with training and organization. Some careful thought should be given to a root cause analysis as to why these things are happening, and what systems can you put in place to minimize the chance of them happening again. If I am working with a clinic and they continue to have problems despite adequate intervention and process redesign, that is when I get a frowny face and start looking deeper into what staff dynamics are contributing to the problem. I empathize with the reality of a busy ambulatory clinic, but we need to make time for the 5, 6, or 7 rights of medication administration to avoid these errors (pick the number of medication rights that corresponds with your era of training).