Mistake on orientation..please help

Nurses Medications

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I am in my 7th week of orientation at my new job in ICU. I have a few years of experience but not in ICU. The other day as I was leaving, I gave a med that had been ordered that day, Tylenol Q8. Since it was a new order, the times for which it had been scheduled after the first dose were not moved for 8 hours from the first dose. So I tried to re-time them. However, I didn't notice that the rest of the times for administration had not been adjusted as well. When I gave report to the night nurse, I let her know about the new med but not the timing. The next morning, she tells me that I caused her to make a med error. Due to the fact that I moved only the first dose and not the others, she gave 2 doses Q6 instead of Q8. She said she filed a report about the incident. I felt horribly and have been kicking myself since..my preceptor brushed it off like it wasn't a big deal and said "it's only Tylenol and the patient wasn't harmed" but I am not the kind of person to make these kinds of mistakes and accept them. I can't imagine causing a patient harm as that is the opposite of my reason for becoming a nurse. I strive for excellence especially when it comes to my job.. I hate that that happened while I was orientation too. I have obviously learned from this but I can't seem to move past it. I don't want to lose my new job either..any advice is greatly appreciated..

Specializes in Telemetry, Med-Surg, Peds.
I am in my 7th week of orientation at my new job in ICU. I have a few years of experience but not in ICU. The other day as I was leaving, I gave a med that had been ordered that day, Tylenol Q8. Since it was a new order, the times for which it had been scheduled after the first dose were not moved for 8 hours from the first dose. So I tried to re-time them. However, I didn't notice that the rest of the times for administration had not been adjusted as well. When I gave report to the night nurse, I let her know about the new med but not the timing. The next morning, she tells me that I caused her to make a med error. Due to the fact that I moved only the first dose and not the others, she gave 2 doses Q6 instead of Q8. She said she filed a report about the incident. I felt horribly and have been kicking myself since..my preceptor brushed it off like it wasn't a big deal and said "it's only Tylenol and the patient wasn't harmed" but I am not the kind of person to make these kinds of mistakes and accept them. I can't imagine causing a patient harm as that is the opposite of my reason for becoming a nurse. I strive for excellence especially when it comes to my job.. I hate that that happened while I was orientation too. I have obviously learned from this but I can't seem to move past it. I don't want to lose my new job either..any advice is greatly appreciated..

Someone didn't do their med checks prior to giving the medications, not once, but twice.

It wasn't your fault. The blame lies with the night shift RN.

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Specializes in Med-Surg., LTC,, OB/GYN, L& D,, Office.

It seems a little more detail could help, for instance what dosage was prescribed, regular, tylenol or with codeine, was it a straight order or a prn order, (which would affect how and where administration is recorded/documented.) Additionally, if there is a question as to the adm. time and or dosing does your facility pharmacy have input or overview? These are just a few things to note ahead of what action the following shift took to read question or correct the order. i agree the best outcome at this stage is no harm LUCKILY befell the patient.

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Well, that's a bummer. You didn't reschedule right and she didn't pay attention. I'm sure you'll be more careful when reschuduling meds and she'll be more careful looking over last doses and such...But if Tylenol x2 doses q6 vs q8 is the worst thing that ever happens than count your lucky stars. There are worse things. Important to be correct in what you do, but it was an honest mistake and at the end of the day a sandbox order. Don't waste too much energy beating yourself up. You'll be more careful from now on and no harm done.

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lol this is completely her fault! Don't worry, you didn't do anything wrong. Get a good night's sleep.

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Specializes in SICU, trauma, neuro.

She didn't do her 5 Rights (or however many rights we're up to now.... but in any case this could have been prevented by doing her "classic" 5 Rights.) She made the error all by herself.

I have seen Epic do some crazy things, such as not changing the future default times after I re-timed the 1st dose, or even reverting to default times EVEN AFTER the PharmD has the 1st dose timed to be given right away.

Yes, an incident report is probably warranted, because if something like the above happened it's in part a systems issue. Said incident report should have been submitted by the one making/catching the error, however.

For your part, let this be a lesson:

1) it's a good idea to check the future times, knowing that it has been am issue, and

2) don't allow yourself to become blindly obedient to the computer, as this RN did

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It was scheduled regular Tylenol 325mg Q8. They were starting with a small dose initially..

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Specializes in Practice educator.

This is not on you. The other nurse is trying to take the blame off herself.

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Oh boy, stay away from THAT nurse. There is NO way she can blame her timing on you.

She can do math.. but failed this time.

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I can't wrap my mind around the fact that an ICU nurse went through the trouble of "writing up" a Tylenol dose that was given two hours early.

Maybe she is a good, contentious nurse, and realizes that the punitive implications of the term "write up" are wrong, and she sees an opportunity for process improvement. Maybe she realizes that the same process that allowed this no-harm error could repeat itself with negative outcomes. Maybe the rsult of this will be that next time, the computer will automatically adjust the timing of the next dose.

Probably not, but wouldn't it be nice?

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Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.

They way our Epic is set up, if the nurse moves a single dose, other scheduled doses won't be retimed accordingly, no matter what the order says.

If ALL subsequent doses need to be changed, we have to send a message to pharmacy (by clicking the message button on the associated med in the MAR) asking them to adjust the times, and telling them what we need the times adjusted to.

If someone has daily/maintenance meds, we have set times that those are automatically scheduled for in our system. If I don't give someone their 0600 Protonix because they are NPO for a procedure, I can move (one time) that dose to 1100 when they'll be back from their stress test/EGD/whatever, and the next day's dose will still show as due at 0600 on the MAR. However, if the patient is a night owl like me and will never wake before 1100, I can message the pharmacy to adjust the entire dosing schedule to always have Protonix due at 1100. That's the difference between "moving" a med or "adjusting times" on a med in our Epic.

Similarly, most people take their "once a day" meds in the morning, so our system automatically schedules "daily" meds to be given at 0830 (other than things like Protonix or Synthroid that they prefer to give on an empty stomach -- those are 0600 meds). Some patients take their daily meds at dinnertime or bedtime or lunchtime or whatever. If I just moved the patient's dose to from 0830 to 1200, that's only going to move today's dose. If I want them all rescheduled for noon going forward, I have to message pharmacy and let them know to adjust the time accordingly.

Related but a bit different, I had a patient with Lasix ordered Q8H, and our system scheduled it for 0600, 1400, and 2200... when the heck was the patient supposed to get any sleep??? First I had to get the doctor to change the order to TID, then I had to send pharmacy a message asking them to time the med for 0600, 1200, and 1800. Pharmacy could change the times -- but not the time between doses -- because it was ordered Q8H, but with it changed to TID that gave them some leeway to do three Q6H doses and then nothing for 12 hours. This is one of those common sense things... obviously it's not reasonable to give three doses of Lasix an hour apart from each other (makes my kidneys hurt to even think of it!), but spreading them six hours apart and then letting the patient sleep overnight is totally reasonable.

If it's something that has a standard/typical time it would be given (like our BID Lasix is automatically 0600 and 1800), sometimes you just need to finagle things a bit on admission day or the first day a new med is ordered to even things out (common sense-wise) until they line up with the regular dosing system the next day. I work nights and I'm a big believer in sleep hygiene, so I'll sometimes spread-out or squeeze-in some doses in order to consolidate med passes and reduce the number of times a patient is woken up. I had a patient last night with 2030 regular HS meds, 2100 Neurontin, and 2200 heparin (our normal heparin time), then 0500 Neurontin and 0600 heparin (our standard heparin time). Needless to say, she got all the evening meds together, and in the morning she got the Neurontin and heparin together. Had she not been discharging, I would have sent a message to pharmacy to change the Neurontin to the same time as the heparin for every subsequent dose -- it just makes sense.

So in the future, if something needs to be totally readjusted for all future doses, make sure your preceptor shows you how to do that in your MAR. But I still don't think you need to be stressing over this, and there is NO way that you caused the other nurse to give TWO doses Q6H -- only ONE would have been off, and every dose after that one would have been Q8H already on the MAR.

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The order said Q8, the nurse gave the first dose an hour or so later than she should've, but continued with the 3 am dose despite the order of Q8. That's on her, not you.

I have a suspicion that the night nurse has a history of med errors. Trying to blame THIS one (if it was one) on the newbie.

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Specializes in Nephrology, Cardiology, ER, ICU.

MOved to career advice

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