Placed a narcotic in a sharps bin before scanning it.

[coldcore]

Hey,

So I am a relatively new nurse, I am just about to hit 1 year experience. I have also just had my first experience with a potential med error. To give some background, today at work was a very busy day, our facility has a tendency of discharging everyone in a day and then getting 6 admissions within an hour usually during change of shift from the ED when there are only 4 RNs on the tele floor I work on, I ended up with 2 admissions within one hour one of those had just arrived while this error was made. So needless to say I was stressed and trying to keep from drowning during this period of time, not an excuse but an understanding of my mistake and an understanding of needing to slow down in those moments especially for situations like that.

With that out of the way my patient was requesting some dilaudid, went and got it, found someone to waste, grabbed the IV potassium she also needed. This patient also experienced anxiety about her IV becoming infected and I made sure to diligently keep sterile technique while dealing with her. So during this process while trying to flush her IV, start the potassium and fumble around with a few things in my hands somehow I manged to scan the potassium but forget to scan the pain med. Gave her the correct dose of narcotic but disposed of the empty container into the sharps container before scanning. I only realized this error maybe two hours later, went back noticed when I scanned the potassium and did a scan override of the bar code correctly documenting the time this was given. My concern is this is going to result in some form of discipline even up to termination for doing a scan override.

However I feel I used the override in a correct manor, I remember exactly what happened, I know where that container is, the barcode is in fact unreadable as I cant get to it in its resting place within the sharps container. I know this is probably unreasonable to suggest but if they want to investigate if we cracked that container open, I have no doubt all would be accounted for. I do also know that this does not look good upon myself if someone digs into the documentation. This is the first time something like this has happened to me, I dont have a track record of issues with med documentation, do you believe something will come of this and does anyone have advice or experience in this matter?

[Guest219794]

First advice- Scan first. That is the whole point of scanning- To catch and prevent actual errors. Had you bypassed that safety mechanism and given something harmful to the PT, this would be a very different thread.

This should not be a big deal. Since there is no over ride choice "accidentally chucked vial". you picked the best one. And, it is technically correct.

Nobody diverts narcotics by not scanning the empty vial. It would be the single stupidest thing to do if you had mixed your self a Dilaudid and Coke.

Choice #1- Drop your boss a note. You will feel better. Your boss will not freak out. For sure nobody diverts by not scanning, then tells the boss.

Choice #2- Don't stress, use it as a learning experience to scan before administering, and move on. If the subject comes up, tell the truth. In telling the truth, skip the all the details. Take full responsibility, and explain what you learned.

This is a great kind of mistake to learn from. No harm.

You can't avoid all human errors, but you can choose what you learn from them.

[Emergent, RN]

Lots of people have done this accidentally with narcotics after wasting. You waste in the med room and chuck the vial in the sharps. Whoops!

An occasional incident doesn't raise an alarm unless an employer is looking for reasons. You sound very conscientious and are probably a valued employee.

[JKL33]

7 hours ago, coldcore said:

So needless to say I was stressed and trying to keep from drowning during this period of time, not an excuse but an understanding of my mistake and an understanding of needing to slow down in those moments especially for situations like that.

Exactly right. Don't be pressured by fake emergencies. That is perhaps the #1 lesson here. The whole place could burn down and someone will be sure to claim that there's "no excuse" because RN.

Perform medication administration the same way each time as much as possible. Always do the 5 Rights (as it sounds like you did) at the usual checkpoints. Then the scanning piece for the final check to confirm what you have already manually confirmed.

7 hours ago, coldcore said:

However I feel I used the override in a correct manor

Agreed. (Correct manner).

1 hour ago, hherrn said:

If the subject comes up, tell the truth. In telling the truth, skip the all the details.

Important.

OP, whether you choose to proactively discuss this or wait to see if it comes up, maintain a matter-of-fact, professional demeanor and choose your words carefully. Stick to the bare facts, which are simply that during the medication administration process you disposed of the Dilaudid vial before realizing it hadn't been scanned. You took the proper steps to see that it was accurately documented as soon as you noticed. Do not refer to this a "potential med error."

I will say this with some reservation, because it is dependent upon individual personalities and settings - - I would tend to favor the proactive approach. It allows an issue to be framed before others can become hypercritical/hysterical. It shows that you aren't trying to hide anything and that you care about doing things right. In this case it also takes on additional significance because you don't appear to be hiding/avoiding something that has to do with a controlled substance. If this were zofran I'd say let it go. The proactive approach (or any discussion of this, for that matter) works best if someone can be matter-of-fact and limit words and especially emotional displays.

Take care ~

[Jory, MSN, APRN, CNM]

Unless it's an emergency, scan overrides are NEVER necessary. This is a bad practice and in my hospital, will get you a verbal, first written, second written, and termination.

What if your patient had been allergic to the pain med?

Your problem is less about the pain med that got tossed in the sharps bin (they can be retrieved) and more about you did an unnecessary override that compromised patient safety.

Unless someone is screaming to the top of their lungs with 15/10 pain...overriding a pain med is never necessary.

[nursebert, MSN]

Oh, you poor thing. I did this more than once especially since I have been a nurse for 23 years and had never used bar coding scanning until 4 years ago. My colleague was able to get the discarded dilaudid vial out of the sharps with a coathanger. Actually a few coworkers were very skilled with extraction techniques. Not advocating for or against...disperate times call for desperate measures. Hope you will be ok.

[nursebert, MSN]

Actually, the robotic point ,scan, and administer technique has greatly discouraged the critical thinking process related to giving meds in my opinion. I have noticed this in nurses who never given meds pre BCMA. I still have the same process ;the right patient, dose, etc. but I also think about if this med is appropriate and a safe dosage and many other thoughts that occur in my mind simultaneously before I ever use the scanner. So, yeah, the scanner adds another step for me