I need some advice. I made a big med error today and I don't know what to do. I can't put into words the way I feel right now. So afraid, ashamed, embarrassed, discouraged. Here is what happened. I'm giving other information NOT because it is an excuse for me making such a blatant mistake, but just to give some insight into how I feel. Even before this, I've been feeling like I'm just not cut out to be on such a hectic unit. I know all nurses have hectic jobs but our floor is one that all float nurses and nurse assistants say they hate and tell me "good luck" once I tell them I'm a new RN on the floor. The other nurses are really great, its just so fast paced, its an ICU step down and in one day you can get several admissions and discharges. Even before today I felt like I was struggling just to keep my head above water. I had two months of orientation but looking back it was kind of like having a team mate to do the work with, so I didn't learn things from the perspective of a nurse working solo.
But Today I did the worst thing. I messed up, it was no ones fault but my own. Basically a patient was ordered to switch to a Lasix drip. When I started the drip, I entered the intended ml/hr into the mcg/kg/hr. I looked at the orders in the computer and remember thinking "double check" - and I **thought** that I had. The patient showed no signs of distress, and only when the bag was empty 3 hours later and I called for another and pharmacy said I had enough for the next shift did I realize that the drip was going at THREE TIMES the intended dose. My heart stopped and immediately I felt this feeling of doom. I immediately checked the patients' vitals, which were fine thank god then told the charge nurse. She (rightfully) freaked out and asked why I didn't have someone double check the rate. I thought we only needed certain drips checked and honestly did not realize. I called the doctor to let him know and filled out an incident report with the charge nurse. She said I was unsafe with patients and after this, I agree with her! I was under the impression I would be fired and was worried about my license. I have not been able to sleep or eat since this happened. I just found out that the patient has been fine in the last 12 hours since this happened and that he is okay. I am SO SO SO thankful that the patient is okay but just feel like such an idiot. I feel like I've worked so hard to become a nurse and apparently I'm not cut out for it. I'll be meeting with the supervisor, manager, and charge nurse in a couple of days (which I'm already so scared for and dredding) but am scheduled to work before then. I'm new and I honestly doubted that I even had a job after this, so when one of the other nurse managers emailed me telling me everything with the patient was fine and that she would see me for my regular shift on Monday I was surprised.
I'm scared to go back. I'm not only devastated to have made such a blatant and terrible mistake that could have been life altering for that patient, but I'm doubting my future and career as a nurse. Before this, my patients and colleges have had good things to say about me but now I feel like I'll always be known for this. I feel like i'll be walking around with a big X on my head. I could my patient serious harm! I honestly feel like resigning, but feel a weird mixture of having just disappointed everyone and yet like I would disappoint them more if I express interest in moving to a different unit with a slower pace. I just want to crawl into a hole. Help.
Uhm, it's just lasix. You aren't going to kill anybody with lasix. Relax. It isn't as if you overdosed them with IV digoxin. Don't make a mountain out of a molehill.
You can drop someone's blood pressure and potassium very quickly with lasix. I would re-visit the side effects of lasix before you give it again. To the OP, mistakes happen. Own them. Learn from them. Move forward in a positive direction.
As noted above, there is not one nurse who can honestly say they are 100% perfect 100% of the time.
Now onto your meeting:
"I made an error, I have a full understanding and have reflected on my error. My goal is safe and effective patient care. To prevent errors in the future, I will make use of my resources to ensure safe medication administration. Beyond the rights of medication administration, I will be sure to read the pharmacy label on the IV bag, against the order, double check the correct dosage in the IV medication book, and have a senior nurse check my pump settings."
They may (and should) have a timelined improvement plan for you. Something along the lines of getting your IV meds checked over a period of time for accuracy. If that is the case, be sure to have ready the order, don't spike the bag until the nurse is present, look at the label, recite the mg/kg or hourly rate or whatever it is that you need to do. Set the pump, have the nurse observe, THEN press "go".
There will be in your career IV meds that you will get to know off the top of your head, and others not so much. And IV Lasix given as drip is not typical, therefore, there's many of us who would have to look it up. Just be sure when you look it up, if it needs clarification, get it. If the order was written mg/kg and that is not how it is to be administered (and your pharmacist is a great resource) clarify!!
Do not get caught up in the emotional aspect of this meeting. Then you could revert to making excuses and elaborating due to feeling defensive. Just don't do that. We all know you feel horrible. But now is time to think about moving forward.
You did the right thing by telling your charge nurse and filling out an incident report. We are human, and make mistakes. Learn from it! Then move on. You can only change the future, not the past
OK... calm down. Really, sweetie, calm down. The patient is fine and yes, most patients survive our first years of nursing practice.
Ok...listen. You may have not heard the last of this. Just go in and face the music. Don't make excuses. But do not let this make your fearful or doubt yourself.
Guess what? Not ONE nurse your work with has never made a mistake. They all have at least one mistake on their minds. So don't think you're some kind of freak.
Next...rest assured you'll never make THAT mistake again.
Lastly...this won't be your last mistake. I have over 36 years of experience and have had my own share. But I have learned to greatly minimize the probability of making one. This can be done by following JACHO rules and following all policies and procedures all the time.
Don't freak out. Everyone makes mistakes. The good think about making a mistake it that it is extremely unlikely you will ever make the same mistake again.
This is one of the reasons there has been so much talk and effort to make nurses more willing to report mistakes and med errors. Your charge nurse should have responded more calmly. My first question would have been to the patient's status. THAT is a reason to freak out. I didn't see you mentioning you're a new grad in your original post, but the charge should have realized her position to provide an example for you by staying calm and assessing the situation.
But forgive me for displacing blame here. The error was still made by you. However, it's common. I've made a few on the hospital floor and you did the RIGHT thing by admitting it. When you have a meeting with your supervisors and directors, I can't stress transparency enough. You will not benefit yourself by attempting to CYA with less than the total truth. Stress that you were scared for your patient, aware of the gravity of the error and now realize the importance for double checks.
And in the end, if you get written up, get placed on a different unit with less acuity or if even if they dismiss you - keep breathing. It won't necessarily keep you from ever working again. I anticipate, based on what happened for me, is that you'll get a verbal warning or a write up and be a little skittish for quite a while.
Please do NOT doubt yourself. The thoughts you think about yourself, regardless if true, are a self-fulfilling prophecy. If this were football I'd give you a smack on the butt and tell you to get back out there.
Specializes in ICU, Telemetry, Cardiac/Renal, Ortho,FNP.
Yeah, I'd agree. You admitted it and that's that. I think all of us have come close to making similar mistakes. I've caught myself overriding the MAR on the wrong patient before I realized "it ain't the computer stupid!"...forgot to titrate my cardiac drips, etc. I can't tell you how many times I've caught night shift forgetting to unclamp an IVPB med. when I came on shift in the morning...they were just tired. Can happen to anybody and does. Don't beat yourself up. I work in ICU/IMC with a lot of CHF patients, too, and I can't remember putting a pt. on lasix drip...IV push (all sorts of doses) but not a drip. Anyway, I'd be more worried about it working at all vs. how much I gave. Double check from now on and move on. You are a good nurse b/c you understood your mistake and admitted it. The dangerous ones don't know and don't care.
kate4rn
15 Posts
You can drop someone's blood pressure and potassium very quickly with lasix. I would re-visit the side effects of lasix before you give it again. To the OP, mistakes happen. Own them. Learn from them. Move forward in a positive direction.