Preceptee medication error

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Hi Everyone,

So I have a question regarding an error that was made last week. I am a new grad, been working on a Telemetry floor for about 8 months now. I have just started precepting, which is a huge honor to be asked, although I'm still quite new myself. Anyways, I was orienting a new grad who has been on our floor for a few weeks now. We are encouraged to try to give them some freedom so they can learn, but also be there as a resource. She went into a room to hang an antibiotic for a patient who had quite a few things running at the time. I'm a bit of a stickler for this, so I labeled all the lines to make sure there wasn't any confusion. As she programmed the antibiotic into the pump, I was in and out of the room and doing other small tasks while there, and did not see her program the pump. The antibiotic was hung, we left. A little later, I heard the iv pump beeping sooner than it should have been finished. I went in, and the antibiotic had been entirely infused over about 45 mins rather than 4 hrs! I spoke to my charge nurse and pharmacy about this, who said that this antibiotic can be run over that timeframe, the frequency just has to be changed from q4hrs to q6hrs. Basically, they said not a concern! I still feel horrible about it, and I filled out an incident report regarding it. In the report I filled out, I didn't want to throw my orientee under the bus, but it may have inadvertently made me look more responsible. I'm just concerned about how this reflects on me by my manager, and how to do a better job of striking that balance between safety and freedom for orientees. Advice, thoughts?? Thanks!

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Was it Zosyn? If so, we used to run it over 30 minutes all the time. Now that you know of a "weakness" your preceptee has, make sure to check up on her programing until she's ready to leave the nest. Nobody needs to be "thrown under the bus" for this, and you'll make yourself look worse than her if you try to turn this into a huge issue.

A little freedom is OK, just stay on top of the high-risk stuff and make sure she knows (and is willing) to ask questions if she's not 100% sure about anything.

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Thank you so much for your thoughts! As a new grad, I'm not sure how big of a deal to make about these things, so I appreciate your response! And yes, it was Zosyn ;)

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Ugh that darn Zosyn! That is a med that we give either in 30 min or over 4 hours. It all depends on the ordering MD, the pharmacist, or the patient. You only know which time length requested IF the pharmacy staff label the IV bag correctly based on whichever preference is followed that day. It's absurd and causes so many "errors". Our IV pump have both times programed and they look very similar in the pumps so if you are in a hurry you can pick the wrong time.

In the future just double check all IV meds.

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Specializes in M/S, LTC, Corrections, PDN & drug rehab.

I'm trying to remember but I can't remember what dosage of Zosyn runs fast. Fourty five minutes doesn't seem too fast for it.

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Specializes in Med/Surge, Psych, LTC, Home Health.

We typically give 3.375 of Zosyn and run it over 3-4 hours. I think

that's about the lowest dose given.

And I too remember when it used to be given over 30 minutes!

OP: don't beat yourself up so much. You are trying to give your

orientee some freedom. That's fine. Now that you see that they

made this mistake, next time when hanging IV antibiotics, make sure

to go with them and make sure they are doing it correctly. Then

hopefully they won't make this mistake again!

Do you all not have the pumps that you just type in the name of

the drug, and the pump automatically programs in the correct

time and rate and all of that, for you?

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Specializes in Neuro, Telemetry.

4.5g zosyn is a loading dose to run over 30 minutes. 3.75g zosyn is the regular order for 4 hour run times. It's meant to be infused that in part because it helps prevent c.diff as well as keeps the therapeutic level of the med constant instead of the blood levels going up and down all day.

One dose programmed wrong is unlikely to harm the patient. Heck, some hospitals still run it over 30 mins as a standard. Try not to worry about it.

This is the trouble with new grads orienting/precepting people. Not enough experience to know what's important to care about and what to look for in their orienteers. I would imagine management feels you are doing well and that is why they asked you to precept. That's good.

What you can learn from this is that while you want to give your preceptee some freedom to learn, it needs to be in a safe environment. You have to double check everything they do until they are proficient in it.

I let my new grad do her thing. I follow her along for some things she is still learning and let her do other things by herself. I check her charting periodically to keep her on track. But everything she does, whether with or without me, I double check. If she goes in to med pass and assess, I go in a bit after while she's charting to check the pump or assess as well.i always just let the patient know that my preceptee is new to our hospital so I am just making sure everything is right while she learns the ropes. I don't tell them she's a new nurse because I don't want them to lose confidence in her or question things, but they at least know someone is around to make sure things are getting done right.

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Specializes in Medical-Surgical/Float Pool/Stepdown.
I'm trying to remember but I can't remember what dosage of Zosyn runs fast. Fourty five minutes doesn't seem too fast for it.

Our largest bags are 4.5g in 100cc ran over 30 minutes for adults. I've never seen an order for zosyn to be ran for any longer at my hospital.

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Specializes in Adult and pediatric emergency and critical care.

Not to be a jerk but you yourself are still a new grad and shouldn't be orienting others, and your management should not have put you in that position. It should reflect poorly on them that they expected such from you.

We give zosyn over 30 minutes in the ED and Pre-OP, over 4 hours everywhere else in the hospital; this is regardless of if it is being as a first dose or maintenance or if we are given 4.5 grams to an adult or weight based dosing to an infant. We also have a long list of antibiotics we push over 3-5 minutes that are given over much longer durations elsewhere in the hospital. In theory you are sparing more of the toxic effects, especially for the kidneys, by increasing the time it is given over and therefore lowering the peak levels it reaches while also maintaining therapeutic dosing. If you have a dedicated IV with compatible infusions this is great, especially if you are maintaining a therapeutic dose rather than giving their first dose, however if you are giving multiple incompatible meds this can start to become a problem.

I've had orientees who I'm basically just teaching how to chart in our system, and those whom I'm actively trying to keep from killing patients. Trying to figure out which is which is part of the difficulty of precepting and why I don't personally enjoy it. This is something you and your preceptee can learn from, and make sure doesn't happen again.

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Not gonna lie, I am a bit concerned that you're precepting with only 8 months under your belt. You're still learning, and now you have to teach too? I commend you for taking the task, and if you feel you can handle it, you can add precepting to your list of accomplishments!

As for the antibiotic, it looks like you've taken the necessary steps by telling your charge nurse and asking the pharmacist. Yes, it's a medication error, but at the end of the day, the patient was not harmed, and they got their antibiotic. Good, the infection is still being fought. I would just double check behind your preceptee a few times with IV medications, especially if it's something that NEEDS to be administered safely, like heparin or dobutamine. When you and your preceptee feel comfortable, give her a bit more freedom.

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Specializes in Psych ICU, addictions.

You questioned about whether to make a big deal of this...well, medication errors can harm or kill people. This time, it was Zosyn so all three of you (you, preceptee, the patient) got lucky. What if it was potassium? Or another medication where how fast it's administered can make the difference between safely and harmful?

With all due respect, OP, 8 months' of experience is not sufficient enough for someone precepting a new grad. You are still mastering the ropes of nursing yourself--how can you possibly be teaching a new grad what you are still learning yourself? While it does show that management thinks highly enough of you to do this, that doesn't necessarily mean it's the best thing for you to be doing, you know?

You need to be fully there for your preceptee. This is especially true if you just started precepting, because you don't know what your preceptee is capable of yet. This means not letting her program a pump and run it without you checking everything first. Those little tasks you were doing should have waited until the pump was taken care of. And once you have verified for herself that she is competent in a skill--and that may take 1 demonstration or 100 demonstrations--then you can back off and let her do it on her own.

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Specializes in ICU.

I also feel that 8 months of experience is not enough time to be precepting a new grad. I completely respect your decision to do it, and I do understand where you're coming from in being honored that they asked. But they really are setting you up for failure at this point in your career. At 8 months in you do not yet have a full command of what to do in all situations. You are still refining your own flow and practice. Be cautious because any place that asks you to precept at 8 months probably does not have your best interests in mind.

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