OrthoRN20

Our morphine is single dose vial (2mg) but dilaudid is not and must be wasted at the Pyxis before being taken to the room. My intention was to give PRN dilaudid to the patient who was reporting severe pain after physical therapy. My stupid way at the time of differentiating them was one is already diluted and in a flush with the empty vial (the rest wasted in the trash with another RN) in one pocket, one is a one-dose vial undrawn. In my mind I thought “go to severe pain room first, then scheduled morphine room after”. When I got to the room I scanned the correct medication, assisted pt back to bed with physical therapy, took their blood pressure, and drew up the morphine to give. I should have never pulled both to begin with but I never thought I would be dumb enough to confuse them and should not have taken up any tasks in between. Upon partial administration of the wrong medication I stopped, assessed the patient, and called the doctor. I wasted the rest of the unadministered dilaudid with my charge RN and wrote an incident report because at this point I would have to pull another scheduled morphine for the patient who needed it but only scan one. We give a lot of pain medication on my floor (up to every hour for multiple patients) and it’s the only place I have ever worked. I honestly think I became overly confident and a little desensitized. This has been a major wake up call.

I deeply appreciate your response. So much of what you said assisted me in identifying my own faults, and you did it kindly. I think a lot of it is pride. I was a CNA and am one of those nurses that got into the business of nursing with the goal of “helping people”. I have been repeatedly disappointed by my inability to do it all. Already I have started pulling narcotics individually and saying NO to anything that stands between me and the patient room. I am better utilizing my ancillary staff and it feels wholly unnatural to me which is a big red flag. But overall I feel clearer. No longer is it “water for 6, narc for 3, walk for 2” now it’s “narc for 3, enlist help”. And it has actually increased my productivity. I have a lot of fears surrounding being disliked by my coworkers or viewed as lazy. But this supposed self sacrificial attitude has done nothing but put me further behind and made me unsafe. I think I will evaluate my improvement and check in with my manager in a couple weeks. If I’m still experiencing work performance issues I’ll talk to my OB about light duty.

I’ve never come across this before. Is the method of carrying the medication because of infection control, or diversion? Every nurse I work with will usually pull their meds including pain medication, place them into a med cup or two, and into either a scrub pocket or jacket pocket. This frees your hands for other supplies as many of us do our morning assessment with the first med pass.

Feeling really frustrated and unsure what to do. I made my first medication error in the 4 years I’ve worked as a nurse last month. I work on a busy surgical/medical floor and in this specific case I had four patients that all needed pain meds every other hour. I pulled dilaudid and morphine and administered the morphine to the wrong patient. I am 20 weeks pregnant pregnant and have been dealing with brain fog. Under normal circumstances, I would have the morphine still packaged in one pocket with the dilaudid diluted, wasted, and labeled in the other. For some reason I scanned the appropriate med (dilaudid), then drew up and administered the morphine. I reported my mistake immediately, monitored the patient condition, and fortunately it didn’t cause harm. But still it really terrified me. I am no longer pulling any medications for separate patients at the same time. I know this is best practice but under normal circumstances I am extremely adept at prioritizing. Well about three weeks later a medication fell out of my pocket on the way to someone’s room and I enlisted a bunch of help to find it. It was found a few minutes later but I definitely was a bit of an emotional reck over it. My manager called me in to tell me she “overheard what happened” and I need to slow down and protect my license. I didn’t defend myself or make excuses. But I’m honestly really upset at being told to “slow down and protect myself” when I have already been very honest about how challenging my assignments have been. Combative patients, isolations that I have to try and trade last minute, 3 discharges followed by 3 admissions, critical staffing issues, it’s not easy to prioritize for anyone let alone someone who expressly stated they are trying to keep up. It feels like because I don’t waddle around complaining they didn’t know I was pregnant and treated me like “normal”. That being the nurse who started charging a year out of school and kicks *** at patient care. But I’m not myself right now. I feel frustrated that I’m slow and forgetful and that it seems like I’m invincible to management until I mess up. It annoys me that they are “concerned” about my errors “so close together” but not the shift where I just team lead short two nurses with a 3 patient assignment, pregnant, with a code? It’s my own fault I guess for speaking up about my brain fog because all it did was put a target on my back. I had my last baby at 37 weeks, precipitously in 3 hours. Im sure some of that had to do with working my butt off until three days before she was born. Im almost considering asking my OB for light duty to “protect my license” since apparently I am such a hazard. Optimally I would transfer to preop or PACU but no one is going to take me on 4 months before I take leave. I know that’s probably just the emotions talking but I’m really tired. The patients are sicker and more confused than ever and it’s only going to get worse with flu season.