Sick over a mistake I made

[EmilyrenaeRN, BSN]

Hey guys. A few days ago at work I discharged my patient without taking her staples out from her c section. I called the patients midwife the next day to let her know and she wasn’t familiar with the patient but stated that she’d look into it. Now I’m feeling nervous, like what if she forgot?? Or what if she passed it on to someone who forgot? I’m so scared this will fall through the cracks. It’s possible the patient has already called her doctor wondering about the staples, but then what if she didn’t. Should I call the midwife again and make sure it was followed up on? Should I call the patient? I’m just so torn up about this mistake. What should I do??

[JKL33]

Disclaimer: Each of our workplaces have their own culture that will come into play when addressing a situation like this.

In my work area, I would simply do a post-visit "follow up" call with the patient to see how she's doing, then segue into whether she was able to get the staples removed. I would appropriately document the call.

It sounds like you did a reasonable thing once you realized the staples were left in. Your interventions (like calling the PCP/midwife) should be documented neutrally. "Staples intact at time of discharge. Notified ______, CNM, who states she will facilitate removal of staples." This is not a horrible mistake. These things happen and pretending they don't or pretending that they should "never" happen just increases everyone's anxiety and overall makes it more difficult to do the right thing for the patient.

It's also not wrong to do a "follow-up"/post-discharge call with the patient* to see if things are going okay for her; I would do that and then segue into whether or not she was able to get the staples removed. Document call appropriately = neutrally. Be prepared to follow through if it turns out she hasn't been contacted by anyone else and has no idea when/how the staples are getting removed.

*If this is not the norm or would cause peers/mgr to freak out, talk to manager first. "I discharged a patient with staples intact. I let her midwife know. I'd like to do a follow-up call to see how patient is doing and make sure there is a plan for staple removal. Sound good?"

Keep emotions out of it. Do not carry on in front of others (manager, peers, patient) as if things are the end of the world when they aren't - that behavior is irresistible to people who enjoy petty critiquing and will bring you much grief. Be matter of fact and proactive.

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[EmilyrenaeRN, BSN]

Thank you so much for your reply. It makes me feel better. I’ll also do as you suggested and do a follow up with the patient and document it in her chart. Thank you!!

[JKL33]

You are welcome!

(Make sure that whatever calls/accessing the chart you do is in line with what is expected in your particular workplace).

?

[brownbook]

Great advice as usual from JKL33.

These things happen. I worked out patient surgery, and have heard this happens inpatient units also. A patient goes home with their saline lock IV still in. Yes it's an error but it is handled as JKL33 mentioned.

You should have told your charge nurse as soon as you realized it. You wouldn't have had to spend the last few days all torn up.

[EmilyrenaeRN, BSN]

13 minutes ago, JKL33 said:

You are welcome!

(Make sure that whatever calls/accessing the chart you do is in line with what is expected in your particular workplace).

?

You know, now that you mention it, we aren’t really supposed to open a patient’s chart after we stop being that patient’s nurse. Do you have a suggestion on how to go about documenting my call? I feel like this is a special situation that definitely needs to go in the patient’s chart for future reference if needed.

[JKL33]

32 minutes ago, EmilyrenaeRN said:

You know, now that you mention it, we aren’t really supposed to open a patient’s chart after we stop being that patient’s nurse. Do you have a suggestion on how to go about documenting my call? I feel like this is a special situation that definitely needs to go in the patient’s chart for future reference if needed.

Yes: Talk it through with your manager. You will have to open the patient's chart to get the contact information itself - - so ask first and make sure your manager agrees that this is an action they support you in performing. Then, with your phone call documentation, you write like this: "Follow-up call with patient as discussed with ______, RN, Nurse Manager." Then continue with the information from the call like we already talked about.

To be clear: Opening a chart to follow up on this is *NOT* a HIPAA violation, period. But your employer's Privacy Practices and expectations can still mean hot water if they perceive that you weren't abiding by their rules. That's why I advise having your manager's buy-in.

Does that make sense?

[Forest2]

I really wish things to be done would not be ordered right before the patient is to go home. But, in any case, I think you have taken the right steps, If your facility allows follow up calls do that, or call the other professional you mentioned regarding what was previously discussed to see that it was taken care of.

[EmilyrenaeRN, BSN]

Thank you both so much! I have just been sick to my stomach over this. I will speak to my manager about it before I open the chart. I’m glad you mentioned that it’s not a HIPAA violation because I worried about that.

I also which they didn’t have us wait until discharge day to take staples out too! With all the stuff that needs to be done, it’s easy to forget. I think that one factor that contributed to this mistake is that we weren’t sure if this patient was going home or not and when I got the go ahead to discharge her she wanted to leave right then so I got her out the door in like 30 minutes. I also know that I’m not the only one to make this mistake. I’ve spoken to several others who have done the same thing so I know it’s not a rare mistake. (Not an excuse at all of course, just trying to examine the situation surrounding the error to try to identify factors that i can change for myself in the future)

[vampiregirl, BSN, RN]

Unfortunately part of being human is that we make mistakes. Part of our growth as nurses is the actions we take when we realize we made/ contributed to a mistake.

Accepting responsibility is huge. Making the appropriate notifications and putting appropriate interventions into place are also critical steps. You've already got this in process.

Something else you may want to consider is working within your unit to put interventions in place to help prevent this type of oversight in the future. Especially since it doesn't sound like you are the first person that has discharged a patient with staples... this sounds like something that needs to be addressed. This can be as informal as you figuring out some way yourself to prevent this from happening in the future or even making formal recommendations for a process change within your unit.

[TriciaJ, RN]

This is not something to feel sick to your stomach about! Cut yourself a break. If others have made this mistake, then your manager should be well-versed in what to do next. I think your unit should look into decreasing the number of things that should be done right before discharge.

This reminds me of a non-nursing situation. I once had an accupuncturist who would occasionally leave a needle behind in me. One time I got back out to my car, adjusted the rearview mirror and caught my reflection with a big needle sticking out of my forehead. How did she miss that when I was sitting across the table from her writing the cheque? So don't feel too bad about a few C-section staples. ?

[FurBabyMom, MSN, RN]

OR Nurse here...we do some procedures "staged" (ex. part one on day 1, then part two somewhere between days 14-18). Those patients are sent home with staples intact between times. Staples and sutures can stay between discharge and a post op office visit (or subsequent procedure) as long as the patients are able to get help if needed (ex. call clinic, PCP, CNM, etc., for s/s infection, etc. - this would have been in the d/c teaching for a c-section anyways due to risk of SSI). With that said, staples are not aesthetically pleasing or necessarily comfortable...

Several days may not be long enough for adequate wound approximation. Though if this is the routine in your facility - I'm guessing subcutaneous layers are closed with a resorbable suture. There are really worse things which could have happened than sending a patient home with staples.

I would talk to your manager and see what they say. It is acceptable (under HIPAA) to pull up your previous patient's chart to make a revision or addendum - or as appropriate per facility to make a follow up call, audit, etc. Many facilities do have a more strict set of audit rules for access though, so definitely check with your manager. Most of the time, when auditing or making corrections, I left myself a "note" from when I re-accessed the chart delineating why I was in the chart (chart audit, chart correction, etc). Then, if asked, I would not have to guess.