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Discussion

Some advice, please....

I am a home health nurse, and have no experience whatsoever as far as large med passes go. I recently applied to, and was accepted at, a LTC facility here where I live.

I worked there for a short amount of time before I made a med error, specifically with Vimpat. It was a drug I'd never heard of before, and honestly, I was in over my head. Hind sight is 20/20, and I can say with 100% certainty that I should have handed over my keys and informed my supervisor that I would be unable to complete that shift's med pass - as I was filling in for days after already completing my night shift.

Not to make excuses, but I still was not completely familiar with the residents, and I was also using a new electronic charting tool that I had never used before. To make a long story short, I was supposed to give Vimpat to two different residents, but did not. To make matters worse, I charted not documented for one dose, then charted documented for another. I did not realize the full scope of my error until my supervisor called me that night while orientating with another nurse on a different floor to inform me of my error. It scared the crap out of me! But I was determined to learn from my mistake and learn as much as possible to prevent another mistake from happening again.

However, today, I made another mistake - I gave a double dose of Xanax to a resident. To be honest, I'm scared, ashamed, embarrassed, and concerned about the effects the double dose will have on the resident. The DON called this afternoon and spoke with me, and let me know that I would have to be let go, and I completely understand. On top of that, I'm mortified that I was not more proactive in making sure that I did everything to prevent something like this from happening. And I'm scared, also, that I won't be able to 'bounce back' from my mistakes.

I love nursing, always wanted to be a nurse, but I'm afraid that if I can't be the quality kind of nurse that is expected of me, then I shouldn't even bother going back to find another job. Where do I go from here?? I feel lost and a little hopeless to boot. I want to grow as a nurse, as well as a person, but I'm afraid I won't get another chance, and I'm also afraid to ask for another one. All in all, I'm very emotional about the whole situation. I don't see myself getting over this any time soon, not to mention that I'm really not sure how. ANY advice would be helpful. Thanks in advance...

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    I too am a home health nurse with no facility experience. As I read your post I could just imagine this happening to me! It must have been very scary for you. First of all they shouldn't have had you do the day shift after working all night - I know that I wouldn't be able to handle that. It's really so easy to make a mistake, just learn from it, and it will help you in the long run. I give you Kudos for landing a job in a facility, just know that this happens quite a bit, I'm sure. Don't let it stop you, just move on.

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    I am so sorry. Big Hugs!! LTC is a hard job for you nurses, and the med passes can be a nightmare and can be hard to get use to it. You sound like you are a caring and compassionate nurse though. would it be possible to try to get your job back at the home care? You could explain to them that the enviroment was not the right fit for you, and that you felt like you were over your head there but would like to come back. Maybe they will receive you back with open arms. Especially if you left there on good terms, and as a good nurse for them.

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    One of our pool RN's just made the exact same med error.He documented "not available" and rolled through the shift.He discovered at shift change that it was right there in the narc drawer all along. He also didn't bother to call the pharmacy for a refill since he assumed the resident was out of it. Med pass in LTC can be daunting. Narcs are frequently an issue.DON"T RUSH through the narc count at the start of your shift. Pay attention to any unfamiliar med and also any resident who has multiple dosages of the same med or several meds. I always encourage orientees to look through the EMR during each resident's med pass and pull the narcs,liquids,powders,eye drops,first before the rest of the pills. Also,check the narc book immediately upon completion of the med pass,if you see a med that has been signed off every day that's a big clue that you missed something.You can save yourself from an error and give it.As for a double does of Xanax,it's likely the resident had the best day they have had in a while,probably has been on it forever and barely fazed them BUT-remember the RIGHTS and follow them,DOUBLE and TRIPLE check everything especially narcs and insulin and stuff....Bottom line,mistakes happen,we learn from them,don't beat yourself up.The nurse who claims she never made a med error is not telling the truth-or it wasn't caught.

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