Staying Honest...?

[LibraNurse27, BSN, RN]

Hi all, I follow an account on Instagram called nurselifern, and they recently did a poll about how many nurses have made an error (almost all!), and then out of those how many reported. I was surprised to see that about 1/3 of those who made an error didn't report it. I admit I've been tempted when the error seemed inconsequential, but my guilt always catches up to me quickly. Most recently, when I was prepping a pt for cataract surgery I started to put the eye drops in the wrong eye!

I had only put in a numbing drop that wears off fast, but had a dilating drop in my hand. I wasn't 100% sure if it had also gone in. The other nurse asked me and I said no, but after 2 mins I felt too guilty and told her I actually wasn't sure. Luckily the wrong eye didn't dilate much, and he was able to get the procedure on schedule with no problems. When people make mistakes, do you think it is everyone's first instinct to cover it up? Or are some people just SUPER honest? Has anyone ever covered up an error (unless you don't want to share of course!), and if so, why? Also, has anyone faced consequences after reporting an error that didn't cause harm and would have been easy to cover up? Just curious!

[JBMmom, MSN, NP]

I'm not proud of it, but yes, I once panicked and started to cover up an error before admitting the mistake. I was on orientation and the preceptors I was working with were nitpicky to the point of ridiculousness. I was transitioning from long term care into the hospital and I think they thought I was coming in with an attitude of knowing everything, despite my attempts to be very open to feedback, or so I thought. I was told that I was spending too much time in my patients' rooms and my charting wasn't done on time. If I didn't have six assessments completed by 10 am I was probably not going to pass my orientation. So, I was already nervous. 

One morning my patient had a scheduled milk of magnesia. I went into the pyxis system, pulled the brown liquid container, scanned it and administered. When I went back into my brain an hour or so later, I still had a medication outstanding. It was the milk of magnesia. I was so confused because I knew the medication had scanned when I administered it. Well, I checked the MAR and I had administered a PRN maalox! It scanned because she had an order, but it was clearly the wrong med. I went back into the pyxis, opened the drawer and sure enough there were two open cubbies with brown plastic containers- one milk of mag and one maalox. Well, when I told my preceptor about the error, I panicked and told her the maalox was in the wrong cubbie in the pyxis. She told me we would have to fill out a MIDAS for the pharmacy to report the error when the machine was filled. I waited about 10 minutes and then went back to her and said it was me, I couldn't try to point the finger at someone else. I was so stressed about the idea of making a mistake that I completely let myself down and lied, and about something stupid, too. I made a promise to myself that I would never do that again, and I haven't. 

Ironically, I was let go from that job before I completed orientation, but not because of that incident. I was told that I should probably go back to my long term care job because clearly I lacked the critical thinking to work in a hospital. That manager has since been fired and now I work in critical care, so I guess it all worked out. I'll always be a little ashamed that my knee jerk reaction was a lie. I thought I was a better person than that. But I panicked at the thought of losing a job that I thought I really needed to provide for my family. 

[TheMoonisMyLantern, ADN, LPN, RN]

18 minutes ago, JBMmom said:

I'm not proud of it, but yes, I once panicked and started to cover up an error before admitting the mistake. I was on orientation and the preceptors I was working with were nitpicky to the point of ridiculousness. I was transitioning from long term care into the hospital and I think they thought I was coming in with an attitude of knowing everything, despite my attempts to be very open to feedback, or so I thought. I was told that I was spending too much time in my patients' rooms and my charting wasn't done on time. If I didn't have six assessments completed by 10 am I was probably not going to pass my orientation. So, I was already nervous. 

One morning my patient had a scheduled milk of magnesia. I went into the pyxis system, pulled the brown liquid container, scanned it and administered. When I went back into my brain an hour or so later, I still had a medication outstanding. It was the milk of magnesia. I was so confused because I knew the medication had scanned when I administered it. Well, I checked the MAR and I had administered a PRN maalox! It scanned because she had an order, but it was clearly the wrong med. I went back into the pyxis, opened the drawer and sure enough there were two open cubbies with brown plastic containers- one milk of mag and one maalox. Well, when I told my preceptor about the error, I panicked and told her the maalox was in the wrong cubbie in the pyxis. She told me we would have to fill out a MIDAS for the pharmacy to report the error when the machine was filled. I waited about 10 minutes and then went back to her and said it was me, I couldn't try to point the finger at someone else. I was so stressed about the idea of making a mistake that I completely let myself down and lied, and about something stupid, too. I made a promise to myself that I would never do that again, and I haven't. 

Ironically, I was let go from that job before I completed orientation, but not because of that incident. I was told that I should probably go back to my long term care job because clearly I lacked the critical thinking to work in a hospital. That manager has since been fired and now I work in critical care, so I guess it all worked out. I'll always be a little ashamed that my knee jerk reaction was a lie. I thought I was a better person than that. But I panicked at the thought of losing a job that I thought I really needed to provide for my family. 

I don't think you should be ashamed, the instinct for self preservation is a powerful thing to override. When it comes down to it, you did the right thing and your error had no negative consequences for the patient.

I currently work in a culture where punitive measures are taken towards those reporting errors, so guess what, we have incredibly low rates of documented errors! Just two weeks ago I had an incident where a significant error was made by a staff member related to an ineffective system process and nothing was documented about this error due to the staff member fearing reprisal from management and even the immediate supervisor was complicit in not reporting it. The bad thing is that this error could have effected the way a test was interpreted by the provider and thus could have a negative impact on care but fear of punishment suppressed them from speaking up.

I have always been told that in healthcare we have to speak up when we mess up so that's what I do, and I've made some really bone headed mistakes that I was embarrassed and ashamed of making but I've learned to put my ego aside and do what needs to be done.

I do think it's only human nature to want to deny that something happened.

[CalicoKitty, BSN, MSN, RN]

One time I pulled a percocet for a patient, but pulled it under another patient from the pyxis. I uh, fixed it, by asking the other patient if they needed pain medication. Luckily, it was a yes. So.. the pull/administer timing would have been wonky. In the end, still the right medication to each patient.. just pulled from wrong drawer... I think having to pull/waste a narcotic would have been a huge hassle.. 

I can't tell you how many times I forgot to "unlock" the secondary of IV antibiotics and caught it shortly after..  I think fewer than the amount of times I found the same left from the previous nurse... They really gotta come up with better systems..

[LibraNurse27, BSN, RN]

2 hours ago, JBMmom said:

I'm not proud of it, but yes, I once panicked and started to cover up an error before admitting the mistake. I was on orientation and the preceptors I was working with were nitpicky to the point of ridiculousness. I was transitioning from long term care into the hospital and I think they thought I was coming in with an attitude of knowing everything, despite my attempts to be very open to feedback, or so I thought. I was told that I was spending too much time in my patients' rooms and my charting wasn't done on time. If I didn't have six assessments completed by 10 am I was probably not going to pass my orientation. So, I was already nervous. 

One morning my patient had a scheduled milk of magnesia. I went into the pyxis system, pulled the brown liquid container, scanned it and administered. When I went back into my brain an hour or so later, I still had a medication outstanding. It was the milk of magnesia. I was so confused because I knew the medication had scanned when I administered it. Well, I checked the MAR and I had administered a PRN maalox! It scanned because she had an order, but it was clearly the wrong med. I went back into the pyxis, opened the drawer and sure enough there were two open cubbies with brown plastic containers- one milk of mag and one maalox. Well, when I told my preceptor about the error, I panicked and told her the maalox was in the wrong cubbie in the pyxis. She told me we would have to fill out a MIDAS for the pharmacy to report the error when the machine was filled. I waited about 10 minutes and then went back to her and said it was me, I couldn't try to point the finger at someone else. I was so stressed about the idea of making a mistake that I completely let myself down and lied, and about something stupid, too. I made a promise to myself that I would never do that again, and I haven't. 

Ironically, I was let go from that job before I completed orientation, but not because of that incident. I was told that I should probably go back to my long term care job because clearly I lacked the critical thinking to work in a hospital. That manager has since been fired and now I work in critical care, so I guess it all worked out. I'll always be a little ashamed that my knee jerk reaction was a lie. I thought I was a better person than that. But I panicked at the thought of losing a job that I thought I really needed to provide for my family. 

You don't seem like a bad person at all! The stress of being nitpicked would make me react the same way. And you later told the truth. You admitted to the error AND to trying to cover it up. That's double honest to me! That's how I felt with the eye drops... I had to admit that I wasn't sure if one of the dilating drops went in or not, AND I had to admit I had only said they hadn't because I didn't want to mess up. But, being honest always feels better in the long run. I don't know how but I've never had a patient be upset with me when I tell them about an error (not that I've made any super serious ones.) Today the guy said if both pupils were dilated he'd just wear sunglasses! Sometimes I think people are too nice to me. But, sometimes admitting an error to the pt makes them trust you more in my opinion. Then they know all the other things you did, you did right! I'm glad you got away from that toxic environment and work in critical care = )

[LibraNurse27, BSN, RN]

2 hours ago, TheMoonisMyLantern said:

I don't think you should be ashamed, the instinct for self preservation is a powerful thing to override.

Wow! That is so well said. I agree. And it takes strength to override this instinct. Especially when you acted on it and then have to roll it back. I remember I once miscalculated the dose of PO morphine for a hospice pt. The correct amount was something crazy like 6.3333 ml out of the 10ml, and I gave an "underdose." I told the pt and he said thanks for telling him and he didn't want the rest of the dose. Everyone told me just to chart the whole dose, but I made things hard for myself by doing an incident report and getting the dose changed for him because he said the higher dose made him sleepy. sighhh LOL

[JBMmom, MSN, NP]

12 hours ago, TheMoonisMyLantern said:

I don't think you should be ashamed, the instinct for self preservation is a powerful thing to override.

 

10 hours ago, LibraNurse27 said:

You don't seem like a bad person at all

Thank you both. I know it was a pretty small error in the scheme of things, and I can blame the reaction on a stressful situation. I'm just disappointed that even though I knew the right thing to do at the time, I made the wrong choice initially. 

I did still end up reporting that the pyxis arrangement, with open containers of very similar looking medications right near each other, was a potential problem. They rearranged the pyxis. 

[DavidFR, BSN, MSN, RN]

I've only seen Pyxis in one French hospital. Where I work, and this is common here, we still have a large pharmacy on the unit, badge accessible but "open" once you're in there so there's no scanning or being controlled like that.  

We have a very non-penalizing culture to encourge reporting errors and learning from our mistakes, which was very much the case when I worked previously in the UK too.  

I think most nurses here are honest about serious errors for the safety of the patient. I once made a mistake over the dosage of a sub-cutaneous anticoagulant. I came clean, took bloods for clotting, told the patient who was great about it, monitored her and she was fine. I was in no way disciplined or sanctioned because I came clean. Had I tried to hide it and been discovered I would have been slaughtered.  

Irrelevant errors are another matter. The Maalox/Milk of Magnesia mix up described above is pretty laughable to a European. Such an error would be shrugged off here and no manager would create a fuss about it. It's hardly a Morphine error and I'm staggered anybody is made to fill out an incident form for Milk of Magnesia.

[TheMoonisMyLantern, ADN, LPN, RN]

5 hours ago, DavidFR said:

I've only seen Pyxis in one French hospital. Where I work, and this is common here, we still have a large pharmacy on the unit, badge accessible but "open" once you're in there so there's no scanning or being controlled like that.  

We have a very non-penalizing culture to encourge reporting errors and learning from our mistakes, which was very much the case when I worked previously in the UK too.  

I think most nurses here are honest about serious errors for the safety of the patient. I once made a mistake over the dosage of a sub-cutaneous anticoagulant. I came clean, took bloods for clotting, told the patient who was great about it, monitored her and she was fine. I was in no way disciplined or sanctioned because I came clean. Had I tried to hide it and been discovered I would have been slaughtered.  

Irrelevant errors are another matter. The Maalox/Milk of Magnesia mix up described above is pretty laughable to a European. Such an error would be shrugged off here and no manager would create a fuss about it. It's hardly a Morphine error and I'm staggered anybody is made to fill out an incident form for Milk of Magnesia.

Healthcare in America is riddled with lawsuits and companies are constantly trying to keep themselves covered and to track any perceived potential cases of litigation and the risk to the company. Most of the places I've worked at were pretty aggressive about reporting all incidents no matter how small. 

[LibraNurse27, BSN, RN]

9 hours ago, DavidFR said:

I've only seen Pyxis in one French hospital. Where I work, and this is common here, we still have a large pharmacy on the unit, badge accessible but "open" once you're in there so there's no scanning or being controlled like that.  

We have a very non-penalizing culture to encourge reporting errors and learning from our mistakes, which was very much the case when I worked previously in the UK too.  

I think most nurses here are honest about serious errors for the safety of the patient. I once made a mistake over the dosage of a sub-cutaneous anticoagulant. I came clean, took bloods for clotting, told the patient who was great about it, monitored her and she was fine. I was in no way disciplined or sanctioned because I came clean. Had I tried to hide it and been discovered I would have been slaughtered.  

Irrelevant errors are another matter. The Maalox/Milk of Magnesia mix up described above is pretty laughable to a European. Such an error would be shrugged off here and no manager would create a fuss about it. It's hardly a Morphine error and I'm staggered anybody is made to fill out an incident form for Milk of Magnesia.

That sounds like a healthier and happier work culture! 

[Hannahbanana, BSN, MSN]

If there’s one thing that has only proved truer than ever since Watergate and ensuing availability of damning or exculpatory data, it’s this:

It’s not the crime, it’s the coverup.

Meaning, whatever happened will eventually come out, and trying to hide it or just not disclosing it makes you look far worse than the error itself. 
You want to be seen as trustworthy and honest. The best way to do that is ... to be trustworthy and honest. Don’t wait for somebody else to discover your error. Own up to it immediately and take steps to make amends, whatever they might be. 

[SmilingBluEyes]

I have self-reported a few medical errors in my career. Most were extremely  minor like wrong time/missed dose.

Once,  I mixed up antibiotics in two rooms next to each other, two patients with same last name. One was allergic to PCN, the other not. Guess who got PCN?  My heart dropped to my feet. It was my first year out of school. When I asked the allergic patient how she reacted to PCN, she said "It makes my tummy hurt".

No harm came to either patient, but you can bet I felt awful having to notify the MD and do two separate incident reports.  I learned from that mistake.