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Student makes med error- how serious?

Posted

Specializes in Family planning, med-surg.

I've about 12 weeks untill graduation. My last clinical I had two patients. I went in and did my morning assessments, then went to the medroom and did my 5 rights, 2 times. In the patient's room I did the third 5 rights and checked the armband. It was the right name, but there wasn't a date of birth on the band. I figured that must just be the band they used in that unit, since the other nurses were obviously giving the patient mediacations. I told the patient the meds and he took them. Later I was completing a checklist (his admission had been handled very poorly) and I came to a box that described two armbands the patient needed to be wearing, an ID band and a "type and cross" for blood. I then realized I had been using the type and cross band to ID him, and it was a mistake. :banghead:

I told the supervising nurse immediately. She went into a sort of panic right away because it's very serious to give the patient meds without the ID band on. She pointed out that I had not asked the patient his birthday and compared it to his ID band, that it's hospital policy to give medications this way. All I could do was tell the truth, that I didnt recognize the armband and was a little thrown off. She didn't understand how I could be in my second year and not know about the "type and cross" band. I didn't have anything to say. I tried to aid her in getting an ID band for the patient, but it was a complicated process, which describes why he wasn't wearing one.

When my instructor came, the nurse told her about it and said that I could not safely give medications and that she didn't want me to care for that patient. My other patient had been discharged, so there was nothing for me to do. My instructor told me to go home early. :(

I wish that was the only problem, but I had one failed catheter attempt and one failed IV (the IV was hard, no one could do it). The catheter was a disaster because I wasn't that familar with the eqipment; when we needed a second one, I grabbed a coude, not knowing anything about it. The nurse told me that I had alot to learn and told my instructor that I wasn't very professional.

It was absolutley the worst experience I've had to date. I was feeling confident and fine, now I feel shaken, like I don't know what I got myslef into. And I am seriously scared of getting kicked out of the program. They have to have a meeting and discuss my case, I won't know for a few days.

Has anyone else been through anything like this? I don't feel like I really made a med error, but I did fail to ID the patient properly, and I've learned from my mistake.

iluvivt, BSN, RN

Specializes in Infusion Nursing, Home Health Infusion. Has 32 years experience.

Did the patient get the wrong medications or not?...its hard to tell from your story. OK so you used the blood armband to identify the patient...most hospitals will have a color for this one...ours is purple.......that armband still should have had the correct patient name. You can not always have the patient tell you there name or DOB....many are confused.....sedated...ect. When you can..great...in the meantime you now know to check that name band and have two identifiers. You know you are a student and still learning!!!!! This was a learning experience....and did you learn...of course you did...and a valuable lesson at that. Some of these nursing programs are way too harsh. And by the way do not feel defeated b/c you could not start an IV....IF even seasoned nurses could do it 100% of the time I would have a lot less work to do as an IV therapist...not everyone can be skilled at that. YES medication errors can be serious...so you are correct in not taking this lightly. I can not tell you how many pts I see that do not have a name armband on or a temporary one from the ED. I refuse to start the IV until the nurse tags the patient...unless an emergency... From now on check every patient you have and make sure at the start of your day they have the correct armband on.

NewNurseAlert

Specializes in Family planning, med-surg.

Thanks, I did not actually give the patient any wrong medication, I just failed to ID him properly, which highlights the potential for a med error. It's silly because I know darn well to check the date of birth, we've been taught that since the beginning. The nurse actually started an IV on that patient before the band was discovered, I think that's why she was so upset. In addition, the previous nurses have been giving him vancomycin, ativan, morphine, without his armband on. I partially think they pinned it on me, when I'm the one who discovered the mistake and came forward. But it's no joke, I got in trouble! And it only highlighted my other faults. I hope I get a second chance...

Sorry it happened to you. The most important thing is that the patient was given the right medicine, IMO. So far all my rotations have the electronic mar and the scanner bracelets, so I haven't come upon anything like this.

jollydogg_RN, ADN, BSN

Specializes in OR. Has 12 years experience.

That all sounds so crazy and so suspicious. I know I'm still in nursing school, about to graduate, but I work as an Extern at a major hospital here in Nashville. I couldn't imagine you getting kicked out of the program for something as such. You came foward, admitted the mistake, which if I may be bold to say, is more than most students in a nursing program would do. You did it out of the future care and concern of that patient is what it seems like to me, to avoid any potential future medication errors for that one person. That shows integrity, and someone with integrity is always wanted in a field like this.

And for IVs? I did a combat life saving course in the army, and I've gotten to start an IV or two in nursing school. I also draw blood on various different patients at my extern job, and I also start catheters by myself in the extern job. I work in the urology/orthopaedics department, so I get to do a lot of catheters :p

Let me tell you this.... drawing blood on elderly patients, patients who are not adequately hydrated, patients with deep veins, and patients who have had chemo arent even easy to DRAW BLOOD on, so I imagine starting an IV would be harder. I had a patient at the VA one time who had leather skin almost, and I actually used force to push and the needle wouldn't penetrate his skin, lol. Seriously, DONT FEEL BAD. It happens, even to the best of nurses. And you're just in school!

Keep your head up. You're in school, and any school that requires you to be perfect during it, well, thats just ridiculous. I would just tell your side of the story, and you already have tons to worry about in school. Just take what you learned and apply it next time in clinicals, because im sure you will be there again :p

Meriwhen, ASN, BSN, RN

Specializes in Psych ICU, addictions.

Thanks, I did not actually give the patient any wrong medication, I just failed to ID him properly, which highlights the potential for a med error. It's silly because I know darn well to check the date of birth, we've been taught that since the beginning. The nurse actually started an IV on that patient before the band was discovered, I think that's why she was so upset. In addition, the previous nurses have been giving him vancomycin, ativan, morphine, without his armband on. I partially think they pinned it on me, when I'm the one who discovered the mistake and came forward. But it's no joke, I got in trouble! And it only highlighted my other faults. I hope I get a second chance...

Last semester, I failed to ID a patient properly for meds. I'd been in and out of the patient's room so much and asked her name and DOB a 1000 times, I knew it by heart...but the ONE time when my instructor was there, I forgot to check :banghead: I caught my mistake before I actually gave the medicine so technically no harm, no foul...but I got a low mark in clinical that week, as well as a well-deserved lecture. I can assure you, I learned from that experience: now will ID them no matter how many times I've done it before, or how peeved the patient is because I'm asking their DOB yet again. Plus, I have this "101 medication errors" booklet that I've been reading to remind myself not to become complacent about checking again.

You didn't give the patient any wrong meds so you didn't cause him any harm, so I really can't see why you'd be out of the program for that. And you admitted your error to them, so they know you know what went wrong. I hope it works out for you.

Edited by Meriwhen
misread something

ghillbert, MSN, NP

Specializes in CTICU. Has 20 years experience.

"I told the patient the meds and he took them."

Looks like he did get meds, which potentially could have been intended for another patient with the same name and different DOB.

Look, you're going to feel terrible. Try not to worry TOO much until you have to though - it won't change the outcome. Sounds like you caught your own error, owned up to it, and fixed the situation. I feel the supervising nurse was quite harsh on you. I would feel safer with someone who realized their own errors than someone who blissfully did things without thinking. Sounds like you'll be a great nurse - and never skip a step in giving meds again. I'd be very surprised and disappointed if you were terminated for this. Make sure you have a plan to take to the school for how to avoid such a situation again - and point out that you caught it yourself, etc. Do NOT mention that other nurses did the same thing... this doesn't help your case, and it makes you sound like you're trying to minimize the error.

NewNurseAlert

Specializes in Family planning, med-surg.

Thanks the problem wasn't just the armband but the negative feedback the other nurse gave. She has worked at the hospital for 25 years and felt I should have known about the catheter. I have since talked to some other student's, none of them know the difference between a coude and a straight cath either. It's just not something we went over. THey think I'm overwhelmed but I'm starting to feel singled out...

BabyLady, BSN, RN

Specializes in NICU, Post-partum.

Ok...first...as students, not sure how it is at your school, but at our school, by the time we graduate, we will be in 5 different facilities, and we only have clinical 1 day per week for 6 weeks in med-surg. It's hard for us to remember which facility has what policies and we do not get re-oriented when we go back.

These nurses..sometimes forget that their hospital is not the only place we go...and we usually have 6 whole days in between to forget everything.

Not all hospitals have a 2-ID policy. None of the ones here do, primarily, because they are small hospitals. So the chances of two John Doe's getting accidently rotated in room 222 is pretty much just short of zero.

The other nurse BEYOND over-reacted. It's not like you gave the wrong med to the wrong patient.

In fact, I would probably wager that a type and cross match band would be more accurate identifier than one generated by whoever happened to find time that day.

Don't beat yourself up over that...some nurses in hospitals don't have enough to do....and you missed a catheter (big whoop, it happens...I've seen charge nurses with 20 years experience miss them), and an IV (that no one else could get...I've seen them call the CRNA to stick...and they STILL miss it).

Don't let one idiot at one place and time define you...you sound like you are doing ok to me.

Well you made a mistake, learned from it. Luckily no one got hurt, I know youre shaken ...Thats a good thing, it means you realized you did something wrong and you were able to walk away from it with a lesson. How has your performance been in the clinical site up to this point? Im surprised they let you guys do IVs (more jealous than surprised) and the Cath thing, I would say practice practice practice.

I think the floor nurses (some not all) are hard on the student nurses. I guess we wont understand why, until we have a student nurse take care of one of our patients. Good luck and keep us up to date with your progress! Congrats on getting this far in the program

Purple_Scrubs, BSN, RN

Specializes in School Nursing. Has 8 years experience.

I think the staff nurse was incredibly hard on you. Of course you have a lot to learn, that is why you are in school! Nursing is not intuitive, you are not born with the knowledge of urinary catheters.

I think you did a good job with the ID bracelet issue also. You uncovered a serious flaw in the system that allowed this patient to get by without proper identification. How many nurses did not notice that the pt did not have an armband? You might not have instantly recognized that the blood band was not the only one he should have, but you had that "aha moment" and realized what was wrong. At that time you did the exact right thing by bringing it to the attention of the nurse and your instructor. I say bravo! I am more concerned about the nurses who SHOULD have known that a band was missing and did nothing. Keep your chin up and hang in there!

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