Telling a patient/family that a mistake was made

[FireStarterRN, BSN, RN]

Yesterday I had a diabetic old man, who had a wife there too. The doctor had come in before my shift and written dc orders. His 7 AM blood sugar was 54. We gave him orange juice. I called the resident to notify him that he had gotten the 45 units of Lantus at 2200, and his blood sugar was 54, and did he want to re-evaluate his diabetic DC meds? After that, the lab called with a serum blood sugar of 40 with the AM blood work.

Then I noticed that the pt also had a 10 AM Lantus dose, also 45 units. I held that as well as his Glyburide in anticipation of the doctor. Glancing through the orders with the doctor, I found only the 45 units Lantus at bedtime order, it looked like there had been a med error in transcription.

Throughout this, I had kept the pt and his wife informed that I was going to discuss this with the doctor, that maybe he would want to adjust the diabetic meds before discharge. I ascertained in my conversation that the pt was well aware of the symptoms of low blood sugar, and his wife was really on top of everything in her wifely duties (she was 13 years younger than him).

I informed the charge nurse that there had been a med error, and we went through the orders again. She deduced that both the pharmacy and the charge nurse who had signed off the orders had misread 45 units of Lantus at 'Bedtime' as 'BID twice'. On looking at it, it was sloppy handwriting that led to this error. She was going to report this.

So, I went to the patient and his wife and informed them that he had gotten too much insulin due to an error in transcription, and that there would be no change to the insulin order on DC. The wife said that errors happen and that there was no harm done. I had already established a good rapport with both the husband and wife, so it was easy to talk to them about what had happened, they were better informed and the pt was DC'd home to the care of his loving wife.

[MikeyJ, RN]

When I worked as a nurse apprentice I once told a a child's mom that a PICC line that was entered was entered incorrectly -- I proceeded to tell her that this is why we do a chest x-ray to verify placement and the IV nurse would be back up to insert another one and that no harm was done to the child.

I was talked to by a few different nurses who all told me "NEVER tell a patient or their family that something a nurse/doctor did was incorrect or that we are at fault."

I understand their reason because it leaves a wide open door for a lawsuit, but I would rather be honest with my patient and their family rather than elusive.

[FireStarterRN, BSN, RN]

I think every case is individual. In this case, withholding information would have misinformed the patient and his wife, since they would think that his usual dose of Lantus caused his blood sugar to drop into the 50s. I felt that withholding this information would have been irresponsible and unethical.

[Jules A, MSN]

I think every case is individual. In this case, withholding information would have misinformed the patient and his wife, since they would think that his usual dose of Lantus caused his blood sugar to drop into the 50s. I felt that withholding this information would have been irresponsible and unethical.

If I read the situation correctly I agree with you 100% that they needed to be told but I would not have taken it upon myself to inform them unless my nursing supervisor instructed me that is how we were going to handle it.

[AlabamaBelle]

At a conference on patient/family centered care I attended last year, a great emphasis was placed on disclosure of medication and patient care errors. The general atomsphere that this helps with trust issues. Most times, the conversations are well-received. Generally, patients & families just want to know we are dealing with them truthfully, rather than hiding things from them. The whole point is to come together and try to identify where the process was broken and to find appropriate "fixes."

At our facility, our NM and one of our intensivists have spoken with families with regard to medication errors, one was insulin and the other was dopamine (the dopamine error occurred off our unit, but we caught the error). Each time, the disclosures were well received, the families appreciating the honesty, if not the extra time that they had to spend in our unit.

[august07]

Depends on the situation. If it's a small mistake that's not a big deal, I wouldn't get the patient all worked up over it. Giving a pt way too much insulin is something I would tell them. I would also tell them if their PICC line was put in the wrong spot, how else would you explain that to the family-"Oh, we always put these in twice!"??

I have been told not to tell a pt. about mistakes made by the doctor. I had a doctor once make a mistake concerning a surgery, but I never told the pt since I felt it was the MD's responsibility to explain it.

[interleukin]

My advice...create solid relationships with patients and family.

If something goes wrong, it's often wait and see whether there is any real damage, but being a genuine person will serve as a great ally.

Unfortunately, if there is damage and they realize they were told well after the fact, you risk appearing disingenuous and risk retribution.

Then again, your relationship may save you.

As someone else said, situations differ and the variables must each be carefully examined according to the context and your comfort zone.

[SarahRN123]

We are told in no uncertain terms that if we make a mistake we are to tell the patient and the doctor about it.

[CHATSDALE]

A patient/family has to have an expectation of honestly from health care workers

sometimes it can be phrased in a better light but do not allow a patient to go home with the meds that might do irreversable harm

[FireStarterRN, BSN, RN]

I think Interleukin makes a great point about how important relationships are in health care. Establishing a relationship of trust in the first place, then following through on it, is invaluable. There's no one size fits all answer to many of these types of situations in health care.

Each situation and individual has subtle differences. It's hard to learn the nuances of this in a book or by taking a class, in my opinion.

[Midwest4me]

we are told in no uncertain terms that if we make a mistake we are to tell the patient and the doctor about it.

i so agree with this, sarah. withhold information regarding an error can lead to distrust if such information is ultimately learned. it's poor nursing to

not be honest with patients about mistakes.

[RN1989]

If mistakes were disclosed more often, there would be fewer lawsuits. Often these people want to know what happened because they get the feeling that something was wrong and being hidden from them. I am tired of physicians and facilities wanting to hide everything from the public and then trying to force nurses to do the same.