Vaccine Question - Mistake worth mentioning?

[kaliRN]

Before this appears to be a question of medical advice, both my boys (2 and 4) were to receive the SAME vaccines today. I have no concerns from a medical standpoint, my question is about a mistake in administration. Here's how the encounter went:

The person giving the injection goes for the deltoid, as my 4 year old "Johnny" is very thin, I suggested she use the thigh. "I try not to do that in children who can walk. If they walk on it in the next hour, it could swell." ... Okay, I'm not a peds RN - I'll take your word for it. Anyway, I'm holding my 2 year old "Dan" and she says, "Okay, "Johnny," your turn." Well, I give her the benefit of the doubt, since my 4 year-old "Johnny" was hugging me too. I stated, "You mean, "Dan" right?" "No, she points to my 2 year old - this is "Johnny." I need to give him his shots."

I explained, you just gave "Johnny" his shots, this is "Dan" ... "Oh well, umm ... " She stammers - clearly realizing her error (and now the stickers/informed consent don't match). I simply stated, "Well, at least they are getting the same vaccines, today." And let her continue.

If this occurred in the hospital, I would need to write an incident report and it would be a med error. However, in an outpatient pediatric setting, I am not sure how this would be handled.

Do I address this with their pediatrician, or leave it alone? I am by no means the type to feel like I should be silent to prevent someone "getting in trouble" - but I also don't know if this is worth mentioning. I just think it could have gone very differently. What if they were not expected to receive the same vaccines - there could be a more serious issue. Perhaps she wasn't as careful because of the circumstances? The goal in reporting errors is generally to enact change in existing policy to prevent those errors from occurring in the future - but I wonder if there's a need for that here.

I know I will be a bit more proactive in the future about making sure the boys are clearly identified. I just wonder if I bother mentioning it?

[NotReady4PrimeTime, RN]

I do think it should be mentioned, for the reasons you've given. If the boys ahd been getting different vaccines then there definitely would have been a med error, and there could have been health-related repurcussions as well. I think the best way to handle it is to speak to the pediatrician, saying that you're not out to get the office nurse in trouble, but you also don't want to see her make the same mistake again with someone else's children when the outcome might not be so benign. You might find that she's already reported herself and defined changes in her practice that will prevent a reoccurence. But it should not be swept under the rug.

[kaliRN]

Thank you for your response, these were my thoughts precisely. From what I know of the pediatrician, I do not believe she would be excessively punitive. I appreciate your insight, I'll put a call in on Monday to make her aware of the error. There was another staff member in the room and its a very small practice, so there is a good chance it was self reported, but for peace of mind ... It would be nice to know I addressed it. As you said, the results could have been far less benign.

[RosesrReder, BSN, MSN, RN]

I'm concerned at the fact that she didn't at the very least apologize and act compassionate. Thank goodness they both were there for the same vaccines.

Had I been that nurse, I would have apologized and validated the fact that you questioned me mixing up the kids.

Lastly, I would have told on myself. Not only because I'd be suspecting you were going to probably complain about it (rightfully so), but because my conscience would not have let me just brush it off.

Definitely report it. Not in a malicious way, but in a 'safety' and precautionary way and hopefully an opportunity to gently remind her to properly ID patients before sticking them!

[Redhead28]

I think you should talk to the office manager. A mistake is a mistake. She or they need to come up with a better system when administering medications. The deltoid is relatively small in 4 year olds and you should limit the amount of medication placed in the muscle. If you requested the thigh she should have given it there. I've never heard of an IM causing swelling in the thigh by walking, you are by nature of giving a vaccine going to have local swelling that should go away quickly. In fact you encourage movement of the limb to prevent soreness.

[kaliRN]

Thank you, jessy_RN. All these thoughts ran through my mind, but as a new nurse, I often question whether I am being a "stickler." What I do in my own practice is still very based in theory and clinical protocol. While I believe things such as the rights of med administration become fluid, but are always present in clinical practice, my concern was this was a "no harm, no foul" moment ... And that I would be ill perceived for reporting it. My conscience tells me, if it were myself, I would handle it in the manner you described.

Originally posted by redhead28:

"The deltoid is relatively small in 4 year olds and you should limit the amount of medication placed in the muscle. If you requested the thigh she should have given it there. I've never heard of an IM causing swelling in the thigh by walking, you are by nature of giving a vaccine going to have local swelling that should go away quickly. In fact you encourage movement of the limb to prevent soreness."

Thanks for posting this, this was always my understanding. If I give an injection on a petite or frail LOL, I use ventral-glut, whenever possible. While I can aspirate to ensure I am in the deltoid, I have always been taught to avoid giving what may equate to too large a dose for a small muscle. Keeping a muscle still to avoid swelling is also contrary to what I have understood. As I said, I am not a peds RN, so I was hoping this was wisdom from this nurse's experience.

[cjcsoon2bnp, MSN, RN, NP]

I agree with the other posters. You should call the office and ask to speak with the peditrician and let him/her be made aware of the error. Like everyone else said, just tell them that your not trying to cause a problem for anyone but it was a med. error and needs to be addressed by the office so that another similar error will not be made in the future with an even worse outcome.

!Chris

[iluvivt, BSN, RN]

YES report it...the nurse obviously DID not have a mechanism to verify the identify of her pts nad you can potentially prevent a medication error for another child. See how easy it is to make a mistake...we all have to be so hyper vigilant