Weird meeting with manager

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I work in a busy ER and am constantly giving pain medications. We have an error-prone system where it's easy to pull a narcotic on the wrong patient and administer it to a different patient. This has happened numerous times to people on my unit. They are also very particular about timing of narcotic medications, if you are over 15 minutes late in giving the med, they write you up. My last ER job, narcotics couldn't be pulled without a physician order being verified and you couldn't override narcotic meds. This made it easy to avoid these stupid errors. There was one incident where I forgot to chart a narcotic. The patient was writhing in pain and I gave the med and probably forgot to scan it. I feel bad about these things and feel like an idiot. Not only that I was interrogated by my manager who in the course of the meeting the way she spoke to me made me feel like she thought I was stealing medications, which no one has ever accused me of. I have never every stolen anything in my life.

Not only do I feel like an idiot but now feel so weird, like they think I'm a narc diverter at work and don't trust me. I also worry if I make another mistake I will be fired. I have never ever given narcs so much at this hospital and the system they have makes it easier to pull the meds on the wrong patient. I might make a mistake again because of the frequency of giving the meds. I will try very hard to be careful, but now I feel so bad about my job, nursing in general, like the hard work I do is unrecognized and the mistakes are all that stands out.

Specializes in ED, Cardiac-step down, tele, med surg.

I also want to thank everyone for the responses, especially Esme (the articles are very useful). I do really appreciate the feedback and value the time you all took to read my post.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

When I was a new grad in the ER in 2008, we didn't have scanners or profiled meds — we pulled what was ordered and made sure it was done by the five rights because we had no safety nets. I feel like relying on things like scanners has made us pay less attention to what we are doing.

I have worked with a few people that I would have never guessed in a MILLION years were diverting and/or using. Great people, I love them but they had problems. Thankfully there were good outcomes, but if I hadn't been told about it by the people themselves, I would have never ever known. So don't get upset or take it personally — ERs attract seekers, but they also attract diverters too.

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I also want to thank everyone for the responses, especially Esme (the articles are very useful). I do really appreciate the feedback and value the time you all took to read my post.

Esme is a treasure! She's helped many, many of us with advice, encougagement, and her willingness to share her amazing amount of knowledge.

Best wishes to you !

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Specializes in ED, Cardiac-step down, tele, med surg.
"There were 3 times I pulled a narc out under a similar sounding name and administered it "

Stop right there. You bypassed the first 2 rights of medication administration ..the right patient and the right drug.

"This is the common issue that occurs frequently in the department. " So, if your friends jump off the bridge.. you would follow.

Take responsibility.

These errors were not intentional, nor did they cause harm. When I have Martinez, Lydia and Martinez Linda in the same room back to back and you give as many meds as I give during the course of a shift as most ED nurses do, these types of mistakes can happen(those are just examples, not real patient names, very similar to why I pulled the med out under the wrong name). It's different than giving a patient the wrong medication or dose. All the patients who were supposed to get their meds got them in a timely manner. I'm not not taking responsibility, I"m just not taking all the blame.

Pharmacy needs to organize our pyxis so we can't pull narcotics out without an order. That would cause less workload for them to have to review all these charts because the errors would decrease.

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Specializes in Pediatrics, Pediatric Float, PICU, NICU.
These errors were not intentional, nor did they cause harm. When I have Martinez, Lydia and Martinez Linda in the same room back to back and you give as many meds as I give during the course of a shift as most ED nurses do, these types of mistakes can happen(those are just examples, not real patient names, very similar to why I pulled the med out under the wrong name). It's different than giving a patient the wrong medication or dose. All the patients who were supposed to get their meds got them in a timely manner. I'm not not taking responsibility, I"m just not taking all the blame.

Pharmacy needs to organize our pyxis so we can't pull narcotics out without an order. That would cause less workload for them to have to review all these charts because the errors would decrease.

I find it very, very troubling that you don't seem to be able to take 100% accountability and instead repeatedly come up with excuses/explanations as to why that doesn't involve/blame you. Shockingly troubling.

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These errors were not intentional, nor did they cause harm. When I have Martinez, Lydia and Martinez Linda in the same room back to back and you give as many meds as I give during the course of a shift as most ED nurses do, these types of mistakes can happen(those are just examples, not real patient names, very similar to why I pulled the med out under the wrong name). It's different than giving a patient the wrong medication or dose. All the patients who were supposed to get their meds got them in a timely manner. I'm not not taking responsibility, I"m just not taking all the blame.

Pharmacy needs to organize our pyxis so we can't pull narcotics out without an order. That would cause less workload for them to have to review all these charts because the errors would decrease.

Errors are never intentional. I don't care if you had Mary Smith # 1, Mary Smith,# 2 and Mary Smith # 3 in your ER. Follow your 5 rights .. and they will get the correct medication. Pharmacy IS your second check, with additional identifiers now required.

I still don't see YOU taking responsibility. YOU are the one pushing the pill. The buck starts and stops with YOU.

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I'm glad to hear you have a plan in place going forward. I know you were thinking of getting the pain med to the patient as fast as you could to alleviate suffering but you have to CYA. It's sad. I know I had a situation in which a patient could not be entered into our EMR system and was also writhing in pain. Another nurse had somehow accessed her chart from an outpatient view and saw a dilaudid order. I pulled the dilaudid but could not muster up the courage to give it before getting the patient in the computer so her and the med could be viewed and scanned. Was too terrified of making a med error with a narc. But such is the world we live in.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
These errors were not intentional, nor did they cause harm. When I have Martinez, Lydia and Martinez Linda in the same room back to back and you give as many meds as I give during the course of a shift as most ED nurses do, these types of mistakes can happen(those are just examples, not real patient names, very similar to why I pulled the med out under the wrong name). It's different than giving a patient the wrong medication or dose. All the patients who were supposed to get their meds got them in a timely manner. I'm not not taking responsibility, I"m just not taking all the blame.

Pharmacy needs to organize our pyxis so we can't pull narcotics out without an order. That would cause less workload for them to have to review all these charts because the errors would decrease.

I have worked in many ERs where the Pyxis was set up as a "procedural" Pyxis, meaning that you can pull whatever you want under any patient's name. It is me pulling the meds, so yes, if I pull it under the wrong name, I am 100% responsible. Totally and completely. 100% of blame for the error. The pharmacy isn't responsible for making sure that I am doing things correctly, that's on me — unfortunately pharmacy has to waste resources to reconcile errors because people are not following correct procedures. Setting a Pyxis up so that meds are profiled (flow over from the EMR/order and you can only pull what's under a patient) exists for safety because people fail to use the five rights when pulling meds.

Take a patient sticker with you to the Pyxis and please, please slow down. If you pull it under a different patient but give it to the correct patient, you are still making errors and you are setting yourself up to make a more severe med error unless you change the way you are practicing. I have worked in my fair share of crazy-insane-busy-medication-overload-weeeee-Dilaudid ERs for more than a decade, but I have never pulled the wrong med because I ensure my five rights every single time, even when I started working in ERs where meds were scanned, just because that was how I was "raised" in my first ER. I know from your posts in the ER forum that you are a conscientious, smart, caring nurse, but I am begging you to protect yourself and your license by changing your approach and realizing that YOU are responsible for ensuring that you are pulling the correct med for the correct patient every time. I know it may take more time and we are eager to alleviate suffering in our patients, but please take the time to do it correctly — it will benefit you (and patients) in the long run!!

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Specializes in NICU, ER, OR.

My only advice is: make it your second JOB to make friends with the system... lol SERIOUSLY... new grad or not-- even an honest error with no suspect of you diverting can cost you your JOB... so, at the forefront of your mind should be the proper documentation and wasting if applicable, at all times. Yes it's that important!!!

if you are really uncomfortable with it, maybe be proactive and ask for a little more training and play time with it? You are going to use it a **** ton, and sometimes quickly... you must be proficient with not only pulling the meds, but the proper documentation, whatever that may be, that goes with it.... like I said -- errors with narcotic documentation, no matter how innocent, WILL cost you your job if it is a pattern

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Specializes in NICU, ER, OR.

I'll say it once more:,it is of ZERO consequence if the " errors" were / are

" unintentional" or NOT... you just CANT make ANY errors when it comes to this....... it's YOU pulling it, it's YOU giving it, so ONLY YOU ARE ACCOUNTABLE!!! Make it your job to ensure it's all CORRECT!!!

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I also want to thank everyone for the responses, especially Esme (the articles are very useful). I do really appreciate the feedback and value the time you all took to read my post.
You are welcome. I have been a nurse a LONG time and I have pretty much seen 90% of crazy things. The ER...we are held to a different standard
My plan is to print a label every time I have a new patient and bring it to pyxis so that I know that I'm pulling it on the right patient. Then I'm going to always scan or chart narcs before I give them even if the patient is writhing in pain. No more am I going to put myself at risk. If this takes longer too bad.
This is a great plan. I did this and carried it on a piece of "report paper" so I could keep my patients straight. Remember, even though the patient thinks they are going to die without pain relief...they wont die.

Has anything further been said?

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Specializes in PICU, Pediatrics, Trauma.
The manager said that she is looking into making the pharmacy require an active med order by a physician a requirement to pull the narc. I think that is a good start. In the ER, narcs are probably the most common med given next to zofran. I am not the only one "on the radar" as they admitted that many people are making errors. I have never had a manager, however, exude the degree of distrust that they did at me. I have also never worked in a place that had that system. They push us to give pain meds out like it's an emergency to boost their survey scores and when we try to do this, more and more narcs, there are going to be more errors. I did forget to chart that day probably because the computer broke down like it often does, the scanner not working and I have the guy his dilaudid who begged me for pain meds. He had pancreatitis, a confirmed painful diagnosis. I advocated for him to get his meds and rushed to give them to him in a timely manner. His pain was my priority in the moment, not the scanner. There is a serious problem with the healthcare system when everyone is a suspect, even people with high-performance evaluations, good recommendations, and never any prior incident of med error. This makes me want to step away from nursing, find a profession where I am valued more than a cog to generate a profit by my employer. The only thing that keeps me in nursing, really keeps me in it is the patients.

I have been through very similar things. Same up-standing nurse without any prior problems, never stole or diverted Meds, and never would. I made an error and it lead to a full in investigation where they found NOTHING of proof, but I was thereafter suspected none the less. It's so frustrating to be suspected when you are innocent. The climate of medical professionals diverting in large numbers makes management very paranoid as they have been fooled. The result though is that many are falsely suspected and suffer consequenses unfairly. It sucks!

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