Medication Errors

[Autumnovember]

Ok so today I had to take a test for something called "ATI" for nursing. One of the questions stated that we gave a patient a synthroid medication and after administering it, we find out we gave it to the wrong patient. The question (regarding to legalities) asks "how would this be documented?"

The two answers our group was debating on was " xxx mcg medicaton given. Client is not in distress." or "xxx mcg medication given. Client notified of error"

Ok so I personally said that the patient has to be notified. My friend, who is an LPN said that realistically does not happen. This just seems absolutely NUTS to me! Which lead to a little bit of a debate...

How can you not tell your patient an error has been made?

She said a lot of nurses have the mind frame that if the patient if notified, that equates to losing their license.

Of course an incident report is filed regardless but I still think its totally absurd not to notify a patient that an incorrect drug was administered to them. It could have effects on so many different aspects of that patient.

What if you have a patient who decided not to listen to hospital policy by bringing in medication that he/she is taking at home and continues to take it behind the nurses back? What if that incorrect drug you administered has an interaction with the med the person is taking from home? Yeah, the patient is in the wrong too but notifying the patient could prevent further complications.

She asked me if I would be willing to lose my license.

Right now, the answer is yes. My patients lives and well being are more important than my damn license. That is a person's life and God forbid anything happens. Ultimately I would immediately notify my supervisor and complete an incident report.

Perhaps my answer will be different if I am ever put in the position of making a decision like that. Who am I to make that choice anyway, even if I didn't want to tell the patient or DID want to tell the patient isn't it ultimately the supervisors decision?

Someone please enlighten me about this!

 

[TooPatient]

I know nothing about the legal side of this or what is normal policy.

But....


If I were in a situation (or had a relative in a situation) where the incorrect medication had been given, I'd REALLY WANT TO KNOW even if there were no problems from it. I would not report the nurse to anyone and would not make an issue of it -- she/he is only human and mistakes happen. As long as there was no complication and she/he were honest with me, I would thank them and be impressed that they were doing a difficult/stressful job and were really a decent/honest/good person.

On the other side, if any complications came up later and I had NOT been told..... well.... I would make a very BIG and public complaint about what had happened. The patient is a person and deserves to know what is happening while they are being cared for.



Honestly, the sad truth is that we live in a world where there are a lot of people who will take advantage of a situation like this and make a very public/expensive mess for the hospital & nurse. I suspect that MOST people informed of a mistake (assuming no complications) would be upset but understanding. The problem is the rest of the people and the attorneys/legal-system.

 

[Autumnovember]

I know nothing about the legal side of this or what is normal policy.

But....


If I were in a situation (or had a relative in a situation) where the incorrect medication had been given, I'd REALLY WANT TO KNOW even if there were no problems from it. I would not report the nurse to anyone and would not make an issue of it -- she/he is only human and mistakes happen. As long as there was no complication and she/he were honest with me, I would thank them and be impressed that they were doing a difficult/stressful job and were really a decent/honest/good person.

On the other side, if any complications came up later and I had NOT been told..... well.... I would make a very BIG and public complaint about what had happened. The patient is a person and deserves to know what is happening while they are being cared for.



Honestly, the sad truth is that we live in a world where there are a lot of people who will take advantage of a situation like this and make a very public/expensive mess for the hospital & nurse. I suspect that MOST people informed of a mistake (assuming no complications) would be upset but understanding. The problem is the rest of the people and the attorneys/legal-system.

Yes, thank you! That is exactly my thinking too. I would rather get my license stripped for being an honest person than for having it stripped because I was dishonest. I cannot imagine not telling a patient about it.

No matter how much she tried to explain it to me, I couldn't take out 1 positive from not being honest...

She told me that they often do not tell the patient of any error unless the patient appears to begin having distress....wwwwtffff?!

 

[TooPatient]

Eeeeeek. That is a rather disturbing policy.

I can understand why they don't tell people, but I don't think I could do that. It is just so sad that there even has to be the question about telling or not telling.

If I were to be in the situation where I gave someone the wrong medication, I don't know what I'd do. I'd be very upset and feel horrible about it and really want to tell them but since it could potentially end a career and make an expensive problem for the hospital (potentially damaging other people's careers too), I just don't know what I'd do.

What a difficult question!
I hope you have a long, happy, rewarding career and never have to actually make that decission.

 

[Autumnovember]

Eeeeeek. That is a rather disturbing policy.

I can understand why they don't tell people, but I don't think I could do that. It is just so sad that there even has to be the question about telling or not telling.

If I were to be in the situation where I gave someone the wrong medication, I don't know what I'd do. I'd be very upset and feel horrible about it and really want to tell them but since it could potentially end a career and make an expensive problem for the hospital (potentially damaging other people's careers too), I just don't know what I'd do.

What a difficult question!
I hope you have a long, happy, rewarding career and never have to actually make that decission.

Oh...but its not even a policy!

I agree...I hope I never have to make a choice like that =/

 

[TooPatient]

Eeeeeek. That is a rather disturbing policy.

I can understand why they don't tell people, but I don't think I could do that. It is just so sad that there even has to be the question about telling or not telling.

If I were to be in the situation where I gave someone the wrong medication, I don't know what I'd do. I'd be very upset and feel horrible about it and really want to tell them but since it could potentially end a career and make an expensive problem for the hospital (potentially damaging other people's careers too), I just don't know what I'd do.

What a difficult question!
I hope you have a long, happy, rewarding career and never have to actually make that decission.

Oh...but its not even a policy!

I agree...I hope I never have to make a choice like that =/

Is there a policy about how this is "supposed" to be handled?

 

[zoebartlett]

Yeah, I'd want to know too. I can't think of a situation when I wouldn't!

 

[lbbaber]

I worked in a hospital for years (I am a SAHM now) and, yes, med errors happen (even to the BEST of nurses) but WE ALWAYS tell the patients. You mentioned doing an incident report. If the nurse is really doing an incident report than the pt. is bound to find out. The situation you described confuses me. How can your supervisor or charge nurse be notified but not the pt? I would think that if a nurse is not telling the pt. of an error than she is keeping it off ALL records and not being honest about writing an incident report and reporting to the charge nurse (not to mention the subscribing DR who would insist on being notified of his pt's situation).

You are ABSOLUTELY right to tell the pt. In today's day in age w/medications being pulled from pyxis dispensers (or a similar brand), EVERYTHING is traceable and it is only a matter of time before the dishonest nurse gets caught.

 

[Autumnovember]

Eeeeeek. That is a rather disturbing policy.

I can understand why they don't tell people, but I don't think I could do that. It is just so sad that there even has to be the question about telling or not telling.

If I were to be in the situation where I gave someone the wrong medication, I don't know what I'd do. I'd be very upset and feel horrible about it and really want to tell them but since it could potentially end a career and make an expensive problem for the hospital (potentially damaging other people's careers too), I just don't know what I'd do.

What a difficult question!
I hope you have a long, happy, rewarding career and never have to actually make that decission.

Oh...but its not even a policy!

I agree...I hope I never have to make a choice like that =/

Is there a policy about how this is "supposed" to be handled?

I'm sure any policy requires a patient be told (I hope)!

I have no clue how it works at her hospital but it is a childrens hospital which leads me to believe even further that they would be oh so very careful about the ethical legalities of this.

 

[Autumnovember]

I worked in a hospital for years (I am a SAHM now) and, yes, med errors happen (even to the BEST of nurses) but WE ALWAYS tell the patients. You mentioned doing an incident report. If the nurse is really doing an incident report than the pt. is bound to find out. The situation you described confuses me. How can your supervisor or charge nurse be notified but not the pt? I would think that if a nurse is not telling the pt. of an error than she is keeping it off ALL records and not being honest about writing an incident report and reporting to the charge nurse (not to mention the subscribing DR who would insist on being notified of his pt's situation).

You are ABSOLUTELY right to tell the pt. In today's day in age w/medications being pulled from pyxis dispensers (or a similar brand), EVERYTHING is traceable and it is only a matter of time before the dishonest nurse gets caught.

Very good question, I have no clue how any of it makes any sense either. Maybe they aren't telling their supervisors? I don't know, I don't get it. Maybe some supervisors don't insist on the patient being told either and kinda do the "sweep it under the doormat" thing where if the patient shows no signs of any issue they will not say anything. Either way no matter what angle I think about it from, it is beyond screwed up not to tell someone.

People in my group seemed to be agreeing with her.

A friend of mine sent her friend a text who is an NP and she also said she would not tell!

Can this thread incriminate her? Being in nursing school makes me question everything I ever post anymore and makes me super duper paranoid!!! It is highly annoying.

 

[swingirl]

I am neither a health care professional nor a patient that this has ever happened to. But if it did happen to me I would NOT want to be told by the nurse who just did it. I would want to be told by a doctor who could answer my questions and really know the possible side effects long and short term. I would not want to be confronted with the nurse who says, "oops, sorry." I wouldn't want to have to throw a meal tray at her or say, "Oh, that's okay. I guess I'll live."

Of course, the professionals are required to report the incident and tell the patient, but I'd rather hear it from my doctor.

 

[Karl_K]

This actually happened to me a few years ago(maybe 10?) while in the hospital.
I was in a lot of pain and asked for a pain med, the nurse brought in a huge metal needle and said this is all that was on order. I was like ugh ok, She injected it into my thigh muscle and it hurt like heck, then zonk out I slept for 6 hours. Later the nurse comes in and sees im uncomfortable and asks if I want some pain meds.
I say not the same stuff as last time no way....
She says.. oh that was a mistake we have pills for you if you want it.
I was like WTF but in no shape to worry about it and took the pill.
Asked my doctor about it the next day and he knew nothing about it and said he would look into it.
Never heard a thing more about it.

 

[Autumnovember]

I am neither a health care professional nor a patient that this has ever happened to. But if it did happen to me I would NOT want to be told by the nurse who just did it. I would want to be told by a doctor who could answer my questions and really know the possible side effects long and short term. I would not want to be confronted with the nurse who says, "oops, sorry." I wouldn't want to have to throw a meal tray at her or say, "Oh, that's okay. I guess I'll live."

Of course, the professionals are required to report the incident and tell the patient, but I'd rather hear it from my doctor.

Oh no no, it is not *supposed* to be told in that sort of manner. I don't know that the nurse has to directly tell the patient herself. I doubt it because when a med error occurs, everything including the side effects to how it can possibly cause any problems in the future is supposed to be told to the patient.

I imagine that it would either be told by the doctor or by the nurse practitioner with maybe the nurse present? I'm not sure.

 

[Autumnovember]

This actually happened to me a few years ago.
I was in a lot of pain and asked for a pain med, the nurse brought in a huge metal needle and said this is all that was on order. I was like ugh ok, She injected it into my thigh muscle and it hurt like heck, then zonk I sleep for 6 hours. Later the nurse comes in and sees im uncomfortable and asks if I want some pain meds.
I say not the same stuff as last time no way....
She says.. oh that was a mistake we have pills for you if you want it.
I was like WTF but in no shape to worry about it and took the pill.
Asked my doctor about it the next day and he knew nothing about it and said he would look into it.
Never heard a thing more about it.

WHAT!

Oh my God. For real, that is NOT how that is supposed to be handled on any level whatsoever.

It disgusts me how nurses and doctors can just write it off like no big deal. Not only do the med errors kill tons of people....they're freakin expensive too!!

 

[Karl_K]

twice my discharge instructions were incorrect:
Once the instructions did not match the prescriptions and the instructions were for a medication I am allergic to.
I caught that one before I left.

The other was more serious:
The instructions were for the wrong dose of lovenex after a dvt.
It was spose to be 150 a day for 10 days there was 10 100s and 10 50s
My written instructions were 100 for 15 days and the nurse said they didn't have enough 100s so use 2 50s.
She wrote them out from memory right in front of me without referring to any paperwork.
It didn't get caught until my warfarin level wasn't high enough at day 10 and the doctor said they needed to get me some more and I said I had 5 days worth left!
I never did hear what happened if anything but he did say he filed a report about it.

 

[Karl_K]

Not really medicine but I was triple scheduled for a ct scan.
I thought it was strange because I just had one the day before and mentioned it, they said the doctor ordered it.
Get down to ct and it was the same tech and she said. didn't you have one yesterday? I said yes.
She made some phone calls and the doctor had only ordered one.
The next day they come in and say they are taking me down to ct...
I am like not again, and tell them to call the doctor and verify it because of what happened the day before at the exact same time..
Sure enough he had not ordered another ct.

I thought it was very funny! at the time.

 

[Gypsy]

I would raise very type of bloody hell I could possibly imagine if I was not told immediately.

I, personally, am THAT person that if there is a chance that SOMEONE is going to have a bad reaction to the medication, even if it is a .01% chance, it's going to be me.

So, while I understand wanting to wait for an MD to tell you something has gone "whoopsie!" I would rather be informed right when it happens so that if I DO start to have a reaction I at least know what is going on while someone is hunting around for a doctor, dithering about potential liability, getting their arse handed to them by the doctor, then finally hunting me down to tell me what happened.

Yeah, waiting is NOT okay. And to me compounds the initial error. And may God help you if I think you are trying to cover anything up.

And if you give me the impression you were more worried about your "potential liability" than your ACTUAL ethical responsibility to me... I will make that potential a reality in every which way I can. Whereas if you are honest and forthright with me... and everything is done to minimize any reaction or problem that might occur as a result, I will likely end up knowing you did all you could, and let the matter rest. Assuming I came to no permanent harm.

I cannot fathom a situation where an error occurred and someone did not inform me immediately upon figuring it out. But it would be REALLY REALLY bad for them if it happened. I can promise you that.

Mistakes happen in life. How you handle them is what sets you apart from the pack. If you put your license ahead of my life... as far as I am concerned you have lost all rights to that license anyway. NOT because you made a mistake. But because you put your license ahead of your ethical responisibility to your patient and their health.

 

[Gypsy]

My question to your nursing staff would be this.

Sitation A:

You make a mistake, tell the doctor and the patient, and everything is handled with transparency. Even if the patient is a complete JERK and tries to get your license pulled... any COMPETENT representation would be able to say "Mistakes happen, here are the stats, EVERYTHING was done to fix the error, and EVERYTHING was handled according to the best medical ethical standards across the board. We can't elimate errors as long as humans are in the equation, but this nurse accepted the responsibility and the consequences, and while we are sorry this happened, to pull her license would be to send the wrong message and would encourage people to cover up errors instead of reporting them and ensuring that any negative consequences are minimized and that the hospital's liability is as low as it can be."

Situation B:

You make a mistake. Then cover it up and are caught because something REALLY BAD happens that could have been COMPLETELY avoided if you had reported your error. Defend yourself now.

 

[Autumnovember]

My question to your nursing staff would be this.

Sitation A:

You make a mistake, tell the doctor and the patient, and everything is handled with transparency. Even if the patient is a complete JERK and tries to get your license pulled... any COMPETENT representation would be able to say "Mistakes happen, here are the stats, EVERYTHING was done to fix the error, and EVERYTHING was handled according to the best medical ethical standards across the board. We can't elimate errors as long as humans are in the equation, but this nurse accepted the responsibility and the consequences, and while we are sorry this happened, to pull her license would be to send the wrong message and would encourage people to cover up errors instead of reporting them and ensuring that any negative consequences are minimized and that the hospital's liability is as low as it can be."

Situation B:

You make a mistake. Then cover it up and are caught because something REALLY BAD happens that could have been COMPLETELY avoided if you had reported your error. Defend yourself now.

I couldn't agree more.

I imagine each hospital has their own policy about how medication errors happen...it makes me so sad that people would put their license before their patient =/

 

[davi_el_mejor]

If I were the nurse that made the error, I wouldn't tell the patient... myself. I would tell my supervisor and the patient's doctor(s). I would then hope that the three (or more) of us would sit with the patient and discuss what happened. That's also what I'd hope for as a patient too.

 

[dani13]

I am neither a health care professional nor a patient that this has ever happened to. But if it did happen to me I would NOT want to be told by the nurse who just did it. I would want to be told by a doctor who could answer my questions and really know the possible side effects long and short term. I would not want to be confronted with the nurse who says, "oops, sorry." I wouldn't want to have to throw a meal tray at her or say, "Oh, that's okay. I guess I'll live."

Of course, the professionals are required to report the incident and tell the patient, but I'd rather hear it from my doctor.

Swingirl-

I have to be honest in telling you that your response really offends me.....I have been a RN (now an APN) for 11 years now, and you better be sure that I am educated about ANY and EVERY medication I administer to patients. I can understand wanting to be notified by the MD, but really everyone has to know that medical mistakes happen EVERYDAY- by doctors, nurses, etc. I have seen it happen several times so far in my career (thankfully not to me). It goes both ways- I have seen physicians write orders for 200 mg of a medication, when 2 mg is the standard dose. Its a constant system of checks and balances. So, "throwing a meal tray at her" seems kind of inappropriate and demeaning. Just saying.

 

[dani13]

If I were the nurse that made the error, I wouldn't tell the patient... myself. I would tell my supervisor and the patient's doctor(s). I would then hope that the three (or more) of us would sit with the patient and discuss what happened. That's also what I'd hope for as a patient too.

This is exactly right Davi. ALL the members of the health care team would be involved.

 

[Autumnovember]

I am neither a health care professional nor a patient that this has ever happened to. But if it did happen to me I would NOT want to be told by the nurse who just did it. I would want to be told by a doctor who could answer my questions and really know the possible side effects long and short term. I would not want to be confronted with the nurse who says, "oops, sorry." I wouldn't want to have to throw a meal tray at her or say, "Oh, that's okay. I guess I'll live."

Of course, the professionals are required to report the incident and tell the patient, but I'd rather hear it from my doctor.

Swingirl-

I have to be honest in telling you that your response really offends me.....I have been a RN (now an APN) for 11 years now, and you better be sure that I am educated about ANY and EVERY medication I administer to patients. I can understand wanting to be notified by the MD, but really everyone has to know that medical mistakes happen EVERYDAY- by doctors, nurses, etc. I have seen it happen several times so far in my career (thankfully not to me). It goes both ways- I have seen physicians write orders for 200 mg of a medication, when 2 mg is the standard dose. Its a constant system of checks and balances. So, "throwing a meal tray at her" seems kind of inappropriate and demeaning.

Dani--

Thank you for chiming in!! Could you please tell me what proper procedures are? I really don't know. You are right though, any practicing nurse should know all of that information and not just the doctors or NP.

I'll be honest though Gypsy, I don't know that I would be able to tell a pt right upfront that I made an error. I honestly would go straight to my supervisor. Maybe my answer my change when I'm further along in my program....but right now I can't picture myself just telling the patient "hi! I made a medication error!" without telling my supervisor first. The NP responsibilities are very similar to that of a MD so finding the ordering physician etc. wouldn't be my biggest concern after the fact. I imagine that if a medication error occurs, the NP takes the proper precautions right after finding out as opposed to tracking down the others for help. Again, Dani is the perfect person to ask here.

 

[dani13]

Hi AN-

Proper procedure would be to first notify your supervisor and the MD, then an incident report is filled out. What happens next is up to the parties involved.

 

[Autumnovember]

Hi AN-

Proper procedure would be to first notify your supervisor and the MD, then an incident report is filled out. What happens next is up to the parties involved.

Got it, thank you!

Would you say though, that my friend is correct in saying that it is covered up from the patient sometime?

Still can't wrap my head around that.

 

[dani13]

I believe that there is no obligation to tell the patient unless the mistake is life threatening, and/or there is potential for serious side effects. Not that its "covered up" , its just not disclosed. I know it sounds crazy, but.....

 

[Autumnovember]

I believe that there is no obligation to tell the patient unless the mistake is life threatening, and/or there is potential for serious side effects. etc.

Wow. I am very very surprised. How is that legal? I read that the patient has to be informed.

Also, how does one know if a drug will be life threatening for that person?

I feel like there are just so many scenarios that could go so wrong from not telling the patient.

At the same time, I do understand that if every medical error was disclosed there would be lawsuits up the butt...not that there isn't already but these errors happen every day...

Ah, I just don't know.

 

[dani13]

I dont believe so. I will clarify this and get back to you. Like I said, thankfully, I have never had to personally deal with this. Its scary!

 

[Autumnovember]

I dont believe so. I will clarify this and get back to you. Like I said, thankfully, I have never had to personally deal with this. Its scary!

 

[dani13]

Your right, Autumm, but just looking at the black and white, there is a HUGE difference between hanging the wrong IV antibiotic and giving the completely wrong dose of a narcotic or cardiac med that can cause respiratory depression and death. Each clinical scenario is different, so when the error happens, the team needs to look at everyone and everything involved to decide what to do.