“I made the worst medication error today and feel so horrible about it. I feel like the worst person and nurse ever. I can’t even think straight. I still don’t know what penalty I will face yet but I’m praying I don’t get fired. I feel like my life is ruined. What if nursing just isn’t the profession for me after I’ve worked so hard for it, I’m so distraught!” wrote nurse R on a nursing forum. She is not the first and will not be the last nurse to feel this way. Unintentionally harming of a patient through a medication error is devastating because it is in complete conflict with our nursing goal of caring and helping. Here are six things nurses need to know if they commit a medication error:
1. Medication errors happen all the time.
Human error is a fact of life and mistakes with medication are the most common errors in health care. Studies have shown that, besides increasing hospital stays and inpatient expenses, medication errors cause more than 7,000 deaths annually in the United States. Patient safety experts at Johns Hopkins analyzed medical mortality rate data and came to the conclusion that medical errors, of which medication errors are the most common, cause more than 250,000 deaths annually making it the third leading cause of death in the US. This is not reflected in official mortality rate statistics because the cause of death is generally reported labeled the ICD code for the patient’s condition.
“…medication errors cause more than 7,000 deaths annually in the United States.”
Throughout the world reduction of medication errors has become a significant patient safety concern and there is increased focus on improving systems and procedures to eliminate errors. In March 2017 the World Health Organization launched a Global Patient Safety Challenge on Medication Safety with the goal to reduce medication associated harm in all countries by 50% over the next five years by addressing weaknesses in systems that lead to medication errors.
2. Nurses are the most exposed to making medication errors
Nurses have always played a major role in preventing medication errors. Research has shown that nurses are responsible for intercepting between 50% and 80% of potential medication errors before they reach the patient in the prescription, transcription and dispensing stages of the process.
The administration stage is the most vulnerable to error because this is where there are fewer system checks and balances. In the hospital setting most medication is administered by a single nurse with the result that nurses’ errors are those most likely to reach the patient.
3. Put the patient first
You discover you have made serious medication error, while you are half-way through administering the drug, at some later stage or when a colleague finds the error. You immediately experience a physical and psychological stress response. Your blood pressure and pulse rate go up, your muscles tense and you are overcome by disbelief, panic, fear, anger and shame.
Your natural impulsive thoughts are usually those of self-preservation – ignore the situation, and it might just go away. But soon your ethical and moral self–takes over as you realize that the patient may suffer harm. Taking ownership of the error and doing the right thing by putting the patient first is the only realistic course of action.
Take immediate corrective measures. Inform the patient’s doctor of the mistake so that action can be taken as soon as possible to counteract the effects of the incorrect medication. Should you not report the incident and the patient dies or suffers permanent disability from your mistake you will have to live with the guilt for the rest of your life. A cover-up may also be discovered and do more harm to your reputation, and possibly your career than that the mistake you made.
The next steps will depend on hospital protocol but will involve informing your immediate nursing supervisor and writing up an incident report. When reporting the incident, describe the facts surrounding the incident clearly and concisely – what happened, what actions you took, who were involved, factors which possibly contributed to why the mistake happened. Relevant factors could include a long shift, understaffing, interruption while preparing the medication, or the incorrectly administered drug having a similar name or packaging to the medication which should have been given.
Be sure to stay with facts only. Avoid personal views, defensiveness, making excuses, lying or trying to shift blame. As you will most likely be an emotional wreck at this stage, it might be a good idea to ask a close colleague to help you with the report.
4. Practice self-care
In the days and weeks that follow you will experience the psychological trauma widely known as the second victim syndrome. The first casualty is the patient who has been hurt by the error and the second victim is the person who has to live with its consequences.
You will most likely play the situation over and over in your mind, lash out at yourself for being so stupid, and experience feelings of self-doubt, anguish, guilt and remorse. You may fear going back to work because you are embarrassed to face your colleagues and also because you have lost your confidence and are afraid of making another mistake. In the months to follow, unresolved psychological trauma can lead to symptoms of post-traumatic stress disorder including sleep disturbances, flashbacks, a severely damaged self-image, and even suicide, as in the case of Kimberly Hiatt
The process is similar to that of grieving, and it is important for you to realize that what you are going through initially is normal. Talk through the situation with friends, family, and colleagues who want to support you. The free eBook aimed at helping you to let go could be a good starting point for dealing with your emotions. Consider professional counseling if you are still unable to work through the trauma after a few weeks.
5. Deal with the consequences one day at a time
While dealing with the emotional trauma of making an error, you are also fretting about the outcome of the event. Are you going to be disciplined, labeled as incompetent, lose your job and face all the financial consequences of being unemployed, be involved in a lawsuit or being reported to your registration board and losing your nursing license?
Worrying about all the possible consequences and creating scenarios in your head which may never even happen only add to your stress. Resolve to deal day-by-day with events as they actually arise. You managed and reported your error to the best of your ability, and there is a good possibility that there will be no further consequences. There could be an investigation with interviews, or a disciplinary hearing, where you should be absolutely honest about what happened and the possible factors contributing to the error. A disciplinary hearing might end in recommendations for supervised practice for a period of time and/or retraining. The result could also be dismissal and maybe a referral to your registration board. Even at this level, the outcome could be that no further action is required. Should you face the most severe consequences such as dismissal or the possibility of losing your license make use of support organizations such as your union or local nursing association. The Institute for Safe Medicine Practices (ISMP) in the US also provides support for second victims.
“When health workers are comfortable in reporting errors without fear of discipline, underlying problems in the system can be identified and changes made to prevent future errors…”
The consequences will depend largely on the policy of your employer, and fortunately, most accept that mistakes do happen and will not dismiss an employee for a first mistake. Medicine safety organizations and professional associations now also advocate that disciplining those who make mistakes does not address the root of the problem and can lead to more harm to patients in the future. When health workers are comfortable in reporting errors without fear of discipline, underlying problems in the system can be identified and changes made to prevent future mistakes.
6. Heal through becoming involved
Everybody makes mistakes. Despite how you feel your colleagues will probably be relieved that they are not in your shoes, rather than looking down on you. They will respect you for openly admitting your error and using it as a lesson for others.
Through your experience, you will be ideally positioned to become involved with both medication safety in your organization and in second victim support programs. You can encourage discussions and continuing education about the wide range of researched knowledge about medication errors and how to prevent them. You can also advocate for fair, just and compassionate treatment of second victims, including the introduction of organizational support systems.