BIG mistake

yesterday, i made a BIG mistake at work. i've made mistakes before.

but this, this was the BIGGEST mistake i've ever made. there were potentially lethal side effects. and i cried like i've never cried before. in fact, i freaked out once i realized what had happened. and i fessed up immediately to the prescribing nurse practitioner and to the attending so that we could rectify the mistake, if it was deemed necessary.

i want to describe every last detail. all of the events that led up to hanging the write medication at the wrong concentration, hence overdosing my patient on morphine. but there are TOO many details. it's never one thing that leads to mistakes. it's a string of little things that typically leads to a disaster. and unfortunately, i'm the last link - at the bedside, closest to the patient, with the most potential to do harm even while trying to help. i want to explain away how it happened. to prove that i did ALMOST everything right. that i had THE very best intention in mind - to provide pain relief to my dying patient who was gasping for breath and whose wife was finally ready and willing to accept comfort care. but i hope that YOU (whoever YOU are) know that i am a safe nurse. that i don't practice carelessly. that i respect medicine and nursing and all of the potential mistakes that could be made. but i don't want to type a novel. i already did that in my documentation of the error yesterday.

suffice it to say, i gave my dying patient more morphine than was ordered. and although i had a second nurse double check my hanging of the potent medication minutes after i hung it, it was not until 6 hours later that the error was caught. and by this time, my patient had had more than 60mg of morphine. for those of you who know medications and dying, this is NOT an unreasonable amount of morphine to keep a patient with air hunger comfortable. Ten mg of morphine per hour is however, a VERY large dose to START a continuous morphine drip. i should have hung the morphine at 2mg/hr and instead, due to hanging a 5:1 concentration bag instead of a 1:1 concentration bag, my patient received FIVE TIMES more than was ordered.

here's the good news. i made this mistake on a patient who was VERY uncomfortable. he was in multi-system organ failure and his death was imminent, whether or not i made an error. his response to the LARGE dose of morphine suggests that his body "needed" the relief. he tolerated the morphine well; morphine causes respiratory depression and even with LOTS of morphine in his system, his respiratory rate was within normal limits. and without ALL of that morphine, my patient might have continued to be VERY uncomfortable.

here's the other good news. the nurse practitioner and the attending were VERY nice. they actually played a part in allowing this error to happen. and while i was sobbing and pouring my heart out (saying, "this is my forte. i'm good at dying. i'm so mad that i made this mistake because it's something that i am so passionate about"), they complimented me on my nursing skill. on my ease at discussing difficult subjects with very vulnerable people. on anticipating orders and advocating for my patient.

here's the best news. my patient was okay (as "okay" as a dying man can be). once the mistake was revealed, it was decided to leave the medication at the current rate of 10mg/hr. the patient was comfortable. his wife (and the other TWENTY family members and friends) was content with her decision to stop curative treatment and start comfort measures. she was at peace, seeing her husband calm. and although my shift was over before he passed, i know that i played a part in helping someone to die peacefully - which was my aim all along.

it's kind of ironic. i should be at work today. i am scheduled to be there. but my grandmother passed away on saturday in switzerland. and i'm taking bereavement. i get my next three shifts off. and you know what, i need a break. i need to grieve the loss of this patient, whom i had cared for numerous times. and i need a bit of time to heal my conscience of this mistake.