What happens in the truck, stays in the truck?

[fireflymedic]

This isn't so much a patient treatment scenario as an ethics scenario aimed more towards medics, but basics can put in their thoughts too. Thank God I haven't had this happen to me, but I know of others that it has and just wondered the general attitude of how you have or would handle it.

You are dispatched to pick up a 33 year old female with chief complaint of isolated fracture to the humerus. Enroute, she begins to complain of pain again (you are on a transfer). You consult with med control and they order 2 mg morphine. You draw it up to administer and push it. About 5 minutes later pt's pain has gone from a 8 to a 3 out of 10. Upon cleaning up the truck after the run, your basic partner finds the vial you used and it's marked diazepam (valium). Instead of giving 2 mg morphine you have given 2 mg valium. Your patient has suffered no ill effects to your knowledge, however it is still early. They did however report decreased pain which is what you were trying to achieve. How do you document this? Who do you tell? Will you tell ER doc of your mistake? Your chief? What will you do different the next time to prevent this error? Will you even tell at all? I'm looking for honest answers here. I'm just curious to see how things would be handled. I'll give my thoughts at the end of the scenario.

[jmp6753]

Whoops!! The best thing you can do is admit to your mistake. Make sure that your patients MIR shows that the pt received Valium. Absolutely make sure that the person you turned over patient care to know also. What ever you do, do NOT falsify your report! Let your work supervisor know. Where I work, we have a really cool medical program director. If we go to him first and admit our mistake we are much better off. Probably a slap on the wrist. If he finds out later or has to investigate it, well, hell have no fury than a mad MPD. The long and short is it was an honest mistake (I hope) and no harm came to the patient. Dont ever try and hide anything. That is playing with fire and will eventually cost you your job and eventually your cert or license.

[Kaisu]

yeah - totally what he said. Come clean - do it quick and document everything.

[spenac]

Never cover up a mistake. Your cover up could cause more harm. Immediately go in and inform the doctor so he can have that knowledge in deciding continueing care of your patient. By being honest probably nothing beyond a quick review of importance of checking and rechecking meds before administering.

[VentMedic]

Tell the ED and do the appropriate paperwork without delay.

If your report says morphine and a drug screen is done on the patient for whatever reason, suspicion may be placed on you for other things far worst than a medication error. Benzos will appear on the results instead of opiates. There is also no guarantee that your partner won't blab it out somewhere after the fact or when questioned to protect his/her own license.

[Eydawn]

Absolutely document it. Fess up immediately, tell the doctor, tell the receiving nurse... and document the error in your paperwork. You can include that it did help the patient's pain... but you must include that it was a medication given in error.

I don't think you'll burn for it... probably have to do a little bit of remedial training or something... and I'm darn sure most of us would really learn something from it.

Wendy

CO EMT-B

[latinaemt1300]

yup.. honesty is the best policy

[firedoc5]

I can only repeat what the others have said. Wendy was right on. Don't try to hide it. Report it. We had a "plan" that if that happened who would be alerted to it. There was a chain of command if you will. Certain hospital officials and management of your agency would be involved. I know that sounds like a lot, but it has to be done. Check with your resource hospital for their policies, and your agency's too.

There might be an inquiry, or someone may just take care of it themselves. With us it would definitely be a right up on your permanent record, possible suspension for a week or two and a "probationary" period. But believe me, I've seen others come back from worse.

Best thing is, just don't make that mistake.

[Richard B the EMT]

I have found that even the most disagreeable supervisor prefers being told that there is a problem, from the person directly involved with the problem, than finding out there was a problem, and the supervisor has to chase down that individual. They may still be disagreeable (the character flaw of the supervisor?), but most want to help you, than shoot you! (If they want to shoot you, perhaps YOU have the character flaw?)

[Asysin2leads]

I agree with Rich and the others. I heard the adage once, "In EMS, mistakes are tolerated, laziness and dishonesty are not." In other words, if you make an honest mistake, and you admit to it, it will be far better than if you lied or were doing something not on the up and up.

I'm not saying there won't be consequences. But the consequences will be far less severe if you admit it and document properly, rather than try to cover it up. Almost without exception both medical directors and supervisors appreciate a crew that tries to do the right thing after a mistake occurs.