Medical error leads to thousands of deaths every year. That's a scary statistic, no matter which side of the gurney you find yourself. And it's one that has poked uneasily at the back of my mind since my earliest days of nursing. The majority of people who enter the field of healthcare do so because they want to help people, to do their part to ease the suffering of this broken world. Imagine how devastating to instead end up hurting someone because you make a mistake. I remember a nurse who unintentionally caused the death of a 16 year old saying in court in a voice heavy with grief, that she would be serving a life sentence of shame and remorse. A seasoned, competent nurse in my corner of the country committed suicide not too long ago in the wake of a fatal error. It's a fear that plagues every one of us who has the potential to cause harm when we've devoted our lives to doing good.
It's one of those moments that is seared in my memory. I was in my early years of emergency nursing and I'd just given a handful of different medications to one of my patients. As I sat down to chart the medications, suddenly I noticed something I'd overlooked. In the middle of the list of IV medications one was subcutaneous - to be given under the skin as opposed to in the vein. But I had just given them all IV. I could feel the heat spread up from my chest, making my face burn and my legs start to feel weak as I realized my mistake. I had just made a medication error. Was it serious? Would it hurt her? I did a quick shakey google search to check if the med could be safely given other routes. I knew I had to tell the doctor. I didn't want to tell the doctor. She'd think I was an idiot. All that hard earned respect, the proof of my competence, I didn't want to risk losing it! The strength of my desire for self preservation surprised me. In the end my concern for the patient and my conscience won out, and the doctor responded by swinging her head back and dropping the Fbomb before trotting away to talk with the pharmacist. In the end it turned out the medication could be safely administered IV. No harm no foul. But that feeling never left me. The shock of how quickly and easily an oversight could result in harm. How a seemingly ordinary shift could suddenly alter lives. The potential for error went from hypothetical to terrifyingly real.
In the end I was thankful for that close call. Because I think one of the best safeguards to error is a healthy sense of fear. I don't mean anxiety, but an ever mindful respect for the potential for catastrophe that keeps you a little more alert, a little more attentive, a little less auto pilot. When I first learned to drive I remember being acutely aware of the amount of power and speed a vehicle has and how easily a mistake could result in harm or death. But the longer you drive you start to lose that sense. You get comfortable. You stop paying as close attention, your mind wanders, you shoot off a couple of texts at 65 mph. And most the time, this doesn't result in harm - adding to your false sense of security until it's too late. As healthcare workers I think a little bit of fear is our friend. Fear alerts you to danger and makes you pay attention. People's lives are in our hands, and there will always be danger. Ours can never be 'just another day at the office', the stakes are just too high.
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