What kind of mistakes have you made on placement? HELP!!

[19irishvet]

So I'm in 4th year and I've completed 13 weeks of Clinical Placement so far. Today, I injected a cat with 10x the correct dose of Meloxicam...and I am really struggling.
The cat is ok at the moment (being flushed with fluids, and it's a stray cat, not one with an owner), but I am beating myself up badly. The cat could die thanks to my stupidity. I misinterpreted the vet's instructions, and no one checked the dose before I gave it, but I should have known by this stage of my education that it was too much.
My last day of placement at this particular clinic is tomorrow...I don't know if I'll be able to go in. I had a panic attack after the Meloxicam incident and had to go home ☹️

Can anyone share any wisdom? Has anyone ever made a silly mistake on placement?

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[DVMDream]

Mistake on placement? How about in practice...

Didn't label a syringe as lidocaine because I wasn't planning on setting it down, was waiting for the tech to scrub once and I was going to use as a block. I got called away and set it down. Tech thought it was flush and gave it IV as she was placing the catheter. Dog was fine.

Prescribed a medication as twice a day, calculated the quantity as though it was being given once a day. Client was pissed they had to come pick up the additional medication.

Have caught myself on many other almost mistakes.. including too high doses, too low doses, giving NSAIDs and roids simultaneously, etc.

You WILL make mistakes in practice. And many have made the same mistake that you have. Own up to it, learn from it, learn how to treat that patient now and move along. This will make you a better vet in the long-term.

 

[CalliopeDVM]

Mistake on placement? How about in practice...

Yup! Everyone makes mistakes, on a placement and in practice.

Don't beat yourself up about it -- just make sure you learn from it. Think about how it happened, and try to institute procedures so that you don't repeat the same mistake. Don't be afraid to ask about instructions, or repeat them to the person to make sure you understood it.

What have I done? Calculated a dose on pounds instead of kilograms, so I gave 2.2 x the dose. Gave a cat a nipplectomy while shaving for a spay. Miscounted the number of tablets required for the prescription I'd written. Left an ovary behind during a spay (in my defense, it was a uterus unicornis). They say that every vet will try to spay a tomcat at least once in her/his career (still waiting on that one).

 

[JaynaAli]

As has been stated already, everyone makes mistakes. An important thing will be what you learn from this and what is done to prevent it in the future. Taking steps like having someone else check all injections, have two people calculate the dose, show the bottle you drew meds up from, making sure instructions are clear, always clarify whether quantities are mg or ml and be consistent, etc can all be useful practices for this specific instance. Sure it’s annoying to do sometimes but it really can be helpful.

 

[Trilt]

Take some comfort in the fact that it's so much more likely to happen when you're new; you get a "feel" for the right doses of drugs over the years. With that said, I still get someone to double check my math on drugs that I use less commonly and don't have that "feel."

**** happens. You're human - you're gonna make mistakes. Accept that it's gonna happen and take steps to minimize them and that's all it takes to be good.

 

[Trilt]

Fwiw, I've had three (!) animals that I know about that have gotten nsaids/steroids together. One I caught within like ten minutes before the first dose, one that I was keeping comfortable before euthanasia so wasn't super horrible (although I still didn't realize I'd done it till later) and one that had a depo injection only two weeks or so prior to nsaids.

I've given a double dose of hydro because I calculated in pounds. I've ripped an ovarian pedicle straight out of a kitty. I've done all sorts of **** and I'm only a year and a half in... now imagine the things I didn't realize I was doing! Being human is a bitch but somehow we survive.

 

[genny]

Yup! Everyone makes mistakes, on a placement and in practice.

Don't beat yourself up about it -- just make sure you learn from it. Think about how it happened, and try to institute procedures so that you don't repeat the same mistake. Don't be afraid to ask about instructions, or repeat them to the person to make sure you understood it.

What have I done? Calculated a dose on pounds instead of kilograms, so I gave 2.2 x the dose. Gave a cat a nipplectomy while shaving for a spay. Miscounted the number of tablets required for the prescription I'd written. Left an ovary behind during a spay (in my defense, it was a uterus unicornis). They say that every vet will try to spay a tomcat at least once in her/his career (still waiting on that one).

I did that. The tom had really undersized testes that weren't all the way descended. Adopted out of a shelter we work with frequently as a girl, got sent to us for her adoption spay, and I just assumed they knew what they were doing. Techs prepped the kitty, didn't notice he was a boy. Opened the abdomen, couldn't find a uterus anywhere. Had one of the techs double check for testes, still wasn't sure. So I de-gloved, found the penis, found tiny testes under the skin, sewed up his abdomen and neutered him. Then called his new owners with the news that they needed to find a new name for their kitty. Now everyone gets double-checked!

 

[hygebeorht]

I'm sorry that happened. It must have been very stressful - but in the future, you'll be extra careful and you'll ask when you're not sure. I've been most likely to make mistakes when I am not sure of something, but the people who can tell me are busy or I am too embarrassed to ask. Every time I find myself thinking that way now, I just think "would I rather wait, maybe look a little dumb, and be safe? Or risk the safety and life of this pet?" It's a no-brainer.

I don't want to diminish your mistake, but worse errors have happened. Be gentle with yourself. You're learning, and eventually you'll get a better feel for doses.

 

[psilovethomas]

Hey! We all make mistakes, we are human.
Instead of rattling off my mistakes, which I have made many, I just wanted to say that I am glad you 1) realized you made a mistake; and 2) owned up to it! It takes a lot to own up to mistakes like this, putting your pride aside for the better of your patient. I just wanted to applaud you for doing so. Sounds like the clinicians are taking the appropriate steps to ensure the kitty will be okay.
Like others have said, see this as a learning experience. I am a strong believer in the phase "everything happens for a reason". It will be up to you to determine what you have learned from this experience.
Remember, when in doubt, always ask, no matter how "dumb" you think your question may be; it could save a life.

 

[pinkpuppy9]

Thought of this thread today when I was talking with some people from the class above mine about mistakes happening on clinics.

I'm sorry that happened. It must have been very stressful - but in the future, you'll be extra careful and you'll ask when you're not sure. I've been most likely to make mistakes when I am not sure of something, but the people who can tell me are busy or I am too embarrassed to ask. Every time I find myself thinking that way now, I just think "would I rather wait, maybe look a little dumb, and be safe? Or risk the safety and life of this pet?" It's a no-brainer.

I don't want to diminish your mistake, but worse errors have happened. Be gentle with yourself. You're learning, and eventually you'll get a better feel for doses.

Kind of along the lines of what is said here...mistakes do suck hard and everyone dwells on them for a bit (try not to, easier said than done), but there's a difference between human error and downright negligence/incompetence/complete lack of appropriate judgement. Sometimes there's probably a bit of all of the above involved, but imo there's a difference between a math error vs. walking away from your anesthetized patient and leaving it completely alone, etc. I also think that poor judgement is a huge hurdle for some people. For example, thinking that the cyanotic dog presenting for labored breathing can wait on you to finish paperwork.

I'm just starting clinics and ****'s overwhelming. It is very easy to make mistakes when a clinician is shouting out a laundry list of instructions, you can't find them again to confirm/they treat you like **** for asking, and the treatments need to be done NOW. And you're tired and worked hard.

Like mentioned above, owning up to it is huge. 1, because you may be able to fix your mistake, 2 because it just shows good character anyways. I've already seen the aftermath of someone trying to hide their mistake and I've only been on clinics for two weeks. I know you're upset but the fact that you are shows that you care. Some people really just don't, and it's sad/scary. I hope everything worked out for you.

 

[Doktor Timo]

When I was a 4th year student I discharged a patient with 3 days of oral meloxicam at 10x the correct dose. Being the student, I of course didn't write or sign the prescription, but I still sent the dog home with the medication and verbally explained the (incorrect) volume of drug for the owner to give at home. I didn't backup my clinician by checking the dose myself (which is something you should do, even as a student). The dog ended up perforating its small intestine and was euthanized after multiple surgeries and weeks of ICU care.

That's not a mistake you forget easily. The important thing is don't waste it. Learn what you can do to make sure that never happens again. Now that I'm in my internship, I'm basically the dose police for any prescription with my name on it. I'll never forget that case, I'll never not feel bad about it, but I've learned how to move on and be a better doctor for it.

 

[hygebeorht]

When I was a 4th year student I discharged a patient with 3 days of oral meloxicam at 10x the correct dose. Being the student, I of course didn't write or sign the prescription, but I still sent the dog home with the medication and verbally explained the (incorrect) volume of drug for the owner to give at home. I didn't backup my clinician by checking the dose myself (which is something you should do, even as a student). The dog ended up perforating its small intestine and was euthanized after multiple surgeries and weeks of ICU care.

That's not a mistake you forget easily. The important thing is don't waste it. Learn what you can do to make sure that never happens again. Now that I'm in my internship, I'm basically the dose police for any prescription with my name on it. I'll never forget that case, I'll never not feel bad about it, but I've learned how to move on and be a better doctor for it.

Oh my god, that's horrible - but your future patients will benefit from your diligence.

I've seen some terrible medication errors, too. One time, a cat was referred after accidentally being injected with a syringe full of Immiticide that had been pulled up for another patient. The cat came in to the referring clinic for something routine, like a dental I think? There wasn't really anything to be done.

The 5 Rights of medications are so so important.

 

[twelvetigers]

One pop-off valve issue in vet school and I'm super paranoid about that now. Mistakes are part of how we learn - you just hope they aren't too bad. And that you realize them, own up to them, and can hopefully help prevent too much badness.

 

[pinkpuppy9]

One pop-off valve issue in vet school and I'm super paranoid about that now. Mistakes are part of how we learn - you just hope they aren't too bad. And that you realize them, own up to them, and can hopefully help prevent too much badness.

Pop-off valves scare the **** out of me. I haven't had an issue yet (thankfully), but in our junior surgery lab the group next to me did. Animal was fine, but holy hell did they experience the wrath of an anesthesia tech.

I like the machines with valves that are automatically open until you push a button to close them. If you stop pushing the button, the valve automatically opens again. Also wayyy easier to bag a patient with those.

 

[twelvetigers]

Pop-off valves scare the **** out of me. I haven't had an issue yet (thankfully), but in our junior surgery lab the group next to me did. Animal was fine, but holy hell did they experience the wrath of an anesthesia tech.

I like the machines with valves that are automatically open until you push a button to close them. If you stop pushing the button, the valve automatically opens again. Also wayyy easier to bag a patient with those.

I tried to get the boss to get one of those. No luck so far, but I haven’t tried stomping my feet and pouting yet.

Here’s what I don’t get - the techs aren’t all that interested in it. I’m like... yeah, well one screwed up pop-off accident and you will be. *shrug*

 

[pinkpuppy9]

I tried to get the boss to get one of those. No luck so far, but I haven’t tried stomping my feet and pouting yet.

Here’s what I don’t get - the techs aren’t all that interested in it. I’m like... yeah, well one screwed up pop-off accident and you will be. *shrug*

Hmm..wonder why they wouldn't be interested. The safety of the patient is the main concern of course, but tbh the ease of bagging is a huge sell too. Those long surgeries where you have to bag the entire time were the bane of my existence when I was teching.

 

[twelvetigers]

Hmm..wonder why they wouldn't be interested. The safety of the patient is the main concern of course, but tbh the ease of bagging is a huge sell too. Those long surgeries where you have to bag the entire time were the bane of my existence when I was teching.

 

[DVMDream]

Hmm..wonder why they wouldn't be interested. The safety of the patient is the main concern of course, but tbh the ease of bagging is a huge sell too. Those long surgeries where you have to bag the entire time were the bane of my existence when I was teching.

It is actually a little harder with those safety buttons to bag an animal. You have to hold the button down with one hand and bag with the other. Without the button you can close the valve, bag with one hand and have the other hand free to do other things.

However, I still like the safety button. Makes me feel so much better that a pop off valve won't get accidentally forgotten in a closed position.

 

[JustPaws]

A tech at a previous job told me one time someone hooked flow by up to an et tube... They didn't realize until too late :-(

 

[pinkpuppy9]

It is actually a little harder with those safety buttons to bag an animal. You have to hold the button down with one hand and bag with the other. Without the button you can close the valve, bag with one hand and have the other hand free to do other things.

However, I still like the safety button. Makes me feel so much better that a pop off valve won't get accidentally forgotten in a closed position.

Personal preference. I find it significantly easier. I like not having to screw/unscrew the valve every 5-10 seconds, especially when a patient is in motion. I've also heard people with arthritic hands rave over the buttons. It cuts the time of each breath, too.

 

[DVMDream]

A tech at a previous job told me one time someone hooked flow by up to an et tube... They didn't realize until too late :-(

A big annoyance of mine at the previous clinic I worked at was when the techs would hit the O2 flush while the patient was still attached. I screamed many times at them, they couldn't understand why it was a big deal despite my explaining exploding lungs.

 

[hygebeorht]

I tried to get the boss to get one of those. No luck so far, but I haven’t tried stomping my feet and pouting yet.

Here’s what I don’t get - the techs aren’t all that interested in it. I’m like... yeah, well one screwed up pop-off accident and you will be. *shrug*

Stomp harder, pout harder

 

[Trilt]

First week of working at my job a pop-op valve broke and I recommended a button one as replacement. Recently another one was getting a little sticky to twist/untwist and our main tech nudged the bosses to get another push one... it's fun to see things slowly infiltrating the workplace. Only one machine left to do!

I think they're way easier than having to constantly screw/unscrew.

 

[pinkpuppy9]

A tech at a previous job told me one time someone hooked flow by up to an et tube... They didn't realize until too late :-(

Couple Devastated After Instagram-Famous 'Chloe The Mini Frenchie' Dies At Animal Hospital

she must have been having difficulty oxygenating post-op, so they re-intubated and it happened. or she was super swollen so she was sedated/intubated the whole time. my best guesses. Sad story.

Did anyone catch the post by the vet who killed her own cat when she forgot to flush the air out of her cat's entire IV line? I think Dr. Andy Roark featured it. that one made me double check myself like 6 times for each patient I set up on fluids in our ICU.

Edit: I've also heard horror stories of cats waking up blind after routine dentals due to their mouths being held open for the entire procedure; a dog that was flipped to his other side (during a dental), the table wasn't cleared of instruments and his eye was punctured by a probe/scaler; alcohol being used on skin that was to be lasered (fire), and more.

 

[JustPaws]

alcohol being used on skin that was to be lasered (fire), and more.

A vet I worked with years ago said she saw(?) an animal's lungs burnt when the O2 caught during a laser procedure. She always made us drape the face with a wet towel during laser declaws. Not sure if she was there or passing on a story she had heard...

 

[hygebeorht]

A vet I worked with years ago said she saw(?) an animal's lungs burnt when the O2 caught during a laser procedure. She always made us drape the face with a wet towel during laser declaws. Not sure if she was there or passing on a story she had heard...

Declaws, ugh, nope, absolutely not. Don't get me started. AAFP finally got around to condemning them, so hopefully they are on their way out of this benighted country.

On another note, it's nice to see good equipment filter into practices. That's why hiring new grads is a smart practice. A friend of mine insisted that her practice buy a centrifuge so she could get PCV/TS on her patients easily. They didn't even have that! (I know there are some day practices that get by with little more than a fridge to keep vaccines in, but that was surprising to me for some reason.)

 

[CalliopeDVM]

a dog that was flipped to his other side (during a dental), the table wasn't cleared of instruments and his eye was punctured by a probe/scaler;

I almost dropped a dental elevator that would have fallen onto (or into) the patient's eye.....all I could picture in my mind was the corneal puncture that might have happened.

 

[pinkpuppy9]

A vet I worked with years ago said she saw(?) an animal's lungs burnt when the O2 caught during a laser procedure. She always made us drape the face with a wet towel during laser declaws. Not sure if she was there or passing on a story she had heard...

Wow, that's scary. I don't think we ever draped faces, but now I feel like I would if I had access to a laser again.

A friend of mine insisted that her practice buy a centrifuge so she could get PCV/TS on her patients easily. They didn't even have that! (I know there are some day practices that get by with little more than a fridge to keep vaccines in, but that was surprising to me for some reason.)

I worked for a practice with no centrifuge. No in-house/outside lab bloodwork ever. We did have a microscope though!

 

[KCgophervet]

My coworker just told me a story today about her own cat's trachea being punctured with an ET tube when it was flipped during a routine dental (they didn't detach the tube from the hose when they flipped her). It was while she was a vet student on externship at the clinic! She wasn't there at the time (didn't want to work on her own pet) but afterwards wishes she had been. Her cat was ultimately fine, ended up with crazy SQ emphysema at home but eventually healed.

 

[JustPaws]

My coworker just told me a story today about her own cat's trachea being punctured with an ET tube when it was flipped during a routine dental (they didn't detach the tube from the hose when they flipped her). It was while she was a vet student on externship at the clinic! She wasn't there at the time (didn't want to work on her own pet) but afterwards wishes she had been. Her cat was ultimately fine, ended up with crazy SQ emphysema at home but eventually healed.

Ugh that would be so frustrating.
Glad kitty was fine eventually, though

 

[Trilt]

Declaws, ugh, nope, absolutely not. Don't get me started. AAFP finally got around to condemning them, so hopefully they are on their way out of this benighted country.

On another note, it's nice to see good equipment filter into practices. That's why hiring new grads is a smart practice. A friend of mine insisted that her practice buy a centrifuge so she could get PCV/TS on her patients easily. They didn't even have that! (I know there are some day practices that get by with little more than a fridge to keep vaccines in, but that was surprising to me for some reason.)

Declaw comments were necessary, right?

We use our surgical laser for mass removals, same thing could happen. Have to use a different scrub and I could definitely see a new person screwing that one up.

 

[hygebeorht]

We use our surgical laser for mass removals, same thing could happen. Have to use a different scrub and I could definitely see a new person screwing that one up.

Yeah, same thing can happen with cautery, too, with alcohol. Alcohol flames are almost invisible, and it's easy to get in a hurry and go before alcohol is completely dried. I used to work in a surgical lab, and heard about one or two patients catching fire years before. Yikes.