I'm a fairly new RN who hasn't made any med errors, but am wondering: If I do make one, should I tell the patient, no matter how minor the error was, or just my manager? Does it depend on whether the patient was harmed?-M.T., PA.

In recent years, many states have passed "I'm sorry" laws, which allow physicians to apologize to their patients when an error has been made; however, these laws don't extend the same rights and protections to nurses. Review your employer's policies and procedures to learn who's authorized to discuss errors with a patient at your facility. Risk managers are trained to make apologies and have the authority to make amends (for example, by forgiving hospital bills), so they may be designated to talk with the patient and family when a serious error occurs.

If you do make an error, you could ask to be involved with risk management as a gesture of support to the patient, but don't act on your own. If you proceeded independently, your apology could be used against you and the hospital as an admission of guilt.

Whenever you make an error or have a "near miss" (meaning the error was caught before reaching the patient), you should complete an event report (also called an incident report) for the hospital's risk management team. These risk and quality experts use such reports to find ways to avoid similar hazards in the future.

In most states, event reports are still protected as risk management tools and aren't admissible in court. Still, you should keep your tone objective when writing your reports, stating only the facts surrounding the error and allowing the risk managers to analyze the situation for possible causes and solutions.

Document all nursing care associated with the error (including interventions and any follow-up care) in the patient's medical record, stating only the facts without blaming anyone or expressing your opinion. Don't mention the event report in the medical record, or it may become admissible in court if a lawsuit develops.