i did so many errors today.*needing comfort guys - page 3

i'm a new grad and i've been orienting for about 8 weeks now.I should hve been starting my night orientation 2 weeks ago but i guess i'm not doing well so my preceptor suggested to my manager that it... Read More

  1. by   P_RN
    Quote from faithmd
    And while pockets aren't the Omnicell (or Pyxis), I also use my pocket (but a front one, I've seen someone sit down on a PCA vial before-ouch!) to store something in that I'm going to hang within a half an hour or so. Much better than setting it on the counter.
    Did anyone not notice this?

    You cannot put a narcotic in your pocket for ANY REASON! That's why they're CONTROLLED SUBSTANCES.

    From the order, to the Pyxis, to the Nurse's HAND, to the patient is the ONLYcorrect path.
  2. by   Mags4711
    Quote from P_RN
    Did anyone not notice this?

    You cannot put a narcotic in your pocket for ANY REASON! That's why they're CONTROLLED SUBSTANCES.

    From the order, to the Pyxis, to the Nurse's HAND, to the patient is the ONLYcorrect path.
    Okay, as I said, pockets are NOT the ideal place, but if I have just gotten back from picking up my narc in pharmacy as the OP inferred (in her second post) was the case for her, and I am on my way into the room to put the syringe in the pump, I will put it in my pocket. Why find someone to witness me putting it in the OmniHell, to take it out within mere minutes once I've gathered whatever I need to take with me to the bedside? I NEVER carry ANY medication for more than one patient at a time, and again, I never carry it for more than a couple of minutes, if I do it at all. I am NOT advocating that this is the way to practice.

    The point here is that the OP left TWO vials of something very dangerous at a bedside, and while the pocket isn't the ideal place, it would have been better for her to put it in one than to set TWO vials of Dilaudid (hydromorphone) at a patients bedside. Not that either is right, I guess it's the lesser of the evils.
    Last edit by Mags4711 on Feb 19, '07
  3. by   GardenDove
    Quote from P_RN
    Did anyone not notice this?

    You cannot put a narcotic in your pocket for ANY REASON! That's why they're CONTROLLED SUBSTANCES.

    From the order, to the Pyxis, to the Nurse's HAND, to the patient is the ONLYcorrect path.
    I had never heard this specific rule. I don't remember if I actually have done it, probably have if I was interrupted on the way to the pt's room. But I never had anyone tell me that it was a no no.

    Sometimes there is an emergency on the way to the pt's room that would necessitate stashing a narc quickly in a pocket.
  4. by   GardenDove
    I was curious why the OP HAD two PCA vials at one time. When I replace a PCA vial, or start a PCA, I only have one vial, and I go directly and replace it to stop that God awful beeping.
  5. by   PralineLPN
    I don't know if you are kiddding about these mistakes or not. If you are being serious, this thread makes me nervous. I handle narcotics with utmost care. I stop and clear my mind, breath for a second or two, do 3-4 checks on my narcotics, then check my narc documents twice, I don't care how busy I am. Leaving a Tums in a pts room is one thing, but 2 vials of Dilaudid left in the room is not good.Not knowing the generic name for Dilaudid is hydromorphone, as the other nurse pointed out is scary in itself. These powerful narcotics will literally kill a person if you mess up the doses and names. You'll lose you license over that kind of carelessness. Pick up a drug book. Don't take this personally, but just stop and think about what you do first.
  6. by   Mags4711
    Quote from GardenDove
    I was curious why the OP HAD two PCA vials at one time. When I replace a PCA vial, or start a PCA, I only have one vial, and I go directly and replace it to stop that God awful beeping.
    I wondered that too, GardenDove. Here is her response to that question from the first page:
    "The two vials was suppose to be reserve i requested it early from the pharmacy because it usually takes them a long time to send up a new vial."

    I still don't get it, and if I had two vials for reserve, I wouldn't be carrying them around with me, they'd be in the Omnicell. I never did catch if she was hanging a vial then, or was just carrying the extras around and sat them down.

    In any case, she'll not forget this, I'm sure it will help her to be more careful with her meds.
  7. by   jjjoy
    In school, the instructors are just as vigilant about the ducolax as the narcotics. I don't know if it's the OP's issue or not, but as a newbie I was nervous about doing ANYTHING wrong and always seemed to be too slow. I was hypervigilant about everything, making it difficult to prioritize.

    I'm very good at imaging all the possible ways I could make mistakes. In this case, I can imagine getting two vials for a patient from pharmacy. I go to the room first to check if the PCA needs a replacement yet before putting them into the Pyxis just to take one right out again 10 minutes later. In the room, the roommate is looking kind of pale and not as perky and alert as earlier. I go to that patient to assess them. I decide to check their O2 sat and go out to find the the Pulseox. I return with the pulseox, find the O2 sat okay. I decide I want my preceptor to assess the patient because I'm not sure what to make of this change of patient status. The preceptor comes in and the roommate now asks about these two vials I left there. Doh!

    And if someone says, well, once you ascertained that patient #2 wasn't in immediate danger, you should've put those vials away before getting the pulseox. I them imagine myself putting the vials away and then having a CNA come tell me that another patient is requesting pain meds. Since I'm in the med room, I check to see if they're due for a PRN. They don't seem to have a PRN ordered which seems odd, so I go to check the chart and notice that the PRN order was missed so I flag it for the unit secretary and notice some new stat orders on one of my patients. I check the Stat orders and get started on that. Twenty minutes later I see a pulseox... sinking feeling in stomach... I run back to patient #2 with the pulseox and find low O2 sats, I get my preceptor who questions my nursing judgement and prioritizing because I wasn't on this as quickly as I should've been...

    Or in the med room, I put the narcotics away, note the CNA message that patient #3 wants pain meds but go right back to the room with the pulseox. The O2 sats are a little low and I get my preceptor because I'm not comfortable with this change in status. She says we'll continue to keep a close eye on the patient. She tells me there are some new stat orders to check. I go check those and take care of them... half an hour later, my preceptor asks if it's true that I'd been aware of patient #3's pain for over 30 minutes and hadn't been in to check on them personally?

    Sigh!
  8. by   PralineLPN
    Quote from jjjoy
    In school, the instructors are just as vigilant about the ducolax as the narcotics. I don't know if it's the OP's issue or not, but as a newbie I was nervous about doing ANYTHING wrong and always seemed to be too slow. I was hypervigilant about everything, making it difficult to prioritize.

    I'm very good at imaging all the possible ways I could make mistakes. In this case, I can imagine getting two vials for a patient from pharmacy. I go to the room first to check if the PCA needs a replacement yet before putting them into the Pyxis just to take one right out again 10 minutes later. In the room, the roommate is looking kind of pale and not as perky and alert as earlier. I go to that patient to assess them. I decide to check their O2 sat and go out to find the the Pulseox. I return with the pulseox, find the O2 sat okay. I decide I want my preceptor to assess the patient because I'm not sure what to make of this change of patient status. The preceptor comes in and the roommate now asks about these two vials I left there. Doh!

    And if someone says, well, once you ascertained that patient #2 wasn't in immediate danger, you should've put those vials away before getting the pulseox. I them imagine myself putting the vials away and then having a CNA come tell me that another patient is requesting pain meds. Since I'm in the med room, I check to see if they're due for a PRN. They don't seem to have a PRN ordered which seems odd, so I go to check the chart and notice that the PRN order was missed so I flag it for the unit secretary and notice some new stat orders on one of my patients. I check the Stat orders and get started on that. Twenty minutes later I see a pulseox... sinking feeling in stomach... I run back to patient #2 with the pulseox and find low O2 sats, I get my preceptor who questions my nursing judgement and prioritizing because I wasn't on this as quickly as I should've been...

    Or in the med room, I put the narcotics away, note the CNA message that patient #3 wants pain meds but go right back to the room with the pulseox. The O2 sats are a little low and I get my preceptor because I'm not comfortable with this change in status. She says we'll continue to keep a close eye on the patient. She tells me there are some new stat orders to check. I go check those and take care of them... half an hour later, my preceptor asks if it's true that I'd been aware of patient #3's pain for over 30 minutes and hadn't been in to check on them personally?

    Sigh!
    What?? Sounds like you're making life a little too complex.
  9. by   smk1
    Quote from WeeBabyRN
    I took this to mean the words. I thought she was saying that she doesn't use the word dilaudid, she uses the word hydromorphone, because that is what it is called in the pyxis and that is why she spelled dilaudid wrong.
    This how I read it as well.
  10. by   smk1
    Quote from faithmd
    Sorry folks, I don't agree, read the line after "pyxis"
    I just thought that she meant she hasn't used dilaudid/hydrmorphone on a PCA pump before, not that she hadn't given it via other routes.
  11. by   Ann RN
    Nurses who "pocket" narcotics can be accused of diversion. Everyone should know this. Nurses that do divert often put narcs in their pocket, later claiming that they "forgot". So be careful. The excuse "I forgot" may not be good enough.
  12. by   PANurseRN1
    Quote from GardenDove
    So? She hadn't done a dilaudid PCA before, so what? She's probably given it IV. I've never done a dilaudid PCA yet because we haven't switched to that yet, but I give it IV all the time.

    Anyone can make an absent minded mistake like this once. She's new and has a nitpicky preceptor breathing down her neck. I'll bet she never does it again!
    I disagree. Those were not "nitpicky" mistakes. Almost bolusing someone with an IV abx? Leaving controlled substances at the bedside? You'd better believe that preceptor has a right to be watching the OP like a hawk. If anything adverse were to happen, the preceptor could get caught up in the mess that ensued.

    I think the OP needs some remedial education. Maybe she'd feel less stressed with a new preceptor, but I absolutely disagree that the preceptor is unduly giving her a hard time.
  13. by   PANurseRN1
    Quote from SMK1
    This how I read it as well.
    No, because she pointed out that while she was familiar with hydromorphone, this was the "first time" she'd ever worked with a Dilaudid PCA.

    I don't understand that at all. And leaving that aside, there remains the issue that she was willing to prepare a PCA with a drug she was unfamiliar with. Big no-no. You never give a drug if you don't know it...period. There are no exceptions, ever, to that.

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