[htrn]

OP with new comment

We have a new MDA that I worked with for the first time last noc. Called him to notify him of a low BP (both mom and baby asymptomatic) and he asked me to turn down the pump. If other threads had not taught me the lesson, this tragedy certainly has.

I nicley told him I do not touch epidurals, but in my mind I was screaming - NO WAY, I WILL NEVER TOUCH AN EPIDURAL, I WILL NEVER TOUCH AN EPIDURAL, I WILL NEVER TOUCH AND EPIDURAL!!!!!!

[tdr61]

Originally Posted by k_cole21

I thought AWHONN guidelines state that RNs should not "touch" running epidurals for labor patients. I traveled to a place once where the labor RNs hung the meds & set the pumps. I refused to do it. I asked the anesthesiologist to program the pump & he didn't know how!

That is exactly what the AWHONN guidelines states. I too worked at a hospital where the nurses placed the epidural bags in the pump, programmed it and started it as well we turned it up or down....the anesthesiologist had no idea how to run the pumps either. The staff nurses there had no problems disregarding guidelines but I refused to...needless to say I don't work there anymore. I would caution any OB nurse to think twice before touching an epidural infusion other than to turn it off...if something were to happen, in most cases you would stand alone in a court of law.

[klone]

Originally Posted by Dani989

It bothers me that RNs pass the responsibility onto the CRNA or MD. They can make a mistake just as easily. We should instead be looking at ways to improve our own practice.

We "pass the responsibility" because it's not within our scope of practice to manage epidurals. That's why CRNAs and MDs have much more schooling and get paid a lot more - because they have a greater responsibility. If I'm going to take on the responsibility that rightfully belongs to the MD, then I darn well want his paycheck, as well.

[PICC ACE]

This is a horrific tragedy. A lapse in care by one nurse has taken one life,devastated many others and sullied the reputation of an otherwise excellent hospital.
The scanning of medications and a patient's barcode represents an over reliance on technology to assure patient safety. Ultimately,it is the nurse and not the scanning system that failed. The epidural medication was given by the wrong route. It is irrelevant that it wasn't scanned properly--the scanning machine doesn't perform the administration.
This was not a system error,it was a nurse error. The epidural pump is nothing like an IV pump. Epidural tubing has a yellow stripe on it. The epidural bag had a bright neon pink sticker that says "CAUTION EPIDURAL". How so many precautions were missed is beyond my comprehension.
When this story came out,I felt sick about it for days. I work with plenty of epidurals,as well as hundreds of IV meds. Just one momentary lapse of concentration while administering medications,just one violation of one of the 5 rights,could prove fatal for the patient. This thread should go in to every single forum,because in the end we nurses are the ones administering medications to patients,we are the ones responsible for their safety,and we all need to recognize that mistakes can occur despite the best-made plans to prevent them,and that these mistakes can kill.
Ora pro nobis.

[zcl12]

This error has happened twice on our unit in the last year! Our epidural bags have bright pink stickers on them, these nurses were just in a hurry and very busy and forgot the five r's. THANK GOD NOBODY DIED. We are now looking into having anesthesia removing the bags without the rn or going to a syringe system. I feel bad for the nurse, unfortunately mistakes happen. I feel worse for the family however.

[Spidey's mom]

We don't have epidural bags. The CRNA places an epidural, pushes the med and leaves. In order to re-dose when it wears off, we call the CRNA or the doc.

Maybe that is a good idea. . . . . .

steph

[SmilingBluEyes]

Steph, I beg to differ. Where I worked when this was done (initial infusion/bolus of epidural followed by re-bolusing PRN) way too often, the epidural wore off by the time the CRNA/MDA got around to re-bolusing and like the proverbial snowball rolling downhill, the pain got way out of control and often, was never brought back under control again.

I like continuous infusions. They are usually very reliable and require little to no tinkering after initial placement. Boluses of medication always carry risks, inherent with initial placement. You have to watch the vital signs and FHTs very closely afterward, cause you will often see hypotension and resulting FHTs decels. Smaller, continous doses are much safer.

Continuous infusion plus educated use of PCEA is the way to go, from where I stand.

[Danianne]

I have to say that it is really sad that errors like this can happen. I am a CNA and if I made an error that caised harm to a resident then it is MY fault and I would not LET the R.N. take any responsibility. Our facility just started to use the barcode system. I have had med erros happen to me personally (student) gave me tylenol#3 instead of reg tylenol even though my chart stated allergy to coedine and I had a massive bad reaction, also I had a bad kidney infection and told them I was allergic to Cipro and they "knocked me out" hung bags of Cipro for three days and were wondering why I was covered in hives and scratching my body until it bled. mistakes happen BUT try to avoid it when you can

[Spidey's mom]

Originally Posted by SmilingBluEyes

Steph, I beg to differ. Where I worked when this was done (initial infusion/bolus of epidural followed by re-bolusing PRN) way too often, the epidural wore off by the time the CRNA/MDA got around to re-bolusing and like the proverbial snowball rolling downhill, the pain got way out of control and often, was never brought back under control again.

I like continuous infusions. They are usually very reliable and require little to no tinkering after initial placement. Boluses of medication always carry risks, inherent with initial placement. You have to watch the vital signs and FHTs very closely afterward, cause you will often see hypotension and resulting FHTs decels. Smaller, continous doses are much safer.

Continuous infusion plus educated use of PCEA is the way to go, from where I stand.

I was kidding . . . I've always thought "walking epidurals" or continuous infusions were the way to go. Our CRNA lives about 10 minutes from the hospital and that can be a lifetime for a woman in pain.

I was shocked when I had my son 5 years ago - my ob said I could have my epidural and the CRNA walked into the room 60 second later . . . too cool.

steph

[SierraN]

Originally Posted by klone

We "pass the responsibility" because it's not within our scope of practice to manage epidurals. That's why CRNAs and MDs have much more schooling and get paid a lot more - because they have a greater responsibility. If I'm going to take on the responsibility that rightfully belongs to the MD, then I darn well want his paycheck, as well.

Hi - where can I find the info about what's in our scope of practice. I'm an Alabama nurse and am having a hard time finding where it says in our Nurse Practice Act that we can't turn down the epidural pump setting. At our hospital we are often instructed by the MD to turn the epidural down because the patient is to numb to push. Sometimes we have to turn the pump off completely they're still numb after two hours! (But that's an entire other story...)


Edit - nevermind - i just found our (Alabama's) nurse practice act on line - we are allowed to adjust the pumps settings and change out the bags - just not give a bolus.