Absolute No-No's - page 10

Hi: I hope to get a lot of input from this question. As experienced nurses, what are some things especially related to medication administration, but anything else, that you would classify in red... Read More

  1. by   bigredrn57
    quote=Emmanuel Goldstein;2532606]There are many things you should and shouldn't do when administering medications. But the two most important IMO is to know what you're giving--- not just blindly follow an order, and never ever attempt to cover up an error.[/quote]
    Always assess your patients before giving meds. Know what is going on with your patient. Think first! Do not be afraid to ask questions. Remember, first do no harm.
  2. by   sfsn
    Just like when wasting meds, don't let another nurse cosign for you if s/he is not really paying attention. And do the same when you are cosigning for them.
    Before we administer insulin in our department, we have a policy of verifying with another RN who co-signs that you are giving the proper amount by the proper route, etc. Well, as a new nurse I once used a different type of syringe and drew up 10 times the amount of insulin than what was ordered. I showed it to my (more experienced) co-worker, she glanced over and said "okay" but she obviously wasn't paying attention! Luckily, a few seconds later my brain kicked in to gear and I realized what I had done before I administered the insulin. It was regular insulin ordered IVP, so I would have had a big problem on my hands!
    Sometimes like with double-checking blood products we just go through the motions without thinking, especially when we are busy and have our own patients to worry about.
  3. by   sharona97
    Quote from Ivanna_Nurse
    Hey All! Here are my contributions...
    Always assess your patient, not the monitor.
    Follow lines and tubing from the pt to the equipment.
    Never give something you arent familiar with.
    Never feel like you cant ask for help or that your questions are bothersome. ~They very well might keep you from making a fatal mistake.
    When doing a procedure for the first time, dont forget your policy and take the most experienced nurse with you.
    Never Ignore your gut instinct.
    If you make an error, fess up right away so the patient can be treated if necessary.

    Cheers, ~Ivanna
    Great post. Had an MA ask me to recheck a BP on a pregnant woman. I walked into the room and she was bent over obviously in distress. Listened to heart sounds and heard the biggest rub in my life, BP,P you get the picture. Told the MA I'd get your doctor in here right now, she didn't think she could interupt him. Transported out within 5 mn. Don't be afraid to follow your gut and your patients symptoms or of the doctor!
  4. by   cyndilou
    Quote from ChloeinAtl
    Ewwwwwwwwwww!!! Yuck, and Gross!
    Come to think of it, I've seen this done too. Seasoned nurses who will handle blood products, IV's (inserting), and colostomy care barehanded (I think it was the WOC nurse!!)

    As if they are truly not going to get slimed? I know that tape part is problematic, but.....
    :smackingf
    Just to add to the Ick factor...I'v seen herpes on a colostomy site always WEAR GLOVES!!
  5. by   sharona97
    Quote from Blenda
    I have to disagree with your comment that LPN's learn the exact same thing in school as RNs. In the state that I work in, AA trained RN's have 2 years of college and BSN's have 4 years of college, while LPN's have 1 year of college.
    Not always. I graduated as an LPN with an associates degree in applied science. 2 Years.
  6. by   ociusmedinfo
    I am always cautious about pushing any IV med. Especially Lasix. I've refused to push Lasix on patients that had symptoms of cardiac or kidney failure when the dose was 40 mg. Smaller doses I'd leave to a decision based on an assessment. I've refused to push Lasix and make the resident who ordered it come up and do it. He was mad but subsequently his patient's heart failure got a lot worse and she was transferred to the ICU. Taking a verbal order and then pushing something that you, as a nurse, feel is wrong will come back to you. You might not be the most popular nurse in the place but you can go home knowing that you did your job.

    I've also had docs decided that when I refuse orders that I think aren't appropriate and request that they come up and administer the med they will change their mind.
  7. by   ERRNTraveler
    Quote from ociusmedinfo
    I am always cautious about pushing any IV med. Especially Lasix. I've refused to push Lasix on patients that had symptoms of cardiac or kidney failure when the dose was 40 mg. Smaller doses I'd leave to a decision based on an assessment. I've refused to push Lasix and make the resident who ordered it come up and do it. He was mad but subsequently his patient's heart failure got a lot worse and she was transferred to the ICU. Taking a verbal order and then pushing something that you, as a nurse, feel is wrong will come back to you. You might not be the most popular nurse in the place but you can go home knowing that you did your job.

    I've also had docs decided that when I refuse orders that I think aren't appropriate and request that they come up and administer the med they will change their mind.
    How would Lasix make Heart failure WORSE? If Lasix is being given for heart failure, it is obviously to remove excess fluid, so how would giving a diuretic to remove that fluid make the CHF worse??? My guess is that the patient's CHF getting worse was not caused by the Lasix.... Also, 40mg is not that big of a dose, if we're talking some serious CHF here....

    Just my opinion.....
  8. by   ociusmedinfo
    In general it wouldn't. But giving a 40mg dose push is not a good idea when you have cardiac complications. The day I got the order I called the pharmacist for his opinion and he suggested a lower dose would probably be better. One side effect of that much Lasix is hypotension. Given the heart condition and the fact that her cardiac output wasn't that great to begin with the lower dose over a period of time was more prudent.

    My point was really when following instructions without question or doing something that you may consider risky is never a good idea. The resident's decision not to come and push the Lasix was and my decision to call and talk to a pharmacist was probably a good intervention for this patient. Of course I got taken to task for questioning this resident. I know we've all be asked to do something that we weren't sure was the best idea given the patient's condition and that a lot of docs would blow up and complained because we just didn't get on with it, but I don't subscribe to that notion.
  9. by   pickledpepperRN
    Great advice here!

    One more that we used to do in the 70s.
    Don't give a placebo.
  10. by   rnparrot
    Quote from Blee O'Myacin
    I want you to remember this statement when you have an 8 patient assignment on a floor when you are supposed to only have 5, the CNA and the Unit Clerk are out sick with a stomach virus which you know you will have tommorow. Your med pass is an hour behind, your three incontinent patients all need to be changed, two IVs just blew, one patient has a bp of 89/55 and the house intern hasn't responded to two pages.

    I'm not saying you shouldn't do three checks and keep the six rights in mind, but don't say "never' until you've been there.

    And I work in the ER, and I'd especially never give a med I didn't pull myself. It's too hectic. The only exception was a code when I gave tPA that was pulled up by the nurse standing next to me.

    So what do I 'never' do? I never let myself get upset over a situation. I roll up my sleeves and do what has to get done. I also never put off my charting because I'll forget something important. I also never "forget" to take a break and use the ladies room. I never let a coworker flounder without help - even if I'm overloaded as well.

    Blee
    i would have to agree with you on this one...i work in LTC...with 21 patients, 2 cnas who have to feed them, change them (several times) and get them all into bed. no problem right? add in some one or two falls, skin tears, calling drs. and family members....and i almost forgot get out on time because OT is unheard of!!!
  11. by   FranEMTnurse
    Quote from rnparrot
    i would have to agree with you on this one...i work in LTC...with 21 patients, 2 cnas who have to feed them, change them (several times) and get them all into bed. no problem right? add in some one or two falls, skin tears, calling drs. and family members....and i almost forgot get out on time because OT is unheard of!!!
    When I was in training, I asked one of the staff what they do if they get behind in their work, and the staff member told me they just leave the resident in bed.:trout:
  12. by   buggal1989
    Quote from ruby vee
    prior to about 1985, we did everything without gloves. there weren't any gloves available for us to use except the one box that was kept in the dirty utility room for the intern to use when they did a rectal exam. once you've spent a decade doing nursing care without gloves, sometimes you forget to don gloves before hanging blood, and as for starting an iv -- i learned without gloves. i have a lot of difficulty starting them with.
    oh, but they weren't gloves - just finger cots (think of a condum for your finger!).

    never ever not wash your hands - it takes 2 mins and can prevent infection - you and your patients!!!!! and gloves are not 100% protection - they have holes and can tear!!! not shouting - just got stuck on the cap lock key!
    Last edit by buggal1989 on Dec 29, '07 : Reason: add more
  13. by   buggal1989
    Quote from ociusmedinfo
    I've also had docs decided that when I refuse orders that I think aren't appropriate and request that they come up and administer the med they will change their mind.
    And don't let 2 yr residents (teaching hospital) ignore the pts BP when you've called and called (ok - just twice) - and then let him gripe at you when the 4th year comes up and yells (and you know what he yelled!!!) at him over the BP when 2 yr. blames you (charting is great to show you've called and was picking up the phone to call the Medical Director when they floated into the ICU). And DON'T let him tell you how to mix Nipride when you know perfectly well the mix is WRONG and the drops per min are WAY TOO LOW to do any good. Stomping on his toes will make him leave you alone!

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