Absolute No-No's - page 3

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   Sassy5d
    Hmmm.. How about.. Never pre pour your pills... I have yet to figure out how that worked. I tried doing it one time and I ended up giving the wrong cup of meds to the wrong person.. Not to mention, I noticed a lot of my coworkers who do that, can't remember the right way to do it when they get inspected.I know it's sometimes hard, especially when you're really busy and you're giving a lot of pills.. But pay attention to each pill you're giving... It turns your cheeks quite red when a pt asks you what the lil red pill is and you just give them the deer in the head lights look because you have no idea.Don't ever give insulin BEFORE you check the blood glucose..Yup seen someone do that...I've also seen a nurse, I kid you not.. add water to a pureed meal and dump it in a tube feed bag.. The pt was a feed and got a bolus if they didn't eat 50% so they just watered it up and dumped it in their bag.. Yuck!Never chart on something you've gotten in report unless you HAVE to! I had an order to straight cath a pt and I got in report from 2 nurses that they both attempted without luck. It wasn't charted and I went ahead and charted that straight cath was attempted previously x2 without results... Another nurse asked and the pt said it was never attempted.
  2. by   TheCommuter
    Quote from Aprilhere
    Never assume the new LPN working with you on a team knows this. You might have a beta blocker given to a pt with a HR of 48, and SBP in the 80's.
    During my time in the LVN program, we were all taught to obtain BPs and pulses on patients who took cardioactive meds prior to administering them, and to obtain apical pulses on patients who were receiving digitalis therapy prior to giving the Lanoxin. And we were instructed on the precise reasons for taking these actions.
  3. by   FireStarterRN
    Never give more than one pill of something without checking the original order, or verifying what a normal dosage is. Three or more pills is a real red flag!
  4. by   showbizrn
    [S]Never give a med you don't know.
    Never medicate a patient you don't know.
    Never administer meds when you don't know YOUR name, date, place, time and circumstance.
    AMEN.:spin:
    [/S]
  5. by   I love my cat!
    Remember that not all pills can be crushed or cut in half and not all capsules can (should) be opened (may be enteric coated, SR, etc.).
    This is a BIG one to be aware of in LTC where many patients will not or cannot swallow whole pills/capsules.
    I've seen Nurses crush/cut medications that should not have been because the Pharmacy sent the wrong meds. The Nurses wanted to give the medications rather than contacting the MD and the Pharmacy for the correct order.
  6. by   cmo421
    Never take the role of giving meds lightly. Too often after passing meds for years,nurses become complasent. Mistakes are most often made when we think things are routine. Distractions play a huge part in errors. Stop what u r doing and switch gears until u can completely concentrate on the MAR and meds. We multitask so often,put this is one area that requires 100% attention. Consequences often depend on the error and pt condition,etc,,,, They vary and are too munerous to mention. Avoid the consequences by valuing the importance of med giving. ( we all have made mistakes, most of us are just lucky that no one died or became gravely ill because of it)


    Christine
  7. by   Ruby Vee
    never ever lie!

    never flush a hickman line with 10 cc of kcl (20 meq) rather than 10cc of ns. the patient arrested.

    don't lie about what you've done when you are horrified to find that the syringe in your hand says "kcl" rather than "ns."

    never push a gram of lidocaine for pvcs. (ok, this probably wouldn't happen now, but 20 years ago our ccu got three patients from a smaller hospital in a six month period, all of whom had their pvcs "treated" with a gram of lidocaine. correct dose would have been 100 mg.) and when all cardiac (and other) activity ceases on said patient, never hide the gram syringe and claim "i only gave 100 mg."

    never give blood without checking the patient's name band. no it isn't the same thing to check against the addressograph plate in the hallway. especially not when mrs. roberts and mrs. charles are in the same room. mrs. charles did not benefit from mrs. roberts' blood -- in fact, it was quite detrimental. (and never ever say "i told you so" to your preceptor, who insisted that checking blood against the addressograph plate was acceptable and was quite angry with you when you refused to participate!)

    never lie about how the transfusion reaction occurred.

    never mistake nitropaste for hand lotion.

    if you drop a bottle of nitroglycerin on the floor, never ever attempt to pick up the glass shards with your bare hands. really. just don't do it. the headache is punishment enough, but listening to your co-workers tell the story over and over about how you (pristine in your new white dress uniform and white hose) wound up on the floor with your legs in the air is excrutiating!

    and if you are allergic to pcn, never ever attempt to mix up a piggyback with your bare hands. never spike a piggyback with your bare hands. never inject too much air into the bottle when reconsituting pcn, causing the bottle to explode into your face.

    (you'd think after the first trip to the er with hives and respiratory distress i would have learned.)

    and last but not least, never ever lie! your patients are amazing creatures and can survive all sorts of med errors. but only if you own up to it as soon as you discover your mistake and set about doing all that is humanly possible to correct it. if you lie and try to cover things up, a near-fatal drug error can become fatal.


  8. by   pagandeva2000
    This is a wonderful thread...priceless....
  9. by   Chloe'sinNYNow
    Ruby Vee,
    sounds like a road of hard knock experience you speak from. thank you for being courageous and speaking out. I didn' t know all this either and hopefully now I won't make the same mistakes.

    :flowersfoChloe
  10. by   AprilRNhere
    Quote from TheCommuter
    During my time in the LVN program, we were all taught to obtain BPs and pulses on patients who took cardioactive meds prior to administering them, and to obtain apical pulses on patients who were receiving digitalis therapy prior to giving the Lanoxin. And we were instructed on the precise reasons for taking these actions.
    I'm sorry. I didn't mean for that to sound like LPN's didn't know this. Just that we shouldn't assume.
  11. by   sleepyndopey
    Quote from ChloeinAtl
    Dang! I knew in my gut this was wrong!!! Are they hiring where you are sleepy n dopey? Like I said, I quit yesterday morn. But not in time to prevent physical illness. Just got word fr doc's office of occult bleeding to accompany what sent me to ER last Friday night of straight pee bleeding!!!

    Scared and out of work and determined to watch pills go down,
    Chloe
    I hope you are okay Chloe! Please take care of yourself. As for if they are hiring where I work, yeah, they are, but believe me-my place of work has issues of it's own. Plus, from your name I assume you are in a warm climate. There is snow on the ground here in NJ.
  12. by   Chloe'sinNYNow
    Quote from sleepyndopey
    I hope you are okay Chloe! Please take care of yourself. As for if they are hiring where I work, yeah, they are, but believe me-my place of work has issues of it's own. Plus, from your name I assume you are in a warm climate. There is snow on the ground here in NJ.
    Oh hun, I MISS snow. It's lousy traffic commutes, nasty attitudes, bigotry, high cost of living, snobbery, pissy attitudes (oh drat, did I mention that twice? Harumph!), crime, etc...that I can do without.

    I'm in metro Atlanta and just quit a job in redneck territory. They filmed Deliverance there! And they still have Klan meetings. I kid you not. I hid my Jewish horns.

    We get ice here, and the whole town shuts down for days after they clean out the Kroger from bread and milk.

    I'm running at the first sign of work! Thank you for your kind words, but the mystery illness prevails.

    :icon_hug:
    Chloe
  13. by   smk1
    Quote from ruby vee
    never ever lie!

    never flush a hickman line with 10 cc of kcl (20 meq) rather than 10cc of ns. the patient arrested.

    don't lie about what you've done when you are horrified to find that the syringe in your hand says "kcl" rather than "ns."

    never push a gram of lidocaine for pvcs. (ok, this probably wouldn't happen now, but 20 years ago our ccu got three patients from a smaller hospital in a six month period, all of whom had their pvcs "treated" with a gram of lidocaine. correct dose would have been 100 mg.) and when all cardiac (and other) activity ceases on said patient, never hide the gram syringe and claim "i only gave 100 mg."

    never give blood without checking the patient's name band. no it isn't the same thing to check against the addressograph plate in the hallway. especially not when mrs. roberts and mrs. charles are in the same room. mrs. charles did not benefit from mrs. roberts' blood -- in fact, it was quite detrimental. (and never ever say "i told you so" to your preceptor, who insisted that checking blood against the addressograph plate was acceptable and was quite angry with you when you refused to participate!)

    never lie about how the transfusion reaction occurred.

    never mistake nitropaste for hand lotion.

    if you drop a bottle of nitroglycerin on the floor, never ever attempt to pick up the glass shards with your bare hands. really. just don't do it. the headache is punishment enough, but listening to your co-workers tell the story over and over about how you (pristine in your new white dress uniform and white hose) wound up on the floor with your legs in the air is excrutiating!

    and if you are allergic to pcn, never ever attempt to mix up a piggyback with your bare hands. never spike a piggyback with your bare hands. never inject too much air into the bottle when reconsituting pcn, causing the bottle to explode into your face.

    (you'd think after the first trip to the er with hives and respiratory distress i would have learned.)

    and last but not least, never ever lie! your patients are amazing creatures and can survive all sorts of med errors. but only if you own up to it as soon as you discover your mistake and set about doing all that is humanly possible to correct it. if you lie and try to cover things up, a near-fatal drug error can become fatal.



    this is such good info. i am very allergic to pcn and probably wouldn't have thought twice about priming/spiking and hanging pcn and the possiblity of getting a little on me. :uhoh21:

    never ever assume you know what a drug is based on part of the name. not all 'olol's are beta blockers and not all 'ipines are calcium channel blockers and not all 'prils are ace inhibitors. look up drugs you aren"t sure of!

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