Am I In trouble?

[gwafuh_rn]

I worked last Tues,night shift (7pm - 7am). An lvn was the one who endorsed me the patients that i will be taking care during my shift.One of the pt has an order of vancomycin iv q tuesday and it was written at 02:00 pm by the pharmacist?The lvn told me that it was given already so the next dose will be next tues.Vital signs were taken by the cna.by 1200am the temperature was 102.8 as reported by the cna.I gave the pt tylenol 650 mg.By 4am it was 103.8 so I called the doctor and told that the pt has a high temp.I also told my supervisor the pt's condition.My supervisor even checked chart for present/past orders,labs,etc.Until the end of my shift,the doctor didnt call back so I endorsed it to the am nurse.wednesday afternoon,the am supervisor told me that the pt had a sepsis beacause the vancomycin was not given and is now in ICU.The pt is not in distress,just a high temp because of sepsis.Am i in trouble??!!! Hope the experienced nurses here will give me an advice..

[gwafuh_rn, BSN, RN]

the pharmacist wrote the order 0200 pm. with the word pm on it.

[RNHuskyFan]

Hi,

I agree with the other replies. I would question more why you waited to report the patients elevated temp to the doctor. By the way, was there a vanco bag in the fridge? That could have raised the question whether or not it was given. I seriously doubt this is an issue that could result in a loss of your license. However, like the others have said, a lesson learned. I also agree with the others that the cause of the sepsis is unlikely to be a few hours missed of a weekly vanco dose. Try to relax.

[gwafuh_rn, BSN, RN]

the rn who was covering for the lvn that time just called me a while ago.She told me that the lvn didnt told her that there was an order for a vancomycin.Anyways,the reason I didnt call the doctor because the pt had a prn med for elevated temp. I got worried when the pt had an elevated temp at 0400 am.That's the time I called the doctor.The rn told me that its not the reason why the pt had a sepsis because 1 bag of vanco wasn't given.

[SuesquatchRN, BSN, RN]

Honey, stop worrying. You won't let something like this slide again and really, that's all you can do.

:)

[gwafuh_rn, BSN, RN]

sorry.thanks for the help.

[island40]

One dose of Vanco is not going to keep a guy from going septic. He would probably have ended up in ICU anyway. You should have called the MD again. No response in a "reasonable" amount of time and you are required to do something about it. i.e. call him/her again, call the house superivisor and tell them you can't get in touch with the attending MD, contact the supervising MD whatever the hospital's protocol is for the chain of command so to speak. This patient deserved to have an MD on his case 24/7 while in a hospital. As the patient's advocate you were required to get him that care. As a legal consultant I would urge you to know your procedure and don't let too much time lapse from first attempt at contact to the next step.

[SuesquatchRN, BSN, RN]

sorry.thanks for the help.

No need for a sorry. I just don't want you twisted up over this. Learn to let this stuff go or nursing will eat you up.

:)

[leslie :-D]

the pharmacist wrote the order 0200 pm. with the word pm on it.

i didn't know pharmacists could write orders...

am i missing something here?

leslie

[kanzi monkey]

It sounds like a systemic error to me--that is, everyone involved was partially responsible. But only for the missed dose--not the sepsis. Don't put that on yourself.

As far as calling the doc with the temp--I'd recommend notifying someone with a temp over 102 (that varies based on the patient--sometimes I'd let them know with something lower, sometimes I'd give some tylenol, check the temp in an hour, then notify.)

A vital sign that abnormal requires a little closer attention.

Again though--the sepis...not your fault.

Learning experience experienced :)

[angel4gramma]

Pharmacist can and do write orders. I see less than yrs ago but Dr will ask them to order antibiotics per protecol depending on labs. They also order labs when the Dr misses it.

[leslie :-D]

Pharmacist can and do write orders. I see less than yrs ago but Dr will ask them to order antibiotics per protecol depending on labs. They also order labs when the Dr misses it.

wow, never knew that, angel.

never, ever saw or heard of it.

do you know why a pt would be on 1x/wk vanco?:)

(thought i'd go 2 for 2.)

leslie

[angel4gramma]

LOL, no except maybe he had renal issues. I have seen 3 times a week after dialysis but, can't recall once a week.