Did I do the right thing? (long)

  1. Sorry in advance for the long post, but you need to know the events preceeding.
    Two days ago we had a Code Blue in our area & pt needed epi SQ. Myself & a fellow nurse were the first to respond. Our carts don't stock epi (a whole other issue!:angryfire) so the responding team had to go to an PACU area about 500 feet or so from us to get 2 vials to administer. Pt transferred to the ER with no further incidence. It was commented by several nurses that responded for the code that epi should be on inventory for crash carts.
    Yesterday, we had another Code Blue. Once again, I was the first responder. Pt could not get her epi pens to work. Those around her had tried 2 different pens. Attending ER doc comes up & pt is wheezing loudly by this point & on O2. I advised that epi pen malfunctioned & he ordered someone to head to omnicell for dosage. I told doc that I carry one in my purse & asked if he wanted it. I was told to get it asap. Ran back to desk, got pen, returned & adminstered epi per order. Six minutes after I injected epi, the new Officer for pharmacy comes in with epi vials. She was told pt had already received epi & to return med to omnicell. Officer demanded to know how epi was obtained & I told her it was my personal epi pen. She was furious to say the least & has threatened to write me up for the incident.
    To make a very long story a little shorter, turns out that the pt was seen in ER by same doc day before for reaction & rx'd epi then. Pharmacy here filled with above mentioned Officer actually instructing pt on using epi pens. Officer gave the pt the wrong instructions for use & that is why the pens malfunctioned!! Had the pt been at home, she would have died. When the doc found out that pharmacy was having a fit, he said in so many words that they could kiss all of our ****. Pt was sitting there & heard the entire discussion which is how we discovered she'd been given wrong instructions. Today, I went down to pharmacy to turn in our order list for tomorrow's surgeries & was asked by a friend in there what happened yesterday with me giving my pen to the pt, he had heard about from the Officer who apparently returned to her unit talking about me.:angryfire
    I feel like I did the right thing & would do it again today if the need arises. Granted, if it were any other, non-emergent issue, I would never give out personal med, but it is standard dosage with standard self-admin system. I don't feel like I am in the wrong. Should I file a variance on the Officer for giving the pt incorrect instructions that could have cost her life?

    BTW, pt sent me a fruit basket taking with note that says "Thanks for saving my life." I cried.

    Thanks & sorry again for the long post.
    Last edit by LilDKessler on Oct 4, '07 : Reason: privacy issues
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  2. 24 Comments

  3. by   RN1989
    Unless you are ready to go job hunting - do not write up the Lt. Start a log of work. Put in this incident with as many details as you can remember. Also remember to write down that the Lt. was discussing this incident elsewhere thus violating HIPPA on both you and the the other pt. Anytime you have these "interesting issues", put it into your work log. Keep your log to CYA should anything happen. If my purse was closer and made getting the drug faster than running to the machine and entering all the info and then getting the med- I'd have done what you did. In anaphylaxis seconds count. You don't know the whole story on why the wrong directions were given by the Lt. It may be that they changed how this brand worked or she may never have worked with this brand and gave instructions for a different brand. But I would not write her up unless she comes after you for this incident or starts multiple attacks on you that you can provide a paper trail for that she is trying to retaliate against you. You saved the person's life. End of story. Keep your CYA book, write in it after every shift, and get on with your life.
  4. by   BrnEyedGirl
    I'm confused,..why are you giving SQ epi to a "code blue" pt?? Epi is like first in ACLS, (IV) but not in the code cart?? A pt who "by this time is wheezing loudly & on O2" isn't coding? Did I miss something?
  5. by   abellam
    Hi LilDKessler,
    Sounds like you work in a 3rd world country. Epi should be in the code cart as it is part of the ACLS protocol and if you don't have it, you should go to the director of pharmacy and make a big deal about it. It is not the nurse's job to procure meds but rather the hospital where we work should provide it for us. The Department of Health can actually ding you if you have personal epi stocks in your own pocket. Who knows if it is really epi and they will actually check for expiration dates too. Good luck.
  6. by   abellam
    PS
    In a code situation, epi is to be given IV for rapid onset of action (and actually you have to flush w/ NS right after) rather than SQ as fat absorbtion via SQ is acutally very slow. Thanks.
  7. by   cmo421
    I have a feeling it was more a resp distress d/t allergic reaction or asthma. Sounds like a Military place also. Enough said, Epi should always be readily available. Emergency carts are defined by the area in which they serve. But if epi is first line no matter what,so should be there. If epi pens are the drug of the day then extras should be taged and kept available. I would make a nice suggestion to whoever is in charge,without making waves and I am betting u get what u need for emergencies! I work as the school nurse at a collage at night solo ,I always had epi pens in reach,cause ya never knew what would walk in the door at 3am,,,,lol
  8. by   grace90
    Quote from abellam
    The Department of Health can actually ding you if you have personal epi stocks in your own pocket. Who knows if it is really epi and they will actually check for expiration dates too. Good luck.
    If a nurse has a legitimate prescription and medical reason to carry the epi pen with her at all times she shouldn't get in trouble for having it in her posession.
  9. by   steelcityrn
    epi pens are not something I have used in a code, and I would never offer any medications from my purse to anyone in a clinical setting.
  10. by   NurseCard
    Quote from steelcityrn
    epi pens are not something I have used in a code, and I would never offer any medications from my purse to anyone in a clinical setting.
    Sounds like the OP and the MD both felt like there wasn't much choice in this situation but to use what the OP had readily available in her purse.

    Having said that, I'm curious about two things:

    1) How does an epi-pen work, as I know nothing about epi pens. When you give a patient a shot from your personal epi pen, are they being stuck with something that has also stuck you? Or no? Again, I know absolutely nothing about epi pens.

    2) I ALSO want to know, how do you have a crash cart with no epi on it? The only place I've ever seen that was in the psychiatric hospital in which I worked. We had "crash carts" but they had O2 equipment, ambu-bag, AED, blood pressure cuff... that's just about it. Everything except the meds and the intubation equipement. If someone codes in that hospital, you do CPR, use the AED, and call 911.
  11. by   MarySunshine
    Well. I'm no lawyer, but I would have done the same thing. HOWEVER, you shouldn't have been put in the situation to begin with and they need to make SURE that they fix their emergency carts!

    I wouldn't let up until you had epinephrine and epi-pens available, at hand, for emergencies from now on. Do you have a good nurse manager you can go to who can assist you in writing this stuff up appropriately without causing danger to your job? Obviously, there is a supply issue and an education issue going on and both need to be addressed. Proceed carefully though!
  12. by   ebear
    I'm puzzled by a few things here... what exactly are you calling a "code blue"? Is that respiratory distress in your hospital? Sounds like that may be the case. EpiPens would be completely useless in a true code situation and I don't know that I've ever seen them on a crash cart. Vials of epi.should be on EVERY crash cart, however. Are you saying that there is NO epi. on your crash cart???? I would CERTAINLY raise a stink about that! Hand a copy of ACLS protocol to whoever makes those decisions at your hospital and don't apologize for it!!!
    As far as the pharmacy fellow, document as the other posters said and keep your log book AT HOME. Also document the conversation with your friend who said he was discussing he situation. Keep an eye on this one.
    If I were in the same situation, with NO other options, and the pt. was in severe distress--I would probably have done the same thing! Sometime (not at all often) you just have to screw protocol to save a life. You can't just stand there and watch them crash!
    ebear
  13. by   suanna
    A far as EPI pens being on a crach cart I've never heard of such a thing. They have a use in the field for laymen use an a bridge to get to the hospital for definitine care-not as a acute care intervention- your hospital sounds a bit 3rd world to me. As for as using your personal med on a patient I'm not sure where you stand legaly but the doc said give it- his is the ultimate liability. I would have asked him to administer the dose since only a doc or pharm. can distribute meds, which is what you were doing. My best guess is that you would be covered under the good samaritan statutes as far as your licence goes but I would try to make as little of this incident as possible and hope it goes away quickly. Any hospital that is using epi pens as often as you are describing has bigger problems that you can fix.
  14. by   AlabamaBelle
    Epi Pens are one time use. I had one for bee sting allergy and my overly curious daughter deployed the thing. Huge needle, meant to be used through clothes in emergency situation while waiting for more advanced help to arrive. After seeing the needle, I decided I just take my chances with a first responder.

    Can't think of one good reason that epi (1:1000 as well as 1:10,000) isn't on your code cart. I'm PALS certified and have been in quite a few codes. Our facility does mock codes and our division (Pediatrics) holds very frequent Code classes. The situation at your facility is a lawsuit/disaster waiting to happen.

    Cindy

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