Did I do anything wrong?

Trauma Columnist · Sep 2, 2003

Gosh - I think what you did was fine! Stick to your guns - what you did was according to your hospital policy, right? I wouldn't worry about it - chalk it up to a bad night. Good luck.

Tweety, BSN, RN · Sep 2, 2003

Sounds like you know exactly what your scope of practice is.

She is liable for not notifying the MD because that is her practice as the RN.

The only thing I can offer is that as a patient advocate perhaps you might have followed up more diligently, because you did withhold ordered medication without an order. You might have stayed on her butt making sure she called the MD, and if she didn't you could have reported it up to the next level. But as you are under the direction of an RN, it is on the RN's head the care of the patient.

Never sign for a waste you didn't witness. You did good there.

Off topic, isn't three juices with a lot of sugar a bit overkill for a diabetic? Just asking. You know the patient, I don't.

JJFROG · Sep 2, 2003

Maybe call the MD yourself, then grab the RN to take in telephone orders.

night owl · Sep 2, 2003

Originally posted by 3rdShiftGuy
The only thing I can offer is that as a patient advocate perhaps you might have followed up more diligently, because you did withhold ordered medication without an order. You might have stayed on her butt making sure she called the MD, and if she didn't you could have reported it up to the next level. But as you are under the direction of an RN, it is on the RN's head the care of the patient.

Never sign for a waste you didn't witness. You did good there.

Off topic, isn't three juices with a lot of sugar a bit overkill for a diabetic? Just asking. You know the patient, I don't.

Thanks tweety for that info. The next time I'm riding her azz about the call!

The three cups of juice with alot of sugar? Well the machine had an arrow pointing down with 49next to it. I'm wondering if the actual reading which it never gave was below 49?? He was responsive, and not diaphoretic and I was thankful for that. So I figured an extra cup of juice wouldn't hurt too badly.

Brownms46 · Sep 2, 2003

Ultimately this TL is responsible for what you reported to her, and the fact that you held the insulin, and should've called the MD. You did exactly as you were supposed to do, but I just would've made sure she called the MD. Did she ever call the MD??

One other thing though. Why the 45 min wait to recheck the BS??

Edited to say: Sorry didn't see 3rdShiftGuy post saying the same thing! I was messing with Pepper my puppy:).

night owl · Sep 2, 2003

45 minute wait for a recheck? It seems that everytime the doc was notified about a low blood sugar he always says, "Give him the juice with sugar and do a repeat FS in 30, 45 or 60 minutes depending on the doc. I just settled for the one in the middle which was 45 minutes, but now that you mention it maybe I should have done a repeat in 30 huh. Well next time hopefully not, but I'm sure it's bound to happen, only this time I'll see that the nurse calls the doc. Maybe I'll dial the number and hand her the phone. That should work.

The day nurse said, "I'll notify the doc. Go home happy labor day!" I said, "Thanks, same to you!" and took off.

LauraF, RN, ASN, CNA, LPN, RN · Sep 2, 2003

You did absolutely the right thing with the narc sheet. If I don't see a waste, I don't sign. What is with her?

As far as the blood sugar, is there a policy against you calling the doc for change of status? You could have called him told him what was going on and what you did. Then if he had orders for you, say "I need to get the charge nurse on the other line for a telephone order, do you mind holding?" Or something nice and polite but putting it matter of factly that you could not take the phone order. But if there is a policy against you calling to notify of change in status then you did right, except I would have dogged her till she did it. I can be a pain sometimes....but I am responsible for making sure she does what needs to be done for my patient. But I also remember what those morning med passes are like. ACK!!!

Brownms46 · Sep 2, 2003

Just guess I'm used to policies for hypoglycemia that say repeat in 10-15 mins, especially if it was lower than 49. But in your place I probably would have done the same thing, in the absence of some kind of guidelines. Does your hospital have this, or do you just call the MD each time, and wait for orders??

I'm glad to read the day nurse took the responsiblity for calling the MD. :cool: . But you know nite owl iit's situations like this that we learn from.

Hopefully it was a very busy day for you both, and this won't ever come up again. And maybe she will be more understanding, since she definitely fell down on the job today, including the way she had signed out the narcs incorrectly.

kids · Sep 2, 2003

You did just fine.

(I think the new theory with the specialists for treating low blood sugars frowns on using sugar & OJ but good luck re-educating the docs)

prmenrs, RN · Sep 2, 2003

I think you did the right thing--but write a little note documenting what happened so that if it comes back to bite you (i.e., the RN reports you), you won't forget your version of what happened.

In fact, any time there's a little glitch w/a report-happy nurse, I'd keep a journal somewhere private. Then you don't have just your memory to rely on.

bluenurse · Sep 2, 2003

I would have called the doc and then if he gave orders paged RN to come and get them.

As far as signing as a witness for meds you didn't see destroyed well that is your call....I know some nurses who do simply because they trust and some don't because they don't trust. But better safe than sorry and I wouldn't sign for meds I didn't see destroyed. That nurse should know better than to expect you to do that!!!