I had a patient come to the floor with an active GI bleed. There was a hx of a recent bleed - tarry stools and emesis. The pt had these symptoms while in the ER - stabilized with a BP of 113/56 in the ER and was moved to my floor about 6 hours later.
His BP was 112/60 when he came to our floor. He was admitted - orders were to place an NGT, Foley and administer 2 units of PRBCs upon arrival. I had him sign the paperwork for admission and sign the consent for the blood transfusion. Pt was resting quietly. Three hours after arrival, the pt had a tarry stool and vomited 150 mL of bright red blood. I made a mistake in thinking I could monitor this - thinking that since the pt had demonstrated these symptoms in the ER, that the physician was aware and that if this continued, I would call to have the pt moved to ICU. The pt had no more episodes of vomiting for the remainder of my shift.
The pt received 1 unit of PRBCs on my shift. His BP began to come up as he received the blood. I mistakenly thought that all was well with this patient and that I could continue to monitor him. At shift change, the physician came in wanting to know why I hadn't called regarding the bloody emesis. To be honest, I didn't know any better - thinking that she was aware of the pt's condition and also that I would continue to monitor the patient.
She said there was an order to call if the pt's SBP was < 90. Sure enough, I missed that. The pt's BP was lower than that and, yes, I didn't call - because I missed that order.
I just don't know what is wrong with me. It's been a while since I've written in and seem to only write in when I mess up. I am being told that this is a learning experience as I've never dealt with a GI bleed before - and yet - I there is no excuse for this. I do not feel like a good nurse and do not feel the least bit trustworthy. All I want is to do this well and it seems that no matter what I do - it's never enough or good enough.
Thanks for listening.