Had my first grievance, not very happy...

Double-Helix, BSN, RN · Jun 21, 2012

Do you do chart checks during your reports? If you don't do them with the nurse going off shift, it's a good idea to get in the habit of doing them yourself.

In our chart checks, both the receiving nurse and the endorsing nurse go through the doctor's orders (at least the last 24 hours) together. The endorsing nurse has the chance to explain any orders and state whether they were carried out or still need completing. Then we go through the MAR to make sure both nurses are aware of what medication need to be given and that all previous medications were given.

While it's most beneficial to do this with the other nurse, it will also be helpful to you to do this on your own at the beginning of your shift. This will ensure that you know what has been ordered and what still needs to be completed.

I'm glad your patient was okay, because a delay of more than 15 hours between the ordering of a medication and administering it is a serious medication error in my hospital. If the patient had had a medical condition where immediate administration of fluids and antibiotic were indicated, the situation could have been much worse.

Esme12, ASN, BSN, RN · Jun 21, 2012

:hug:.....we all live and learn. Sometime it is the ones we least expect that will give us grief. Ashley has great advice. This is actually what "Walking Rounds" are supposed to cover. You go over the IV's and fluids, assessment at the bedside, check PCA pumps go over orders at the bedside ....the you can finish the "other" stuff away from the patient.

One of the first things I have always done was check my patients orders for the last 24....it has saved me more than once.

It's ok...we all make mistakes it's what we learn from them that's important.

LynnLRN · Jun 21, 2012

Did you know the meds were due and then choose to do other tasks first and give the meds later? What time did you do your assessment at? I'm assuming you started at 7pm? I'm assuming (or hoping anyway) you did your assessment prior to 11pm at night, could you have brought in her IV fluids and meds at that time? Maybe you should look at your work flow and see how you can change your patterns to be more efficient. I feel like it would be very important to get IV fluids started on that patient as soon as they got to the floor, besides having a patient actively having a heart attack or coding or something idk what you would have been doing that takes priority over a new admit?

I say just take her complaint as a learning opportunity and evaluate your practice and what you can do better.

Bec7074 · Jun 21, 2012

I'm sorry. I would be bitter too. As a nurse, you would think she would understand. I've also never been in severe pain, though, so I don't really know how I'd react. Maybe she was just "throwing her weight around" a little since she worked there. It's hard to tell why people act why they do sometimes.

Chart checking is a great suggestion so you know what's been done and what hasn't. Another suggestion is to prioritize and make lists. Having a new admit and other patients to care for is challenging. Whenever I have a new admit, whether I admitted them, or they arrived just before shift change, I look through the admission orders and make a list of what's left to be done. Even if you didn't have much time to look at the chart, you would probably realize that for someone with kidney stones, hydration and antibiotics are very important. Some facilities will even check to make sure that antibiotics have been started within so many hours after admission--it's important for some statistic (I think it's correlated with lower cost of care maybe) or another (as well as for the patient!) Therefore, I would have started those things as soon as possible, and then maybe went and saw my other patients before going back to my list to finish the admission stuff. Our unit secretaries sometimes get annoyed if they're trying to put in orders and I want to briefly glance at the chart, but it helps you get the care your patients need started faster. You'll get better at this kinda stuff. Keep your chin up. It's just one patient. I think we all have had had a patient complain about us at one time or another. Live and learn.

morte, LPN, LVN · Jun 21, 2012

the patient came in at 650 PM and got the meds around 11 PM right around 4 hours, not fifteen.....I think.

Do you do chart checks during your reports? If you don't do them with the nurse going off shift, it's a good idea to get in the habit of doing them yourself.
In our chart checks, both the receiving nurse and the endorsing nurse go through the doctor's orders (at least the last 24 hours) together. The endorsing nurse has the chance to explain any orders and state whether they were carried out or still need completing. Then we go through the MAR to make sure both nurses are aware of what medication need to be given and that all previous medications were given.
While it's most beneficial to do this with the other nurse, it will also be helpful to you to do this on your own at the beginning of your shift. This will ensure that you know what has been ordered and what still needs to be completed.
I'm glad your patient was okay, because a delay of more than 15 hours between the ordering of a medication and administering it is a serious medication error in my hospital. If the patient had had a medical condition where immediate administration of fluids and antibiotic were indicated, the situation could have been much worse.

mjs2118 · Jun 21, 2012

No, the patient got her morphine at 7 something before I was even done getting report altogether because I had to override the system. She got her pain meds right away... Where I work, a lot of times we don't even get done with report until 8pm, so we don't get things in full swing till then. I always see all of my patients right after getting report, and I usually do my assessment first thing and pass meds at that time as well. As for the new admit that got there at shift change, I should have at least started the fluids, I'm not sure how that didn't happen, it's been a while. As for the anitibiotic... I first have to wait for pharmacy to send it, which takes a while sometimes at my facility... And I don't think I mentioned this earlier, but before I could start the antibiotics, the patients IV went bad even though I had flushed it when I gave the morphine earlier, which I guess could have contributed to getting the anitibiotic going a little later... So yes, from 8pm to 11pm in the world of nursing is hardly any time at all.

Been there,done that, ASN, RN · Jun 22, 2012

You acted promptly administering the analgesic. What was her pain level after that?

This could be a contributing factor... kidney stones are one of the most painful human conditions.

What is your facilities policy regarding the time frame to begin new medication orders? Unless they are ordered stat, 2 hours is usually the acceptable time frame. How long did it take for the IV to be restarted? Did you restart it, or call the IV team?

How was the need for a restart a contributing factor to the delay?

And, what have we learned here?

If you are taking care of a nurse(from your hospital or not) she will be observing you with a trained eye. She MAY also expect to be on the top of your priority list.

I think you performed alright. I hope your manager understands that this scenario involves a newbie v.s. an established nurse.

I have been a nurse for 30 years.. I would not have written you up.

Good luck, keep us posted.

jadelpn, LPN, EMT-B · Jun 22, 2012

If she got her pain med on time (and yes, she did have to remind you that you could over-ride for it, although it is not encouraged to do so in some facilites, but perhaps she is peeved you didn't know this, but bottom line, she got pain meds) and she also is most likely aware that you have to wait for the pharmacy to send you the antibiotic, I am not sure what her issue is.

It is not as if you chose not to mix her med on time, you have to wait for it to be filled. Lesson from this is to make sure you review your orders, and make sure they where they need to be (pharmacy) so that you are informed before going in to see the patient. And if the patient is in pain, rate it, tell patient you will bring pain meds, and even if you have to call pharmacy to have them put pain med in the system STAT, if say there is no other nurse to witness your over-ride, I would not get into the habit of saying "well, I have to wait to have the med put in the system". People in pain are sometimes more defensive than one would think, and it can come off as an "excuse".

Double-Helix, BSN, RN · Jun 22, 2012

the patient came in at 650 PM and got the meds around 11 PM right around 4 hours, not fifteen.....I think.

My mistake. I'm so used to military time that I automatically read 650 as AM. Four hours doesn't seem unreasonable if your antibiotics come from the pharmacy- especially at night. OP, are you sure the patient complained? Or was this time discrepancy noted during a chart review? Many times these things are picked up by our manager during quality checks, not because of a patient complaint.

morte, LPN, LVN · Jun 22, 2012

LOL, i figured it was an AM/PM disconect.

My mistake. I'm so used to military time that I automatically read 650 as AM. Four hours doesn't seem unreasonable if your antibiotics come from the pharmacy- especially at night. OP, are you sure the patient complained? Or was this time discrepancy noted during a chart review? Many times these things are picked up by our manager during quality checks, not because of a patient complaint.

BuckyBadgerRN, ASN, RN · Jun 22, 2012

Speaking as someone who has been through the agony of kidney stones, I can understand why your patient/coworker made a complaint.

Seriously. I have had 4 babies, 3 w/o epidurals and one was 9# 14oz. I've had 2 tattoos, belly button pierced, a plantars wart removed from the ball of my foot. Would you like to guess which of those things was the most painful? Yep, that fecking kidney stone. I've gotta lean a little towards your patient on this one....