Have you ever refused to give a certain med?

[MargRN]

I had never given Vit K in the IV form.

It was ordered on a patient who was having diarrhea and had been on heparin earlier in the week and was then on Lovenox. So IM was not ordered. MD was wanting to do an EGD in the next few days.

The nurse that followed me after my shift said that it had only been ordered once before that she knew of adn she refused to give it but the MD was there and he gave it for her. EDIT HERE: this nurse was talking about a different patient and a different situation.

I read and re-read every drug book I could find to make sure I was doing it correctly. Our pharmacist was gone for the day and the ER nurses were busy. I called the nursing superviser at home who I had seen she had given this Vit K IV earlier in the week. She wasn't home.

Anyway... the patient tolerated it well. I spent almost 30 minutes with her making sure she was OK. Her BP was fine.

Have you ever refused to give something?

[TinyNurse, RN]

good thread, feel the same way as the above poster though regarding p waves.....uggg

xoxo Jen

[gwenith, BSN, RN]

Hate to tell you but IV Vit K is a routine order here LOL!!! But that is in ICU. Just give it as a VERY S-l-o-w push. Don't dilute it in a burette. Sorry common practice. But we seem to give some drugs differently.

[AmiK25]

I work in an ICU in major teaching hospital and we are not allowed to give Vitamin K IV. Apparently, a couple years ago, a patient died from having been given a dose IVP in one of our other hospitals in our system so now when we take it out of the pyxis, we have to push an extra button saying we promise not to give it IV. I am not saying you are wrong for having done it, I am just telling you what our policy is.

[MargRN, BSN]

Apparently, a couple years ago, a patient died from having been given a dose IVP

I read that it has been fatal with IV administration. That's why I was asking the other nurses and reading reading reading. The MD had ordered it on this same pt earlier in the week. (Yes, it was due to her INR)

I diluted it with 11cc NS and pushed 1cc ever 2-3 minutes.

It was OK. But when the nurse coming on said, "I refused to give IV Vit K"... that freaked me out.

THanks for replies and the cardiac info is interesting but I hardly ever have those meds b/c those patients go to a larger facility.

[plumrn, BSN, RN]

We routinely gave IV Vit k to lower the INR, also. We had a pt who developed arrythmias, b/p dropped, and she became diaphoretic before the whole dose was even given. She recovered fine, but it sure made everyone take a longer look at all of the potential problems with it, and policy was changed to a monitored unit only with close observation.

[canoehead, BSN, RN]

We have a policy to only give IV Vitamin K if there is active bleeding. Otherwise, slower routes and watch for a worsening condition.

[MargRN, BSN]

We routinely gave IV Vit k to lower the INR, also. We had a pt who developed arrythmias, b/p dropped, and she became diaphoretic before the whole dose was even given. She recovered fine, but it sure made everyone take a longer look at all of the potential problems with it, and policy was changed to a monitored unit only with close observation.

I only work registry but I am going to talk to the manager about making a special policy for IV Vit K administration. THe patient did fine - this time. She was not on telemetry as it had been DC'd earlier in my shift.

This has been a learning experience for me but it concerns me too.

Thanks again!

[NursesRmofun, ASN, RN]

I refused to give Ativan IM stat to a detox patient who was not agitated or having tremors/DTs. She was oriented, calm, and very cooperative also. The Psychiatrist was doing an initial consult and the patient refused his treatent, so he ordered Ativan stat as a verbal order. I went to see and assess the patient again. She remained calm but said she did not wish to receive his treatment. I asked him to give the Ativan himself if he wanted it given. He did not give it. He did not write the order or argue the point either.