Have you ever refused to give a certain med?

  1. 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?
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  2. 19 Comments

  3. by   jemb
    Definitely.

    Several docs at one facility where I worked habitually ordered Demerol/ Vistaril IVP for the sickle cell patients. Couldn't tell you how many times I called to say 'Excuse me, but I'm not giving vistaril IV." It always amazed me that these docs, who were very intelligent, could never remember this and just kept ordering the same thing.
  4. by   MargRN
    I would never give something contraindicated such as that.

    Just the Vit K IV is not something I'm used to doing.
  5. by   elkpark
    Years ago, I was working med-surg at a VA after working psych for my entire career up to that time (the VA really hired me for psych, but offered me a med-surg position because their policy was to hire onto the med-surg units and promote from within -- so I took the job on the med-surg unit and worked five months before a psych position came open. It was wonderful experience, and I enjoyed it). We had a man one time who was "et up" with cancer (as we say here in Appalachia ), terminal, and experiencing lots of pain. We were keeping him comfortable with lots of MS, which meant that he was pretty out of it all of the time. One lovely afternoon, his family came in to visit and were v. upset that he couldn't sit up in bed and make perky conversation with them. They got hold of the resident and gave him h*** about "over-sedating" their loved one, and he wrote an order for 2 mg of Narcan. I had never given Narcan before, so, in addition to looking it up, I checked with our (wonderful) NM before I went to give it. She said, oh no, you don't want to give him that much Narcan -- just put about 1/2 a mg into his arm and wait to see what happens.

    I followed her advice, slowly slid about 1/2 a mg into his arm, and the man sat up in bed, screaming in pain, like I'd just slammed a door on his fingers. I was pretty impressed! I sure as heck didn't give him any more, and the family was back at the resident immediately, complaining that he was in pain. So we socked him with a bunch more MS and he slipped back into pain-free, peaceful semi-consciousness.

    It was not uncommon on that unit (covered by lots of residents) for our NM to approach the residents about particular orders and tell them that no nurse on our unit was willing to administer (whatever crazy order they had written), and, if they really wanted the patient to have that med, they'd have to administer it themselves ... It always turned out that, if they were going to have to press the plunger on the syringe themselves, they had second thoughts and changed or cancelled the order ...
  6. by   Agnus
    Quote from elkpark
    Years ago, I was working med-surg at a VA after working psych for my entire career up to that time (the VA really hired me for psych, but offered me a med-surg position because their policy was to hire onto the med-surg units and promote from within -- so I took the job on the med-surg unit and worked five months before a psych position came open. It was wonderful experience, and I enjoyed it). We had a man one time who was "et up" with cancer (as we say here in Appalachia ), terminal, and experiencing lots of pain. We were keeping him comfortable with lots of MS, which meant that he was pretty out of it all of the time. One lovely afternoon, his family came in to visit and were v. upset that he couldn't sit up in bed and make perky conversation with them. They got hold of the resident and gave him h*** about "over-sedating" their loved one, and he wrote an order for 2 mg of Narcan. I had never given Narcan before, so, in addition to looking it up, I checked with our (wonderful) NM before I went to give it. She said, oh no, you don't want to give him that much Narcan -- just put about 1/2 a mg into his arm and wait to see what happens.

    I followed her advice, slowly slid about 1/2 a mg into his arm, and the man sat up in bed, screaming in pain, like I'd just slammed a door on his fingers. I was pretty impressed! I sure as heck didn't give him any more, and the family was back at the resident immediately, complaining that he was in pain. So we socked him with a bunch more MS and he slipped back into pain-free, peaceful semi-consciousness.

    It was not uncommon on that unit (covered by lots of residents) for our NM to approach the residents about particular orders and tell them that no nurse on our unit was willing to administer (whatever crazy order they had written), and, if they really wanted the patient to have that med, they'd have to administer it themselves ... It always turned out that, if they were going to have to press the plunger on the syringe themselves, they had second thoughts and changed or cancelled the order ...
    OMG! Narcan is an emergency drug. When used it compeletely reverses ALL effects of an opoid 100%. When we give it we give only enough to restore respirations that have stopped. Then quickly medicate with a non opoid if pain relief is needed.

    We need not only to educate our residents but our families and patients. I guess they all got educated this time.

    Yes, I agree you did well insisting that they give questionable meds themselves. That would certainly be my response if they were unwilling to accept my arguement against it.

    I have never worked with residents or med student or interns before. On my new job I get to work with them. I used to think a resident knew something. Yea right they are about as dumb as dirt. I have told my family to never let a resident near them for anything. And I have only been on this job for 3 months.
  7. by   zudy
    An ER dr ordered me to give Adenocard to a pt in tachycardia. I refused, pointed out that there was a P wave present, HR in the 140's, 150's and to figure out why the pt was tachy. He says,well, give it to me and I will give it. I refused to get it out of the Pyxis. He started arguing w/ me, just then a cardiologist walked by, I asked his opinion on the pts EKG, cardiologist says that's tachycardia, whats wrong w/ you zudy?


    3 months later, same senerio, except I wasn't there, the nurse was a new grad. New grad gives the Adenocard.
  8. by   PMHNP10
    I have refused to give NTG. There is an inmate who, when he is not getting his way, starts having chest pain. When we go to his room, he is telling jokes to staff, and laughing, and in the same breath saying he is having chest pain. In addition, when we take his VS, his BP is like 96/63; P is 72; O2 is 93% (he is a COPD'r). so if you are saying right now that I'm wrong for refusing to give the NTG, well let me add the small detail that he is telling us he is going to have these pains until such and such happens. The MD is standing right there, but is insisting to give it; so indeed we plopped a NTG in the MD's hand and let him have at it. Of course after the fact we find out that he has recently had a cath which revealed 30% occlusion, which should not cause angina while at rest.
  9. by   zacarias
    Hey,

    Don't worry, Vit K IV is quite normal. It is indicated usually when someone's INR is elevate (e.g. liver disease) and the doc wants to get it down so they can do a procedure such as EGD, TIPS etc.
  10. by   RNPATL
    elkpark - I totally understand what you are saying with your post. Just the other day we had a similar incident with a resident who had some crazy orders. The patient was having diarrhea (C. diff.) and the resident ordered that we measure the diarrhea in cc's and provide a 1/2 cc fluid replacement with D5 1/2 NS 20of K for every cc of diarrhea .... ok, I am thinking to myself .... um, interesting order ..... talked with the resident and asked him if he wanted to ring out the diarrhea and meaure for the replacement. Seems like if we put the patient on maintenance fluids it might solve the problem. Whatever!
  11. by   plumrn
    We can't give Vit k IV, on the ward. It can only be given in a monitored unit, so the pt can be closely supervised.
  12. by   Silverdragon102
    I have given IV Vit K a few times on people with raised INR on a general ward and had no problems.

    Anna
  13. by   jaimealmostRN
    Quote from zudy
    An ER dr ordered me to give Adenocard to a pt in tachycardia. I refused, pointed out that there was a P wave present, HR in the 140's, 150's and to figure out why the pt was tachy. He says,well, give it to me and I will give it. I refused to get it out of the Pyxis. He started arguing w/ me, just then a cardiologist walked by, I asked his opinion on the pts EKG, cardiologist says that's tachycardia, whats wrong w/ you zudy?


    3 months later, same senerio, except I wasn't there, the nurse was a new grad. New grad gives the Adenocard.
    Uh oh :uhoh21: , I'm scared now! So, only give adenosine if pt in SVT with NOOOOOO p waves? Were just learning this now. Besides not giving it in 2nd and 3rd degree blocks, anything else us (almost) new grads should know??? :uhoh21:
  14. by   TinyNurse
    good thread, feel the same way as the above poster though regarding p waves.....uggg
    xoxo Jen

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