Unfinished tasks from previous shift?

[pirap]

I work on an extremely busy med-surg floor(HA-who isn't busy!) anyway..and we are only 1 of the 4 remaining 8 hour shift floors in our hospital. We are a huge hospital/hospital system. I work 3p-11p. The other day I came on shift and after report got to the floor at 315 and began seeing patients. The surgeon was at the nurses station and was MAD that the PPN was not hung yet when he had ordered it at 915. OK for one PPN and TPN isn't just magically sitting around in pharmacy..it has to be mixed so by the time it was finished it was 1145. When pharmacy sent it up the bag said "HANG AT 1500." The nurse I think was confused about "PPN" and thought that it could not be infused in a peripheral line--it had hydrocortisone in it--so of course she could have hung it-instead she got an order for a PICC line. Angio was backed up and they didn't even come get her until 1900. I hung the PPN at 1530 as soon as I went into her room. The surgeon was mad and I looked stupid because I could not answer WHY it was not started yet.

My question..how should I handle a previous nurses mistake or error? Was this truly an error on her behalf? The pharmacy orders the time that PPN/TPN is started anyway. I am not the type of person who would "sell-out" just to make myself look good and blame someone else..

How do you guys handle mistakes, oversights, errors or unfinished tasks where you work? I'm not really talking about med errors-we have a system in place for that. I have a year experience--she has 10+ years.... I know not everything can be done and sometimes you have to pass stuff on...

[RunningWithScissors]

Nursing is a 24-hour job; some things just have to roll over for the next shift to pick up and run with.

What's wrong with just telling the doc "it's hung now, it's OK" without going into the whole explanation (he probably doesn't give a hoot) and DON'T feel "stupid" hey, it's hung, so there!

As far as how to handle mistakes/leftovers from other shifts, I always tell the nurse personally next time I see them, NEVER "write it up" behind their back....the only reason I write something up is if it's a dangerous situation that needs process change or something BAD happened (like heparin running at 900cc/hr or something, and THAT is to protect the patient because NOT reporting it could have BAD results for the patient!)

[DusktilDawn]

Yes, the nurse could have been confused about the PPN. Would 1500 be the usually time your pharmacy would start a new TPN/PPN order? Did the surgeon specify that he wanted he PPN to started ASAP, ie: start now? Unless otherwise specified, a new TPN/PPN order would be started at 2200 where I work.

[TazziRN, RN]

If the doc got on me for something that hadn't been done when ordered, I would have said "I hung it as soon as I got it. Let me research to try and find out what happened." Then I would quietly talk to the previous nurse.

[Indy, LPN, LVN]

I'd probably take Tazzi's approach. State what "I" did and avoid talking smack about another shift; after all, I wasn't there. Sometimes... it's very, very rare, a doc who knows what my shift is, will ask why wasn't it done earlier. One doc was very pointed with his inquiries and that's how I found an error of omission of some AM meds for his patient. So there I am at 2300, trying to push demadex into a lady with just about no veins, to make up for the BID dosing that just wasn't done and the doc said "do it now"... and wouldn't ya know it, I blew that IV.

It was after MN before I got help with the IV and finished the dose, and no, I didn't write up a med error. The AM nurse had retimed the dosage several times, each time the patient left the floor for a test, and wound up forgetting to do it the last time so her reminder wasn't there, and she missed it. All this over a diuretic that probably wasn't gonna do much good on a woman who couldn't drop her weight due to the huge bag of mcdonald's food that her family brought her for lunch every day. The doc actually thought the demadex and our ability to weigh her properly was what caused her weight to go up every day.

/rant off.

[UM Review RN, ASN, RN]

Docs get mad all the time for things other people did or didn't do -- lab, X-ray, pharmacy, whatever - and we wind up taking the flack for it.

It gets old. The point is, the doc has no right to yell in the first place.

That might be the issue right there - nobody likes to be the object of someone's anger - rather than finishing up another nurse's work.

You might very well have titled the thread, "I hate taking flack for others" because you were OK with picking up the leftovers from the other shift until the doc got mad at you, right?

You might want to have a talk with this doc about how he's treating people.

[oldiebutgoodie, RN]

One of my favorite questions from a doc is, "Why is this patient still here??!!" (usually indignantly, with the assumption that SOMEBODY should have discharged him/her eons ago).

Well, gee, Dr., I would LOVE to discharge this patient (and many, many more...) but that's not my job.

I am waiting for the primary to write that fabulously complete order, "D/C home". (no mention of f/u appointments, meds, etc.) That way I can call the primary to clarify, and he/she can also be indignant that I am bothering him/her.

Okay, I am also done ranting now. There. I feel better.

Oldiebutgoodie

[Gennaver, MSN]

I The surgeon was at the nurses station and was MAD that the PPN was not hung yet when he had ordered it at 915. ...When pharmacy sent it up the bag said "HANG AT 1500." The nurse I think was confused about "PPN" and thought that it could not be infused in a peripheral line--it had hydrocortisone in it--...

Hi,

Wait, you are taking the docs word that the nurse was "confused?"

I'd check with her first. I mean maybe it was a simple mistake on the doc's part. Could be that he ordered a picc or he order the PPN for 1500.

Just because he is blustering loudly doesn't mean that he is right.

First thing I'd do is not automatically assume that my ten year experienced coworker made a mistake or tried to make work easier for herself by listing it for 1500, right? Unity...supporting one another and maintaining a professional standard.

Later, when alone with her I'd ask her what happened but, to the doc I hope I would say, "Well the orders say x y z and that is all I know, would you like it hung now?" That is it. Could be he is totally wrong and she double checked with him in the first place but he was blustering so.

Gen

[Tweety, BSN, RN]

You gave us a very detailed explanation of the events. You could have explained this to the doc the same way you told it go us. Apologize and say you'll educate the prior nurse. Nothing wrong with telling the truth "the previous nurse thought the patient needed a central line access and was waiting for a PICC line" and leave it at that. If that wasn't good enough refer the doc up the chain of command to the charge nurse or manager.

Usually, I just apologize and tell them "I'll fix it now, and further investigate and try to assure it doesn't happen again."

I do not deliberately make the nurse who made the mistake look bad or bad mouth them to the doc, or any other department.

Our TPN's and PPNs are always hung at the same time every day, 2000 regardless of when the doc rights the order.

[purple1953reading]

In my experience we have 30 mnutes on either side of the time ordered. So if it said hang at 1500, and you hung it at 1530 there is no mistake. The physcian should have specified a time, if the pharmacy does not set times, as they do in most institutions. Usually he forgot about it anyway by the next day. I have been attacked by physcians for things I didnot do, but they really don't care about the explanation. They just want to gripe. I tend to just ignore that, I might have said the pharmacy stated 1500, if you like you can change the time in a new order, and I will contact the pharmacy and put it on the med sheet.