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What would you do? Moral Dilemma



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No. 10
from KenCCRN
Old Sep 26, 2007, 12:05 AM

Default Re: What would you do? Moral Dilemma
Originally Posted by firstyearstudent View Post
I have been orienting and I went in to give my patient his once daily dose of IV Neupogen that he is getting x5 for his Stem Cell Harvest and eventual autotransplant and I noticed the the nurse that had been on the previous day shift had not opened the line and it hadn't run in. I'm pretty sure he didn't get it since the patient reported no bone pain the previous day. I told my preceptor and she just shrugged. Should I have reported this or is it better just to pretend you don't notice this type of thing if it probaby won't harm the patient. (They will do a WBC count before harvesting the cells.)

I left it in my preceptors hands but soon I'll be making these decisions for myself. I don't want to get another nurse in trouble. On the other hand, what if an error has ramifications for the patient? And how will this nurse get the feedback to know he/she needs to be more careful.
FirsYear:

I think WOOH is right....it could have backflushed into the piggyback bag. I frequently run the piggy back dry and then open the pump chamber and the primary fluid back flows all the air and bubbles back out and up into the piggyback....sometimes I let too much in and it looks as though there may be some med left over. I would not report that especially if it was a day from when you noticed it....way too long.
Ken
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No. 11
Old Sep 26, 2007, 12:22 AM

Default Re: What would you do? Moral Dilemma
Originally Posted by KenCCRN View Post
FirsYear:

I think WOOH is right....it could have backflushed into the piggyback bag. I frequently run the piggy back dry and then open the pump chamber and the primary fluid back flows all the air and bubbles back out and up into the piggyback....sometimes I let too much in and it looks as though there may be some med left over. I would not report that especially if it was a day from when you noticed it....way too long.
Ken
An objective report of what was found will help the doctor decide whether an additional dose is needed, particularly if the counts aren't at the level expected. This isn't about placing blame, rather making sure the patient gets the full pre-treatment needed for the transplant.
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No. 12
from sharona97
Old Sep 26, 2007, 06:21 AM

Default Re: What would you do? Moral Dilemma
I refused to give a med once while doing clinicals. I told the nurse I was with that day I could'nt give it as it was the wromg med. She insisted I give the med as this is what has been given all along,hmmmmm

So I agree with the subjective approach , know what you see, and as it turned out it was the wrong med this poor woman had been receiving. I don't think I was a shy student, but I did care about doing the right task.
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