Sometimes, if the census is low at our clinical site (rehab/LTC), our instructor will not assign us a patient. Instead, we take over "all the CBG/insulins" or "all the blood thinners" for the facility for that shift. Then, we are each given a yellow sticky with a list of patient room #s, names and a drug.
For diabetics, it is more straightforward. Check the sugar, look at the sliding scale and scheduled dose in the MAR and give the insulin.
But today I had Lovenox for a man and it is a higher dose than I've ever given: 70mg BID. Furthermore, the last 3 doses were not recorded on the MAR. We pointed it out to the assigned RN, and I assume they will investigate.
I really didn't understand why his dose was so high and his chart was MIA. He was in the center for rehab from a BKA but the surgical site was healed. The patient was also up in a wheelchair. No diagnosis on the MAR of DVT or PE, which were the only conditions my drug book indicated doses this high for.
My instructor is very nice, but also very passive and never wants to make any waves. So she had me give the injection.
It bothers me because I didn't know why I was giving the med. 30-40mg, OK-- DVT prevention. She didn't have an answer other than "they've been giving this dose for a month, so it must be correct". Well, technically, they didn't give the last 3 doses and he had some bruising, so I was thinking maybe it was held because they were afraid of bleeding--but no note or explanation given in the MAR for the blank fields.
As I thought more about how we were working, it bothers me that I'm just running injections around like a trained monkey and not seeing any kind of big picture, which makes me feel unsafe.
Anyone else have a clinical that works this way? Does it bother you? I'm thinking next time we do this drill I'm going to put my foot down (I make waves) and say that I can't give a med unless I know what the patient's issues are and why they are getting it (and why there are discrepancies, if that is the case).