Close call

Nurses Safety

Published

Specializes in ICU.

Ok if a nurse knows that a bed weight is off (weighing +20 kg ) wouldn't it be wise to take more action than just make a comment in the flow sheet? Especially since multiple meds are weight based? Instead of passing this info on to the next shift it was just got missed for several days . Luckily nothing major happened but the ramifications could have been deadly with the right vasopressor or sedative. Lesson learned to watch the accuracy of my patients weights more closely.

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Specializes in Critical Care.

At least where I've worked, we don't actually change the weight we're using for drips after those drips are established, we would also just note it in the weight charting on the flow sheet or EMR if a different weight is obtained. There are some medications where this makes a difference, but drips are usually titrated to effect and obviously if you take your current drip rate and change the "kg" part of it you are going to be changing the rate that you've already determined is what they need through titrating.

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Specializes in Medical-Surgical/Float Pool/Stepdown.

I agree with MunoRN, we use the initial weight for titrating all of our gtts on the floor and in the ICU's. The person that charted the inconsistent weight though should have done every thing within reason to chart as close of a correct weight as possible. It should be known how much extra things weight that happen to be on the bed (or Pt for that matter) from extra pillows to blankets to monitoring equipment, and all extras should be subtracted as such to chart the closest real weight as possible, especially in cardiac Pt's. IMHO...

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Specializes in ICU.

I know If I came up with the initial weight I would have tried to rectify but instead he blamed the staff the next 4 days for not catching the discrepancy in weight. It just burns me that everyone was blamed but it wasn't even passed on in shift report that the weight was up 20+ kg. Yes we titrate to effect but with propofol we couldn't figure out why she was so hypotensive

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Specializes in Critical Care.
I know If I came up with the initial weight I would have tried to rectify but instead he blamed the staff the next 4 days for not catching the discrepancy in weight. It just burns me that everyone was blamed but it wasn't even passed on in shift report that the weight was up 20+ kg. Yes we titrate to effect but with propofol we couldn't figure out why she was so hypotensive

Having the weight wrong doesn't cause propofol to make the patient more hypotensive than if the weight is correct, that makes no difference. If the patient is hypotensive due to the propofol then back off the propofol, it doesn't matter if you think you're at 50 mcg/kg/min but you're actually at 30 or 70, if it's dropping the patient's BP excessively then you reduce the rate or take other action.

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Specializes in ICU.
Having the weight wrong doesn't cause propofol to make the patient more hypotensive than if the weight is correct, that makes no difference. If the patient is hypotensive due to the propofol then back off the propofol, it doesn't matter if you think you're at 50 mcg/kg/min but you're actually at 30 or 70, if it's dropping the patient's BP excessively then you reduce the rate or take other action.

I'm thinking along the same lines as you also but this was the rationale that this nurse had to make sure everyone was aware that happened. Had to fill out a UOR and notify everyone working thstvnight that the nurses had been dosing incorrectly drugs for 5 days. What the nurse didn't tell everyone is that he didn't get the correct weight after he KNEW it was blatantly wrong.

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