Changing route of admin - page 2

by Nlink 5,227 Views | 21 Comments

Recently a nurse (RN) where I work chose to admin a prn bucally instead of via g-tube. The order stated via g-tube. This client has a high risk of aspiration. I did not find out about this until after it had already happened and... Read More


  1. 0
    Buccal means absorbed through the mucous membranes,not swallowing.Agree to disagree? I would still mind my own business.
  2. 0
    Thank you aldragonRN.

    Client is not paliative so I can't see a Dr. changing the order to buccal/subling with the potential for aspiration. Perhaps order should be changed to include an H20 flush though.
  3. 0
    Yes Buccal is not swallowing however client is non-verbal functions developmentally at a 2 month level and cannot follow directions. Also has spastic quad and is never not flailing around therefore putting anything in the clients mouth would be a risk.
  4. 1
    Quote from nlink
    perhaps order should be changed to include an h20 flush though.
    wow, you guys don't have h20 flushing protocol after med administration?

    we have a protocol to flush with 5 ml h20 between each medication and 30 ml h20 between each medication pass.
    SHGR likes this.
  5. 1
    Flushes with regular meds, pre and post feeds and "water feeds"...but no there is no protocol as to how much h20 to use to flush each client after a prn. I just take some water out of the next flush. For example if giving prn at 1300 and next meds due with 100cc h20 at 1400, I would use 50cc to flush the prn and 50cc to flush the 1400 meds. As far as I was aware until this incident that was what was always done.
    CompleteUnknown likes this.
  6. 0
    I agree that it is a med error. But I am curious as to what the medication was. Was it a med that can actually be absorbed via buccal route. Also, I think it's laziness to not give a med because a flush is not due. I also understand that this isn't about trying to get your coworker into trouble. But it is nice to be aware of what type of nurses your working with. You need to know who you can go to or who is incompetent in case situations arise where you would need assistance. I wouldn't trust your coworker.
  7. 0
    It was morphine. Unfourtunately we only have one RN working at a time so you get what you get as far as assitance goes. But yes, it is good to know who before who is competant, at least you have an idea what you might be getting into when you need help lol.
  8. 0
    *know before
  9. 2
    Clearly a med error per joint commission standards.

    There are no grounds for an argument.

    Right patient, Right Drug, Right Dose, Right Route, Right Time, Right Documentation

    This is taught in week one of semester one of nursing school.........

    Only the provider can change the order. If they refuse to change the order, escalate per the chain of command at your facility....
    Psychcns and sapphire18 like this.
  10. 2
    I wouldn't even consider this an error, but it IS practicing outside of her scope of practice. Only the MD can change the route of a medication. This completely changes how the med is absorbed, among other things. It is a nursing action to flush a G-tube before and after administering a med...we generally use 30cc as a post-flush. You don't need an order for this. Think of it like this- if it was a pt taking POs, they'd use at least 30cc to swallow the pill, right?
    Sugar Magnolia and KelRN215 like this.


Top