Changing route of admin

Nurses Medications

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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 was working in a different building at the time. Can an RN change the route of medication without an order? Would this not be considered a medication error? Is this something I should encourage the other nurse who called me upset about the situation to persue in regards to reporting a med error/talking to management? She did chart that she opposed this decision, she is an RPN, and the the RN chose to do regardless of her objection. It is possible that this resulted in harm to the client, he was sent to hospital later on that day however I have not worked since and do not know why he was transferred.

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.

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Specializes in Wound Care, LTC, Sub-Acute, Vents.
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.

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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.

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Specializes in peds-trach/vent.

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.

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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.

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*know before

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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....

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Specializes in ICU.

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?

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Morphine can be given SL. If she is giving 1 ml then I assume it is liquid morphine, which is normally given SL.

SL is not the same route as PO, it is a different route of administration. PO, SL, GT are three completely different routes of administration.

So this was not a case of a GT med being given PO.

It was a GT med given SL. Or rather, an SL med that was appropriately given SL to a G-tube patient. That is something that needs to be clarified.

I have g-tube patients who receive other types of SL meds including morphine without a problem, but I always double check with the dr./pharmacy if I get an order like that to make sure it is OK.

We have standing orders in our facility to do flushes with med pass. If you are concerned about how to handle this then I agree that the first step is to get some kind of orders for PRN meds.

I would advise you to stay out of this. From your post it is not clear what exactly was going on. The fact of the matter is that yes, this may have been a mistake, it may have been inadvertent, it may have been deliberate. There is no way to know that.

But I think that since morphine is very commonly given SL, then the nurse was not changing the route of administration, but rather giving a med in the manner it is typically given without stopping to double check what she was doing.

We all of us make mistakes. You will make mistakes, you will see other people make mistakes. Pick your battles wisely.

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Morphine can be given SL. If she is giving 1 ml then I assume it is liquid morphine, which is normally given SL.

I have g-tube patients who receive other types of SL meds including morphine without a problem, but I always double check with the dr./pharmacy if I get an order like that to make sure it is OK.

We have standing orders in our facility to do flushes with med pass. If you are concerned about how to handle this then I agree that the first step is to get some kind of orders for PRN meds.

I would advise you to stay out of this. From your post it is not clear what exactly was going on. The fact of the matter is that yes, this may have been a mistake, it may have been inadvertent, it may have been deliberate. There is no way to know that.

But I think that since morphine is very commonly given SL, then the nurse was not changing the route of administration, but rather giving a med in the manner it is typically given without stopping to double check what she was doing.

We all of us make mistakes. You will make mistakes, you will see other people make mistakes. Pick your battles wisely.

Ummmm seriously? The order was give it in the g-tube. Giving it any other way without a modification of the order is a med error. It scares me how so many seem to not concur...now maybe shecalled the doc and got a verbal and the doc just has not entered the change yet....that is a possibility.

Medication administration has 6 RIGHTS. Doing it any other way is a mistake and it is dangerous.

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