PR order question

[smurfynursey]

Hi everyone...I have a question and I am unsure as to what the answer is.

I work at a pediatric facility for special needs kids. Today I had a patient that seized often and alot. I talked to the ADON and she said she was going to call pt. Xs neuro for an order for breakthrough seizures. At this point she had just finished having one that lasted 3-4 times her "normal". Given that I didnt have an order, I didnt do anything - as I couldnt.

about 30 minutes later she came back to me and said, you can give dose Y of drug Z as a PRN for breakthrough seizures. I just got the order from the doctor".

At this point the patient was doing better and had stopped having as many frequent seizures, though tests will show that she has them more than we think.

about 10 minutes later the ADON came back with the order written on the MAR and gave me the narc key. I then went into the med room, pulled, counted, gave, ect. the med.

Later I was pulled into the office by my boss questioning why I hadn't given the med sooner. I said that I didnt have the order and I wasnt okay with taking a VO from the ADON who got a VO for the drug. In my mind she could have told me to give any dose of any drug and I wouldnt know until it did, in fact come through on paper. My boss was concerned about my inaction and lack of urgency. I realize (now) that I should have asked her to give it if I wasnt going to right away....but what would you do in this situation? I am still a new nurse (1.5 years) and gun shy about giving narcs to babies...furthermore the way this was presented makes me twitch.

Would you give a med to a child without seeing the order? I agree that my judgement wasnt the best however I dont agree with what my boss was expecting me to do.

[Redhead28]

When your ADON got the order why didn't she pull the med and bring it into the room, where you were monitoring the child and give it? Or was the concern that you did not call for a prn order sooner?

[smurfynursey]

I was in the room with child x and 5 other kiddos, and the med room is a closet like space off the room I was in. I didnt think of that, however. The ADON and DON keep the narc key so it sort of makes more sense that she would have given it as soon as she got the order...

[NotReady4PrimeTime, RN]

Ummm... narcotics have NO anticonvulsant effects. What drug were you giving for these breakthrough seizures?

[Redhead28]

I assumed Ativan or Valium and these are usually with the narc's.

[smurfynursey]

Clonazapam in this case.