Absolute No-No's

Nurses General Nursing

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Hi: I hope to get a lot of input from this question. As experienced nurses, what are some things especially related to medication administration, but anything else, that you would classify in red for a nurse to never, ever do? Also, what have been the consequences of nurses doing these things? Thanks, in advance!!!

ALWAYS question an order that doesn't sound right. Don't back down if you KNOW it's not right.

When I was working on a med unit, we had a patient who was was being treated with some psych meds. He needed something for anxiety really badly so I called the psychiatrist (it's a teaching hospital). He ordered a med that was 10 times the max dose. I clarified the dose, he said "yes, that's it." I said that I couldn't give it - he insisted that I do. I repeated I couldn't and wouldn't. He was welcome to come and give it himself. He was furious, said he'd ordered that many times. I said that this was quite possible but since neither I nor my coworkers (I checked) had ever given doses even near that much, no-one was going to give it. He could either order something else or come in and give it himself.

We called the nursing supervisor for back up, she agreed. She said that it is possible that he's given it (I realize that) but she also agreed that such an unusual dose on a telephone order was asking for trouble.

End of story? Dr. came in and gave the med. He got a good tongue lashing from the supervisor who pretty well said everything I had said and she told him that I was completely right in my refusal to give that verbal order.

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Ask yourself with every med why is this patient getting this med.

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Specializes in Neuro ICU, Neuro/Trauma stepdown.
I'm sorry, but I find these comments about LPNs to be asinine.

I think the OP meant that in any team situation, the way LPN and RN teams are often made, everyone needs to be on the same page. Believe it or not, there are nurses that would give a BP med without verifying BP...both LPN and RN

Mine: (in addition to the many pearls listed here)

When you think someone may need restraints...put them on 'now' and dont delegate!

Check your orders, question what the MAR says.

TIAN (toilet in advance of need), if they've been known the play in it, check them a tad more frequently...

Verify your PCA settings (pt was getting 2mg dilaudid q 10mins, not the intended 0.2mg, yikes!)

Dont allow yourself to be bullied, pts do try to manipulate. And catty nurses do exist.

Hang out for a second after asking "is there anything else you need?" There is, and they'll be letting you know right about the time you hit the door, just after you've washed your hands.

Take care of yourself, including enough sleep (nightshifters, this means you too!) and nutrition to do your job well.

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Oh. My. God.

:smackingf I completely agree.

That's exactly what I said when I read that!!:lol2:

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I remember in nursing school.. and I joke about this from time to time....lol

We were in clinicals... doing bed baths and what have you... And this poor woman had cdiff... Everything in the surrounding area was raw and slightly bleeding... I can not even imagine the pain that must have caused..

Well, she also had a foley and the other student nurse had called me in to help pull them up in bed after the bed bath... I will NEVER forget this.... Ok, we should all know how to do cath care right?!?!? Well some how, some way, she confused CATH CARE with PERI CARE and was cleaning the externals of this poor, poor woman with alcohol swabs..

So for my absolute no no, NEVER perform peri care with alcohol swabs!!!!

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Specializes in Did the job hop, now in MS. Not Bad!!!!!.
I remember in nursing school.. and I joke about this from time to time....lol

We were in clinicals... doing bed baths and what have you... And this poor woman had cdiff... Everything in the surrounding area was raw and slightly bleeding... I can not even imagine the pain that must have caused..

Well, she also had a foley and the other student nurse had called me in to help pull them up in bed after the bed bath... I will NEVER forget this.... Ok, we should all know how to do cath care right?!?!? Well some how, some way, she confused CATH CARE with PERI CARE and was cleaning the externals of this poor, poor woman with alcohol swabs..

So for my absolute no no, NEVER perform peri care with alcohol swabs!!!!

Ouch!! :eek:

(and I'm still wincing from putting the blood in the microwave!!)

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Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.
I remember in nursing school.. and I joke about this from time to time....lol

We were in clinicals... doing bed baths and what have you... And this poor woman had cdiff... Everything in the surrounding area was raw and slightly bleeding... I can not even imagine the pain that must have caused..

Well, she also had a foley and the other student nurse had called me in to help pull them up in bed after the bed bath... I will NEVER forget this.... Ok, we should all know how to do cath care right?!?!? Well some how, some way, she confused CATH CARE with PERI CARE and was cleaning the externals of this poor, poor woman with alcohol swabs..

So for my absolute no no, NEVER perform peri care with alcohol swabs!!!!

OUCH!!!:madface:

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Specializes in Hemodialysis, Home Health.
never take the role of giving meds lightly. too often after passing meds for years,nurses become complasent. mistakes are most often made when we think things are routine. distractions play a huge part in errors. stop what u r doing and switch gears until u can completely concentrate on the mar and meds. we multitask so often,put this is one area that requires 100% attention. consequences often depend on the error and pt condition,etc,,,, they vary and are too munerous to mention. avoid the consequences by valuing the importance of med giving. ( we all have made mistakes, most of us are just lucky that no one died or became gravely ill because of it)

christine

couldn't agree more.

this week i had a hh pt. of mine sent to hosp. for a gi bleed. one of her daily meds is dilantin. once a day.

while in the hospital for the first 2 days, she was given the dialantin q 6 hrs. she questioned this, and the nurse kept telling her this was what was on the mar and what was ordered. this went on and on..pt. was pretty sick due to gi bleed and wasn't up to arguing. but she did question each time, then began getting anxious over it. finally she refused to take it and the nurse stormed out of the room in a huff.

pt. called her daughter, daughter contacted hospital, insisting on verifying the order.

as it turned out, when the ed wrote down what meds the pt. was taking,the dosage was mis-typed. med list sent to medsurge floor with the typo error.

never minimize a pt's questions or concerns about a med. especially if they are insistent.. that should be a red flag.

this pt's dilantin levels are now through the roof. by the time her dd contacted the hospital, pt. was already twitching with spasms to all extremities.

listen to your patients.. they deserve that much. they may be right, they may be wrong.. but be on the safe side and check it out. don't just assume that "it's on your mar, so it must be correct."

and last but not least, never ever lie! your patients are amazing creatures and can survive all sorts of med errors. but only if you own up to it as soon as you discover your mistake and set about doing all that is humanly possible to correct it. if you lie and try to cover things up, a near-fatal drug error can become fatal.

see the above.

when this patient's dd called the nurse's station, she was told they verified the dosage on the patient's bottles brought in from the home with her, so they knew it was being correctly given.

the only thing was that no med bottles were ever brought to the hospital with the patient. the dd had brought only her current and updated med list.. patient never carries any meds with her, no bottles were in her posession. bottles were at home on her kitchen table.

here was a lie to 'cover up".. to attempt to make out like they knew they were right and pt. was wrong... instead of listening, questioning, doublechecking.

this is a wonderful thread...priceless....

it certainly is... great learning tool !

as i pop them out of packages in front of the patient i tell them what they are (name them) and what they are for. asking them right afterward, "does that sound right?" "do you take these at home?" sometimes they freak out because they look different than the ones they get at home and that's when we talk dosages etc. if they are really iffy, i go check the order in the chart and come right back. that works really good.

good advice. but as said above, the mar could still be wrong. if the patient is anxious/upset over dosage and has been taking these meds for awhile at home and he/she questions the dosage... don't just blow him/her off or rely on the mar. go ask some questions.. call the md.. whatever it takes. :)

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Specializes in Med/Surg.

Original comments deleted.

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Specializes in Emergency, Cardiac, PAT/SPU, Urgent Care.

Never push IV Dilaudid or Phenergan quickly - also, make sure you dilute them or give them slowly through a running, compatible IV solution.

Don't give IV Dilantin through an IV site in the back of a hand - if you need to, restart the IV in a site with a bigger vein - oh, and use the appropriate filter!

Always do frequent IV site checks if a patient is getting IV Dopamine through a peripheral line.

If at all possible, establish an IV line before giving SL nitroglycerine - you can then be prepared if the patient's BP responds too well to the med.

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Never push IV Dilaudid or Phenergan quickly - also, make sure you dilute them or give them slowly through a running, compatible IV solution.

In the case of phenergan, there's no "or" about it. Please dilute and give slooooowly (or better yet, hang as an IVPB). Giving through a running IVF does not dilute it enough to prevent injury. I developed a severe phlebitis as proof of this...

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