Opinion about a nurse's erros

[PNPss]

I'm an APN in a peds practice. Saw a 7 year old girl for a routine medication follow up, we do every few months and give refills.

Hadn't seen her for 4 months and the MOA triaging her says, by the way, she lost some weight. I pull up her growth chart and she has lost 14 lbs! She is small to begin with (only 8th percentile for height and 13th percentile for weight) but now she has fallen off the growth chart. I went to my MOA and said she is only 30 lbs, are you sure that weight is right. She assured me she double checked it.

So I did a thorough history about diet, appetite, any abnormal symptoms, everything seems to be going well. She doesn't even look terribly thin, but again, she is a small child.

Did a lab work up and fingerstick glucose in the office, everything comes back normal. I said again to the MOA, "you are sure about that weight?" and she says yes. I'm thinking diabetes, cancer, any number of horrible things.

They came back the next day to review labs and a nurse weighs her. She is miraculously back to her previous weight (actually up 2 lbs)!

So the entire ordeal was due to a triaging error.

i know this was technically the MOA's error but I am also feeling very guilty. Her extreme weight loss did not sit well with me but I trusted the vitals I was given (as I feel I should be able to)...but should I have just weighed her myself if I was skeptical? How many of you take a "if you want something done right" approach to things like this? I am so frustrated by this, for not just myself but the patient's family. I didn't make the error but I feel that I am ultimately responsible for what happens with patients. Some peers are saying no way, it is on the MOA. Thoughts? Opinions?

[Libby1987]

14 lbs in 4 mos? If I lost 14 lbs even at my adult size I'd have to go buy all new clothes, my pants would literally fall off. 14 lbs is so dramatic, especially in such a short period, that if I couldn't observe or glean any insight from mom to confirm that great of a loss, I would have re-weighed her if only from a "that can't be right" perspective.

Why are you referring to your medical assistant as a nurse? Do you think of MA as interchangeable with nurse?

[Oldmahubbard]

You're a genius if your subject line was deliberate.

I am very interested in eros for nurses

[squishyfish]

I also concerned about these "erros." If I have concerns about something, such as vital signs, weight, glucose level, I will either request a recheck or recheck it myself.

[DizzyJ DHSc PA-C]

I always recheck abnormal vitals/weights that seem off. It is my responsbility 100% to make sure they are correct and not an MOA, MA, RN, etc....Weights are extremtly important in pediatrics for dosing consideration and watching for failure to thrive. The only error was you questioning the weight to be incorrect and then not rechecking it....and having a thread about nurse errors when there was no nurse present in the story....well you're a nurse...so I guess the title can apply since it was your error.

[flowerpowerntx]

People make mistakes. It happens. I'm sure from now on you will always double check. I tend to always place more blame on the individual with more experience/education. Ultimately, the buck stops there. However, if I had worked with my assistant for many years and felt extremely confident in their job performance, I would place more blame the other way. Either way, it really doesn't matter. It was a learning experience. Move on.

[Have Nurse, ADN, RN]

A lot depends on what time she was weighed, whether or not she had emptied her bladder/bowels or had just eaten,and whether or not she was dressed at the time. So, if you know those things and you still want to weigh her, that is your prerogative. To be professional, I wouldn't throw the M.O.A. under the bus just yet, but I would keep careful documentation if this comes up again in the future.

[BostonFNP, APRN]

A lot depends on what time she was weighed, whether or not she had emptied her bladder/bowels or had just eaten,and whether or not she was dressed at the time.

14lbs is a lot of bowels and bladder and clothes!

[Mavrick, BSN, RN]

I can see not noticing a 14 pound discrepancy on a 200 pound adult but 14 pounds is almost 50% of the weight of a 30 pound child. Not something any observant healthcare practitioner would overlook.

I would think anyone working in pediatrics would be better at estimating weights.

[KelRN215, BSN, RN]

I'm curious, since no one has asked, what did the child's parents say? I would think if they know their kid weighs 44 lbs, they'd question it if a practitioner said "OMG, your child has lost 1/3 of her body weight, she's down to 30 lb and has fallen off the growth chart!"

[NurseSpeedy, ADN, LPN, RN]

Everywhere I have ever worked, for the last 30 years, as an RN and an NP, weights have been notoriously, notoriously and totally unreliable.

So unreliable, that I have stopped paying attention, unless the patient looks different.

This issue is also unfix-able.

My opinion.

Sometimes I wonder if there's any way that there's something wrong with the scale itself. My daughter goes to the same doctor as me (family practice). Her pediatrician retired and she's generally healthy so for now I figured I'd just bring her to mine until we find another pediatrician. Well, it had been maybe 4 months since she had been in to see a doctor and it was her first time at this one. She gets on the scale. It's one of the ones that you actually have to move the weights over to get the value. I had been there a few weeks earlier and thought the scale was within reason of where I usually was at. Well, my six year old 51 inch child was suddenly 75 lbs! I thought. That can't be right. She's a size 6 for her shorts because she's so thin. She does have a lot of muscle but come on. But I saw them weigh her and they did it the right way....maybe the scale was off balance???

I checked her on the scale at home and she was 54 lbs. Now she hasn't been in for almost a year and it will be interesting to see if the scale shows her at her current 64 lbs or where the heck the number will be.

I've always rechecked everything for myself if the numbers seem off. I either find out that they really are off, or we really have a problem. At work, if a tech comes to me with a wacky value, I go in to evaluate the patient, re-check myself, and then go from there with calling a doctor or not. At least half the time it's nothing to worry about (such as the manual BP in normal but the auto was high. It also helps to check it after the patient has had time to calm down after coming back from the bathroom and out of breath) but then there's the other half that something does need to be done.

[NurseSpeedy, ADN, LPN, RN]

14lbs is a lot of bowels and bladder and clothes!

You have no idea how many times I get an excuse like that when I show up with a scale! (My patients are adults and many of them like to eat).

My thoughts are that they are here because they cannot breathe, not because they haven't had a bowel movement in over a month or suffer from severe urinary retention....that hospital stay estimate just got a whole lot longer if they're telling me the truth!

[inthecosmos, BSN, MSN, RN, APRN]

I would try and discuss this issue with the MOA. The error can detrimentally effect care.