I have been working ICU for 8 months straight out of school. Lets not make tjis into a "new nurses should not go into ICU" thred please, that wont help me.I was called last night and told not to come in this morning to the unit. Instead I should goto nursing services and meet with my manager and her manager. Yikes.
1-Last Friday I admittedly made an error (I work ICU). A Patient was admitted from the floor and i wrote an order for ativan 1 mg q 3 hrs, it should have been PRN, i forgot to write PRN. I reported off to the night nurse about the ativan helping with pain/agitation and he realized not to give that much. The patient got several doses 8 hours apart, but the doc flipped when he saw how the order was written
2- Several weeks ago, I had an extremely agitated patient who was also 350lbs. There was an order for haldol 2 mg ivp prn, no time constraint. The nurse who gave me report said she had been moaning all night and nthing could be done, and that she had proabl;y not slept in days and her solution was to close the glass door so she couldnt hear the pt moan. I felt this to be NOT helpful to the pt. I ended up giving some 70 mg of haldol over the 12 hour shift. I looked up the safe dosage and that falls within the safe dose. Some books say 5 mg every half hour, some say 10 mg, then double until you get the desired effect every half hour stopping at 50mg. At no point did the patient have decreased resp[irations or drop her blood pressure. She fell asleep for a few hours but thats it, all in all even that much haldol was not that effective. That was several weeks ago and I guess they were reviewing the MAR and somone flipped. I also asked the other nurses on the unit, including the charge if it were ok that i give that much and noone said anything other then they had not given that much before but it didnt violate the order or the corecct safe doasge. Also They were upset that I didnt question the order for not havinga time constraint, which i will do in the future.
Fallout- Luckily I didnt get fired but now I must verify ALL medications with the charge nurse before I give them. "charge nurse, can i hang some vanc?" crap... and I am not allowed to work overtime because they felt I have worked too much and was too tired. The crazy thing is I am helping THEM out and they cut my overtime completely!!! I am thinking I will find a new job and put my two weeks in ASAP
No, YOU are not getting the picture but this thread has gone on way too long trying to support you. You refuse to acknowledge the errors you made so yes, you might as well move on, and contact us with your next error.
b- lots of literature to support what i did, nothing in writing suggest i did anything wrong.
I do agree however that next time, i will cal a doc when i have to use that many times his PRN order, that is where my lack of expereince hurt the most. Other then that I beleive the memebers of this board would probably feel differently had they been there as well
you should consider yourself lucky in that you still have a job. if this had happened at my facility, my ass would be otd. making excuses (such as blaming the docs, other nurses) and trying to justify your actions ('it was a correct order') only reiterate the fact that you messed up and won't take ownership!!
for future reference:
1. review the 5 rights with each med. i don't care if it's tylenol, review the five rights!!!!!!!
2. do nurses have prescriptiveauthority? last time i checked they didn't. if you have a question about an incomplete/unclear order, ask the person who wrote it. you went beyond your job description (check out the npa) by deciding how often to give the haldol.
3. own up to your mistakes!!!! take some accountability!!!! you sound immature and whiny when you blame others.
4. review acls. if you keep up the "i didn't do anything wrong.....they're all out to get me......the patient was 350 lbs. so it's ok....." rant, you're going to need it.
I would like to see the "lots of literature to support what i did" that you post of. So far all you have posted is 1 random internet site.
every critical care iv drug guide I have looked up haldol has me administering within safe dosing guidleines providied all parameters are montored for, several have me at a fraction of the max daily dosage, do your own homework
So a hotshot doc wants me fired and his partner tells me as much, and I should ignore that and try not to get fired under thos circumstances, whose missing the bigger picture????
Lets just say we agree to disagree on the dosing and administration of haldol.....
As it turns out, I am guilty of very little except pissing off a hotshot pulmonologist who like to percutaneously trach people when he should leave that to the surgeons. This patient is 350 lbs, and this doc messed her up bad and is looking at getting his pants sued off. He reviewed charts/ mar and found where I had given that haldol and lost his ..... Anyways I have run this by pharmacist and other docs, and they say as long there were no signs of ekg changes/hypotension, decreased respirations, or NMS, which I assesed for as the drug admin guides said, i was WELL under the upper level dosing guidelines. And thus haldol was ordered for anxiety/agitation. So I administered correctly, and yes, I did run it by my coworkers and the charge nurse that day and they all agreed that the guide and order were correct, they were also familiar with the patient and everything we had tried previuosly on her ( which everyon on this board is NOT, but thanks anyways).
So then this morning another pulmonologist in his group pulls me aside and reasures me that I didnt really do anything wrong, and that this guy has sicked my manger on me, and they asked her (the friend pulmonologust) questions about me. She says I think they are trying to get buuld a real case against you, you have pissed dr so & so off, I think it is BS, I have seen this before, I am so sorry etc etc. I think this is not fair and I hate to see them to this to you.
My coworkers said they stuck up for me when all this went down last week too. I felt awful today having to ask other nurses to give meds to my patients and I realized, built into many of our protocols are statments like" adjustments may be made when considering additions of this and that etc etc) in other word use your jusgement for lets say titrating insulin when considering TPN and and steroids. Well My judgemnet could easily be considered an error and i could be fired. I cant work like this for 60 days.
Another point was brough to me by my coworker- if you made a med error, there is ahospital policy for dealing with that. It invloves classes and videos etc etc, why are you not int that program? Why, because you made no med error. The only error I made was pising this doc off, by not knowing he would not like me giving his patient this much haldol.
I realize many of you think its alot. but you didnt see what WE saw, didnt see what we tried, and didnt see how it effected this patient. That is why noone said anything on that day. And that is why there is such a wide variation of haldol dosing administration in the ICU setting.
I am a good nurse, and i am not going to let this keep me down. I did my homework and assesed correctly. Today my patient that i transferred tothe floor grabbed me and hugged me, that why i am in this. I have an interview at another hospital tommorrow, and im going to take the job at another ICU if offered, until then, I will do my best to cross my t's and dot my i's .
NP (not really gonna be an NP) :)
especially in the ICU setting you should be careful with medications. These patients are fragile! I have never heard or seen anything that equates to this wide variety (essentially you were setting your own time frames and amount)....I really agree with the other posters--this was a pretty big error. Your book gives generalized dosage info--it does not take into consideration patient status...as this is something you must assess. If during your assessments after a few administrations of the med, with no effect, why did you not call the dr.?????
Well actually i think she does get it. She has acknowledged that given the situation again, she would call the doc. Isnt that what the issue was in the first place, the fact that most felt she should have contacted the doctor about the med not being effective for what it was being given for. That it only helped her rest for a short period of time, and maybe something else would have been a better option or even in addition to the Haldol. I think she does get that.
Literature or no,, she did check her books, run it by other nurses/supervisor and NOONE gave her cause to rethink her dosing. I dont know maybe they do give those doses regularly in THEIR ICU. I personally wouldnt but i cant be responsible for what another nurse chooses to do.
If she has since found the Dr in question has her in his sights, there isnt much she can do about that. Ive seen doctors do this just because they dont like someone,, and it has nothing to do with their nursing.
To the OP, i hope your interview goes well and you get past all this. If nothing else this has been one heck of a learning experience for ya and you wont let it happen again, regardless of who it is that wrote the order or why. I'm not so sure i wouldnt stick out the probationary thing because it will take a lot of fortitude for another facility to hire you if you are under a probationary period where you are coming from. Then as soon as its over,, get the heck out. If they let you swing on this,, just think of what other situations could come ahead. It's not worth the risk. You worked to hard for the license and you deserve more support from your co-workers than you got there.
I'm not so sure i wouldnt stick out the probationary thing because it will take a lot of fortitude for another facility to hire you if you are under a probationary period where you are coming from. Then as soon as its over,, get the heck out. If they let you swing on this,, just think of what other situations could come ahead. It's not worth the risk. You worked to hard for the license and you deserve more support from your co-workers than you got there.
so essentially yes, up to 500 mg iv has been given but obviously we're talking about very extreme cases. overall it basically discourages high doses and goes into prn uses.
plus it's important to keep in mind that the op presented this pt initially as agitated, then moaning. that does not sound like someone out of control, therefore a poor indication for using this drug.
every critical care iv drug guide I have looked up haldol has me administering within safe dosing guidleines providied all parameters are montored for, several have me at a fraction of the max daily dosage, do your own homework
I have done my homework and none of my books (PDR, Davis's Drug Guide, Springhouse Drug Guide, 3 of the most well known) say you are way off base especially for an elderly person.
QuigRN
66 Posts
No, YOU are not getting the picture but this thread has gone on way too long trying to support you. You refuse to acknowledge the errors you made so yes, you might as well move on, and contact us with your next error.