Brain farts

[Quietnurse18]

I’m a new nurse of about 8 months. I went through a period of absolutely hating my job and went through some pretty serious depression. I’m stuck in a two year contract, but here lately I’ve felt better about work and think I can at least keep going with it for a while. Anyway, to get to the point, sometimes I brain fart. I work at night so sometimes I’ll have insomnia and just be too tired to be at the top of my game. Like what’s currently bothering me is that I left work for a meeting this morning and one of the nurses asked me if I had given my patient some juice this morning. I said yes, their blood sugar was 80 and I didn’t want it to drop. But then it hit me they had been NPO for a bronch. I had like, a 2 second brain fart where I forgot. I think they canceled the bronch. I’m beating myself up about it currently and over analyzing my night like crazy. I’m thinking now of something I forgot to say in report and about a million other things I could’ve done better. But the kicker is I did a bunch of things right last night too. I guess I’m seeking reassurance or advice on how to not feel so crappy when I make mindless mistakes like this one ?

["nursy", RN]

OK so you did make a mistake. Not like me who never makes mistakes because I am perfect. Oh wait...NOT. Anyway, while this was an error, what I'm wondering is on your facility's back up/safety procedures. If a patient is NPO there should be a sign on the door or above the bed or some kind of warning somewhere so that everyone knows. The patient should also be aware that they are NPO (assuming they are alert). Was there something in place? If not maybe you can initiate something to prevent further errors.

[Quietnurse18]

They were aware they were NPO, but I guess we both had a moment and forgot. We don’t have signage but usually I write it on the whiteboard. But I didn’t this time because there were no NPO orders but I saw a bronch ordered so I got the doctor to put it in that night. It was just an all around stressful night and I hadn’t slept enough. This patient had had several periods of hypoglycemia during they’re stay so I just went on autopilot. This was just the first time I’d really made a consequential mistake.

[Sour Lemon]

I vaguely recall doing something similar to that as a new graduate. Along with the signs and other things you may already do, I found it's helpful to really stress to the patient not to eat or drink anything if someone tries to offer it. I also tell the CNAs, the families, etc. I've found that:

1. Confused patients sometimes still understand well enough to turn down a snack

2. Oriented patients will assume that food or drink is OK because you're giving it to them unless you've told them otherwise

3. Even when a confused patient doesn't understand, it's helpful to say the words out loud while you're looking right at them

[Quietnurse18]

Yeah, that sounds good. Sress to them it’s important not to eat or drink anything. We all have a lot on our mind so if anyone offers you something, try to remember to say no. Thank you all for the advice!

[ruby_jane, BSN, RN]

48 minutes ago, Quietnurse18 said:

They were aware they were NPO, but I guess we both had a moment and forgot. We don’t have signage but usually I write it on the whiteboard. But I didn’t this time because there were no NPO orders but I saw a bronch ordered so I got the doctor to put it in that night. It was just an all around stressful night and I hadn’t slept enough. This patient had had several periods of hypoglycemia during they’re stay so I just went on autopilot. This was just the first time I’d really made a consequential mistake.

And you'll never do it again.

As an aside...if they were relatively labile with their blood glucose and had to have the bronchoscopy, what *might* have happened if they were truly NPO? Is it likely they'd have had a finger stick prior to the procedure? What if they became hypoglycemic during the procedure?

I'm not in the hospital anymore and trying to think if there was something you'd have had around - maybe glucose tabs? But those are a very ambulatory care thing.

Chin up!

[Sour Lemon]

51 minutes ago, ruby_jane said:

And you'll never do it again.

As an aside...if they were relatively labile with their blood glucose and had to have the bronchoscopy, what *might* have happened if they were truly NPO? Is it likely they'd have had a finger stick prior to the procedure? What if they became hypoglycemic during the procedure?

I'm not in the hospital anymore and trying to think if there was something you'd have had around - maybe glucose tabs? But those are a very ambulatory care thing.

Chin up!

Typically, we give them something IV ...an amp of D50, or D5 something or another as a maintenance fluid if it's not contraindicated.

[ruby_jane, BSN, RN]

47 minutes ago, Sour Lemon said:

Typically, we give them something IV ...an amp of D50, or D5 something or another as a maintenance fluid if it's not contraindicated.

Especially if you knew they were labile....thanks!

[Quietnurse18]

Yeah I was thinking about that too. If they’d become hypoglycemic before the procedure. But yeah, we can’t give IV glucose or the oral glucose gel unless they meet the BG requirements in the MAR so we try to get ahead of it with some juice.
Thank you all for the advice though! I’ll try not to feel so down about it. Everyone makes mistakes. We’re human

[Sour Lemon]

1 minute ago, Quietnurse18 said:

Yeah I was thinking about that too. If they’d become hypoglycemic before the procedure. But yeah, we can’t give IV glucose or the oral glucose gel unless they meet the BG requirements in the MAR so we try to get ahead of it with some juice.
Thank you all for the advice though! I’ll try not to feel so down about it. Everyone makes mistakes. We’re human

You can still give D50, just not with that "generic" order. I gave it to a pre-op patient last week with a marginal blood sugar, but I had to call and ask for a one time dose or a PRN order with broader parameters. The MD opted for a one-time dose.