Come On People, How Stupid Are You??

CapeCodMermaid, RN · Jun 28, 2017

I told the NP to consider a thorough review of blood pressures for 3-5 days and then changing the Ned to something that doesn't require PRN dosing every 8 hours, and discontinuing the med on the guy who fit the parameter criteria 2 times out of 104 chances!!

CrunchRN, ADN, RN · Jun 28, 2017

Not good. I haven't taken math since nursing school 24 years ago and I have never worked acute care or SNF as a nurse and I would know better. Maybe when you are giving meds to 66 people per med pass you just gloss over that stuff? I don't know. Definitely need to take those nurses aside and make them aware of the need to focus more.

NuGuyNurse2b · Jun 28, 2017

I've held BP meds outside of parameters before. I mean not as bad as this scenario, but I've held Lopressor for SBP of 110 even though the parameter says

OrganizedChaos, LVN · Jun 28, 2017

I've held BP meds outside of parameters before. I mean not as bad as this scenario, but I've held Lopressor for SBP of 110 even though the parameter says
That's slightly understandable. But the fact that multiple nurses didn't give a b/p med when the b/p was *clearly* elevated, just... I have no words.

NotMyProblem MSN, ASN, BSN, MSN, LPN, RN · Jun 28, 2017

If this is a consistent issue with this particular medication/patient/resident, I would have to wonder what the notes say. Is the resident refusing this med for any reason? Is his or her family refusing on behalf of the resident? With that many med errors, the provider should have been contacted long before that many opportunities were missed.

If a resident had an order for the medication to be given 4 times a day, for example, that still would only be 28 missed doses in a 7-day period. Do you not have a protocol in place that requires notification of the physician when X-amount of refusals or failed administrations occur for whatever reason? How often are audits done? You have a major system's failure in your facility. It might be time for a revised protocol, with that protocol being introduced during a mandatory training/inservice session with licensed personnel. I would not rush to call anyone stupid, especially if there has been no disciplinary action, additional training, policy enforcements, and those "stupid" nurses are still allowed to pass medications.

On another note, just because a person passed the nclex, it doesn't mean that they understood the mathematical content of nursing. Who knows? Maybe they passed enough other components to still gain licensure. Another point to consider is this: due to the large amount of look-alike, sound-alike medications, many facilities have since gone to writing or typing out frequently misunderstood symbols and names. Maybe your protocol revision update could also include a memo to the physician and the pharmacist as well.

Just my take on things...

Meriwhen, ASN, BSN, MSN, RN · Jun 28, 2017

Nope. I have to take a intermediate algebra math class for my BSN completion. Sure to use that symbol. Some just get it mixed up consistently.

This. Which is why it's better to write out "greater than" and "less than" whenever possible.

Everline · Jun 28, 2017

Sometimes I have to stop and think for a moment when I see those symbols, . In the case of bp meds, though, a little thought and common sense goes a long way. However, I think it's best to write things out and avoid symbols and abbreviations that can be confusing. But then, sometimes mistakes are not what they seem and are related to things we don't immediately realize. In this case, although it seems like a dumb mistake, if multiple nurses are making the same error, there may be something else besides ignorance/stupidity to account for it.

Jeniele, ADN, RN · Jun 28, 2017

Stupid question here. What about the patient's pulse? Side effect of hydralazine is tachycardia, so if the PT was tachy wouldn't that be an indication for holding the medication and considering an alternative for the hypertension? I've seen scenarios when nurses have held BP meds for HRs of PTs in both instances of tachycardia and bradycardia.

kbrn2002, ADN, RN · Jun 29, 2017

Since this was done by multiple nurses education might not be effective. Discipline probably wouldn't be helpful either with more than a few nurses involved. The easiest solution, though admittedly a little time consuming, would be to audit all orders in the building and change every single one with a symbol or easily confused abbreviation to the actual written word. Somebody went through all our orders a while back and changed every single eye drop order that was still abbreviated OS, OD or OU into left, right and both. The providers that write those orders don't even use those abbreviations anymore as they were so frequently confused.

NuGuyNurse2b · Jun 29, 2017

Stupid question here. What about the patient's pulse? Side effect of hydralazine is tachycardia, so if the PT was tachy wouldn't that be an indication for holding the medication and considering an alternative for the hypertension? I've seen scenarios when nurses have held BP meds for HRs of PTs in both instances of tachycardia and bradycardia.

You can see if there's prn nitropaste for that. it affects BP more than it does HR.

Kooky Korky, BSN, RN · Jun 29, 2017

A nurse on the shift before me once documented CMS on a leg that was not there!

More than one doctor or med student has been known to say PERRLA bilaterally, but the patient had a glass eye.

OP, did the NP stop the order? Rewrite it? Change it? Did you all do an inservice on this scary situation?

retiredmednurse · Jul 1, 2017

My hospital is JACHO certified. If I'm not correct aren't a few of those abbreviations that JACOH requires that they, among many others, are no longer to be used? I have been out of the hospital for a few years now, but it seemed that the symbols now needed to be written out for the reason above.