Concerned..please help

Boomer MS, RN · May 11, 2017

Was wondering if someone could provide me with some good advice as I am concerned about something that happened at the hospital where I work.
Hx: I have been a nurse for a year now. I participated (for the first time) in assisting in a lumbar puncture on a 17 year old patient who came in with HA. They dx'd this patient with peusdotumor cerebra.
What happened: During the LP procedure, I was told to administer 2 grams of Versed iv push (1 gram at about 40 minutes apart) to the patient to help calm her, as the procedure was traumatizing.
Unaware of the policy regarding the areas Versed could be administered, I gave this med to the patient. The patient was not on a monitor, however I did take vital signs before/after the LP procedure and the patient was stable. The patient was transferred 20 minutes later to an icu for close monitoring.
Concern: After procedure, the next day word got out (apparently by my co-worker who worked with me that night, but didn't know the policy either) that the physician (who none of the nurses like) ordered me to administer Versed on my floor when it should have been administers in the PICU where the patient should have been on a monitor during administration. Now word has gotten out to everyone in my area and PICU area about what happened. Most of the nurses feel I should report the ordering physician to administration, (not only bc they felt it was unsafe but more so because they want to get this physician in trouble.
Adamant about not reporting the doctor, I felt by me reporting the event, I would also be held accountable and get in trouble bc I didn't know the policy. Well, one of the nurses who wasn't even present during the event took it upon her self to not only go to the manager of our area but also discuss what took place to the CNO (chief nursing officer). Now in my opinion, it makes it seem as if I was hiding or keeping them from knowing what happened, because I didn't report it to anyone.
Im not really sure what I should do next and it's really stressing me out.

It is paramount that nurses know their facilities' policies and procedures, most importantly for patient safety. If you are unsure and have questions, you need to ask someone. The charge nurse is a good resource. The first year of practice is probably the hardest.

I hope you meant 1 mg of versed, not 1 gram, which is not the correct dose. One milligram is 1/1000 of a gram. I suspect it is a typo!

From what you say, an incident report would be appropriate. Be honest about your mistake. Stay away from the emotion about this MD being disliked and stay with the facts. This will be a learning experience for you, one of many. I suggest going to your manager to discuss this, as being open and honest go a long way. Perhaps there is also another RN whom you trust you could run this by? We've all made mistakes, believe me.

Maria1308 · May 11, 2017

Yes, it was mg not grams! Which in my opinion 2mg was ok for a 310 lb patient.

Sorry for the typo and I sincerely appreciate your response.

RiskManager · May 11, 2017

It is never too late to file an incident/event report. We really need the reports so we can start and document our investigation appropriately. I would put in there that you were initially unsure if a report should be filed and are now doing so.

Wuzzie · May 11, 2017

You are not going to like this but it needs said...

I participated (for the first time) in assisting in a lumbar puncture on a 17 year old patient who came in with HA. They dx'd this patient with peusdotumor cerebra.
Did you ask for help or guidance since this was your first time?
What happened: During the LP procedure, I was told to administer 2 grams of Versed iv push (1 gram at about 40 minutes apart) to the patient to help calm her, as the procedure was traumatizing.
As much as I would like to believe I do not think this was a typo. You are clearly unfamiliar with this medication and should not have adminstered it until you were.
Unaware of the policy regarding the areas Versed could be administered, I gave this med to the patient.
This is entirely on you. You should have looked at the policy or asked prior to giving the medication.
The patient was not on a monitor, however I did take vital signs before/after the LP procedure and the patient was stable. The patient was transferred 20 minutes later to an icu for close monitoring.
Second indicator that you have no understanding about the proper use of Versed.
Concern: After procedure, the next day word got out (apparently by my co-worker who worked with me that night, but didn't know the policy either) that the physician (who none of the nurses like) ordered me to administer Versed on my floor when it should have been administers in the PICU where the patient should have been on a monitor during administration.
Again, this is something you should have checked prior to giving the Versed. It is your responsibility to know your hospital's policies"
Now word has gotten out to everyone in my area and PICU area about what happened. Most of the nurses feel I should report the ordering physician to administration, (not only bc they felt it was unsafe but more so because they want to get this physician in trouble.
It was unsafe because you are unfamiliar with the appropriate does and usage of Versed not because the physician ordered it. Getting the physician "in trouble" shouldn't be part of a professional environment EVER!

Adamant about not reporting the doctor, I felt by me reporting the event, I would also be held accountable and get in trouble bc I didn't know the policy.

You should be in trouble.

Well, one of the nurses who wasn't even present during the event took it upon her self to not only go to the manager of our area but also discuss what took place to the CNO (chief nursing officer).

Somebody NEEDED to report this and it wasn't going to be you.
Now in my opinion, it makes it seem as if I was hiding or keeping them from knowing what happened, because I didn't report it to anyone.

The truth hurts.

Im not really sure what I should do next and it's really stressing me out.

What I'm really concerned about is your utter and complete lack of understanding of how very wrong YOU were. You, and only you, are responsible for your practice. You made multiple errors and are not taking ownership of any of them. Not only that but your only concern is how you are being made to look bad which you deserve.

What you should do is take a long look at your role in this debacle and then get down on your knees and thank whatever higher power you believe in that nothing bad happened.

Nurses who are unable to practice self-reflection in situations like this are a danger to their patients. You need to take a long, hard look at your culpability. SMH!

Dranger · May 11, 2017

Aww c'mon the worst thing that could have happened would be the patient buying themselves a tube lol

RotorRunner · May 11, 2017

This is a safety issue. I would recommend being upfront and honest about what happened and to come up with a plan to prevent this from happening again. The fact you you used the word "grams" instead of milligrams twice in your post leads me to believe that you aren't familiar with the medication. Administering Versed to an unmonitored pediatric patient is not safe nursing practice. I would report this in whatever internal reporting system you have at your facility, and as I said before, have a plan for how to prevent this happening again that you can verbalize to your supervisor. No harm was done to the patient, which is the most important thing.

YoutubeTheNP · May 11, 2017

You are lucky administering versed by itself is not considered conscious sedation, otherwise you could be in big trouble. From your OP, you do seem under-educated about the drug, it's use, and potential harmful effects. I understand your typo about the G and MG, but why was the medication given 40 minutes apart? LPs take 5-10 minutes to complete. Weird order from the MD

I don't see how you could have any major disciplinary action from this, but it should be a very good learning experience. Versed by itself should be no different than administering dilaudid, morphine, or ativan IV as hey should fall under the same administration protocol for your unit. They are potentially dangerous drugs. You can reference the conscious sedation guidelines which you can find online if they really try to make this a problem for you. GL with whatever happens.

HeySis, BSN, RN · May 11, 2017

OK, I'm finding several other things here, the dosage made me gasp first of all, and I wondering if the following sentence was going to be the pt stopped breathing.... So while it was apparent you did give this much, it leaves one to wonder if you did know how much you gave.

Next...

Versed on my floor when it should have been administers in the PICU where the patient should have been on a monitor during administration.

pt was transferred to ICU after but versed is usually administered in PICU??? which leads us all to think peds pt.

But what.. then..

Yes, it was mg not grams! Which in my opinion 2mg was ok for a 310 lb patient.
Sorry for the typo and I sincerely appreciate your response.

I have seen some big peds pts, but none that are 310lbs!! So would you normally take an adult pt to the PICU to administer versed?

And I agree with the others, you should have stopped when you were helping for the first time and asked for guidance. And YOU should have completed the event report. Your co-wrorker was correct to raise this up the chain of command, it's a safety issue, and you became a double safe issue (1. performing a task you did not know how to do) when you refused to report the incident.

Liking or disliking the MD has nothing to do with this scenario, and should be left out of the story entirely.

hlnorrn · May 11, 2017

An incident report should be filled out. Document just the facts with no emotion. It wouldn't hurt to make an appointment with the CNO and make sure that she is aware of your side of the situation. The other nurses wanting the physician to get in trouble sounds kind of childish. In my experience, it is not very often that a provider will actually get in trouble, more than likely it will just go into some kind of peer review. The longer you stay silent the more it may look bad. Honesty is always the best policy.

mmc51264, BSN, MSN, RN · May 11, 2017

We have a safety reporting system that is in place to avoid things like this. Sometimes doctor don't think, sometimes they don't know. We are not allowed to do anything that is considered "conscious sedation" but we have nurses that don't know what that entails and the residents don't always know.

Use this as a learning/teaching experience by filing a report. This time there was no harm. Might not be the case next time and you might be the one to prevent a "next time"

Our facility is a "no blame" facility. It is a team effort and obviously there was a gap in communication if you and the doctor did not know the policy.

OlivetheRN, ADN, BSN, RN · May 12, 2017

As others have already said, big safety issue here. Administering a med that you are clearly not familiar with without either looking up the info about it and the policies about giving this particular medication on your unit is bad practice. It's never a bad thing to ask questions or for help, especially when you're in your first year of nursing. I'm not and I still ask questions or ask for clarification for things on probably a daily basis. As far as whatever system your hospital uses for safety reporting that is absolutely appropriate for this situation. As nurses we have to take ownership for our mistakes, because we are responsible for people's lives and wellbeing. Yes, the MD was too, but ultimately you were the one to push that med and were responsible for monitoring that patient appropriately (which they weren't monitored appropriately). Leave the emotions and how other people feel about that particular doctor out of it.