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.
The whole "2g of versed (1g over 40 minutes)" is SCARY, and I really hope it was a typo.
Not scary at all... of course it was a typo or a misspeak.
Really, none of you have ever misspoken your doses?
Recently, I inadvertently said, "50 mg of fentanyl" despite having used the drug on a daily basis for years. Nobody decided that I should be immediately whisked away for remediation. They simply replied, "50 MICs?"
Specializes in Medsurg/ICU, Mental Health, Home Health.
If "word has gotten around," and no supervisors have discussed the event with you, then I don't think reporting the incident will really have an impact on you personally. What could happen is an improved system. Remember, incident reports are not "write-ups."
As a rule, if you have never given the medication, please refer to policy prior to administration. How else would you know how quickly to push it?
Aww c'mon the worst thing that could have happened would be the patient buying themselves a tube lol
I'm sure they had intubation supplies and a skilled intubater readily available on this general pediatric unit for an obese teenager with neuro changes who wasn't on a monitor. I'm sure that will be an easy airway. Slide that tube right in. And I'm guessing this girl you were verseding up with "2 grams" of versed had no history of OSA from weighing 310 pounds at 17 either.
I agree with you about the midaz dosing not being particularly high. However, I would actually be MORE concerned about their airway because an LP was being done. Often times the patient positioning required for an LP can make airway obstruction harder to catch early. As an aside, I don't know what type of floor this occurred on, but in my peds hospital, LPs cannot be done on the floor, regardless of what drugs are given during it.
I think he / she would be directly in front of the patient, helping them stay in the correct position. They'd be able to detect an obstruction.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
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.
First, you are giving out way too much information on a very public forum.
Second, if you were giving 2 GRAMS of Versed IV push, you were giving 1000 times the usual dose. I'm hoping you meant "milligrams". If you weren't familiar with the drug, you should have looked it up. As an RN, you're responsible for knowing the usual dose range of the drugs you give. You're also responsible for knowing your facility's policy on IV push medications -- if you weren't supposed to be giving it on your floor, you shouldn't be giving it. Did you check with the charge nurse or run it by a more experienced colleague? Did you call the pharmacy for clarification?
Third, your concern seems to be for yourself and not for the patient you could easily have killed.
Fourth, it doesn't matter whether anyone liked the physician involved. It is your responsibility to remind him that Versed isn't to be given IVP outside the monitored areas of your facility. It's your responsibility to push back, even if the physician is unpleasant, rather than allow harm to come to your patient or to violate hospital policy. And since you didn't know anything about Versed, it was your responsibility to check with the charge, the pharmacy or your hospital's policy before giving it.
Fifth, a person of integrity takes responsibility for their practice. YOU made the error, YOU should have reported it. Your concern seems to be that the nurse who did report the situation is making you look bad. YOU SHOULD LOOK BAD. You're concerned that it makes you look as though you were hiding something by not reporting the incident . . . but you said the reason you didn't report was that you were concerned about "getting into trouble" or "being held accountable." You ARE accountable.
What should you do next? I would suggest that you polish up your resume because a person who lacks accountability and personal integrity has no business being a nurse. Perhaps you will be really lucky and skate on this one because you're extremely likable and your manager wants to give you another chance. I just hope that you take this situation to heart and learn from it, but so far I'm not impressed with your ethics.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
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.
If this is the first error the poster has ever made, and she throws herself on the mercy of management, perhaps she can skate by. But OP admits that she declined to report the incident because she didn't want to get into trouble, which points to a pattern of dishonesty and lack of accountability on top of the ignorance of her facility's policies, her failure to get a second opinion or inform herself before giving the drug and her unwillingness to advocate for her patient because the physician had a reputation for unpleasantness. Had this happened on my unit, the poster would in all NOT be working on my unit.
Mistakes are forgivable. Lack of accountability and integrity are not.
Ruby: I find your posts to be very informative. Good for beginners, people in the middle, as well as old timers, for a reminder now and then. Thanks for taking the time to add your to-the-point input.
Fourth, it doesn't matter whether anyone liked the physician involved. It is your responsibility to remind him that Versed isn't to be given IVP outside the monitored areas of your facility. It's your responsibility to push back, even if the physician is unpleasant, rather than allow harm to come to your patient or to violate hospital policy. And since you didn't know anything about Versed, it was your responsibility to check with the charge, the pharmacy or your hospital's policy before giving it.
This! In reality a physician can order whatever the heck they want, but it's up to nursing staff who actually administer the medication to know the policies and operate within their boundaries!
OP, you should speak to management immediately. Own up to this mistake and learn from it. Though a 2mg dose for an apparently very large peds patient shouldn't really be too dangerous, not monitoring your patient when you give them drugs that affect mentation and respiratory drive is bad practice. In truth, any medication-naive patient can have more of a reaction than you expect to some medications, and not being familiar with a med also means you might not recognize issues or know how to correct them. Did you have a reversal agent at bedside?
I have seen a full-grown, muscular, fit man stop breathing with a teeny dose of Dilaudid, and his nurse didn't even put him on the pulse ox originally. You can bet she changed her practice after that scare. For whatever reason, we had to push quite a bit of Narcan on this guy — he was just very opiate inexperienced and sensitive to it.
Patients trust us. Earn that trust and work hard to maintain it!
bgxyrnf, MSN, RN
1,208 Posts
Really, none of you have ever misspoken your doses?
Recently, I inadvertently said, "50 mg of fentanyl" despite having used the drug on a daily basis for years. Nobody decided that I should be immediately whisked away for remediation. They simply replied, "50 MICs?"