Could I be sued for neglect or lose my license over this?

[Ccinct]

I work in a long term care facility. Last night I had a resident who has sleep apnea and is non-compliant with her bi-pap and also has a history of acute respiratory hypercapnia and hypoxia. Around 2:00a she told me she was feeling anxious so I gave her a PRN trazodone 25mg, a medication she has taken many times before. About a half hour later she became SOB so I took her SP02 and it was 70% RA. I put her on 5L of 02 via non-rebreather mask and called my RN supervisor. I am a LPN. The RN did not even go in the room to assess her because her 02 sats went up to the 90s. My supervisor just opened up her chart and pointed to the page that said DNR and told me that means we don't send her to the hospital. I firmly told her that is not true and that I want to send the patient to the hospital. By this time we had the patient on 3L via NC, her 02 sats and VS were all WNLs but she was so lethargic that she was not even verbally responsive. Her baseline is alert and oriented times 3. I called on call and asked to send her. The on call MD said no, monitor her there and get an order for PRN duo neb which I administered. I once again pleaded with the supervisor to send her and the supervisor told me no because the facility needs to save money and when we send people out it wastes money. I could not get in touch with the resident's son, her POA but at 6 am I called her brother who came to visit. At 7am a new supervisor came on who also just wanted to keep the resident at the facility and monitor her there despite the fact that she was still not verbally responsive. At 3p, the new shift came in and they finally sent her out. The called me to say that I needed to come in and write a statement. They told me that the hospital had intubated her and that I should have called 911 even though the MD and my supervisor told me not to. I also found out that the page in the resident's chart was wrong and that she was actually a full code. The other thing that I am worried about is that I signed out the Duo neb tx and the trazodone late (I had to sign them out as late entry) because I didn't have time to put them in the EMAR with all that was going on.

On the one hand I feel like LPNs can't legally assess and I was just listening to the RN and the MD who told me she was fine and to monitor her at the facility. On the other hand I am worried that the state will hold me accountable and I will potentially get sued for neglect. Does anyone have any advice for me?

[RNikkiF]

You were working under the supervision of that RN. That situation is on her license. I hope you put your statement that she didn't go in the room too. It'd be easy to Monday morning qb this, and I wasn't there, but my first thought was to ask why you didn't put her cpap on her and see what happened first? Assuming she has a bleed in o2, anyway. Sounds to me like 1. You were a fantastic advocate for your patient. And 2. You had no control over the decisions of the RN and md. Rest confident that you did everything in your power. Sometimes we advocate and people don't listen. I guarantee that if that RN and MD hear you make statements like that again, they'll remember this, know you have good judgment and hopefully they'll listen.

[Sensibility, BSN, RN]

All you need to do in those cases is chart that the O2 saturation etc was reported to the nurse and physician (with their names). No orders received. You can't go over their heads. As it turned out, you were correct. But you might have been incorrect. Calling 9-1-1 is their responsibility. Meds typically have an hour window. Hope that helps.

[CaffeinePOQ4HPRN, BSN, MSN, LPN, RN]

I would start looking for another job if I were you. Your facility sounds terrible!

[CapeCodMermaid, RN]

Everyone with a license is responsible for his/her own actions.

[tiger777]

Please do not put someone on a non-rebreather at 5 LPM, you are actually giving them less oxygen than is in the atmosphere! A non-rebreather needs to be at at least 10 LPM of oxygen.

Even though this is very correct and accurate, the one thing that will save you is your documentation that the MD and supervisor was made aware of the patients status, the RN should have assessed this. You are protected period.