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Coworker making patient WORSE...what to do?

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Jo Dirt Jo Dirt (Member)

Has 9 years experience.

I am currently working a hospice case in a private home where the man is terminal with cancer. His condition is slowly but steadily deteriorating. About a month ago he got very dehydrated and we received doctors orders for a prn IV of D5 1/2 NS, of 25cc/hr d/t hx of CHF.

25cc/hr is the problem. I work the night shift and we have a nurse on the day shift who seems to think more is better, and she is flooding the little patient with a whole 1000ml bag in a 12 hr shift, plus will have a new bag hanging when we get there with about 100 cc's gone. Another nurse and myself have repeatedly tried to talk with her about how the patient is overloaded but she only tells us "I don't think he is getting too much, 25cc's an hour isn't enought to keep a kitten alive, that's just a little more than a cup per shift!" Instead of having the IV flow rate at 25cc she keeps it up around 100 at all times, even when he is drinking adequate fluids.

I came in last night to find the patient with severe congestion in his chest, as well as 2+ pitting edema to his lower extremities and in his sacral area. After talking to our supervisor (who runs the case from out of state) I d/c'ed the IV at once and by this morning he still had some congestion and a wet sounding nonproductive cough but the swelling in his feet and sacrum had gone down though not all the way. When we tried to talk with the nurse again she got very defensive and said the man is dying, you expect he is going to be in perfect shape? If his sacrum and legs were swollen last night why are they not swollen now? (saying this all in a very condescending tone)

What's worse, she is not charting that the patient is receiving all the extra fliuds and has faxed a written request to the doctor to allow the fluids to be increased from 25cc's because it is not enough. Also, the man's kidneys are not working all that well and he is having a hard time excreting all this extra fluid.

Other than charting, what can you do?

meownsmile, BSN, RN

Specializes in Med/Surg, Ortho.

Why isnt the hospice coordinator taking care of this problem? I know in hospice there is a very wide range of wiggle room for taking care of the patient but if she is obviously putting him into CHF and wearing him down quicker, why isnt your supervisor taking care of the situation?

UM Review RN, ASN, RN

Specializes in Utilization Management.

Obviously, she needs to be reported for her med error of giving the wrong dose of IV fluids.

Maybe if you explain to her that jacking up the fluid rate is actually practicing medicine without a license, for which she can lose hers? Or better yet, maybe a superior should explain that, because she needs to be called on the carpet about that.

Why should the poor patient have to die by CHF? Drowning in your own fluids is not a good way to go. :angryfire

I am currently working a hospice case in a private home where the man is terminal with cancer. His condition is slowly but steadily deteriorating. About a month ago he got very dehydrated and we received doctors orders for a prn IV of D5 1/2 NS, of 25cc/hr d/t hx of CHF.

25cc/hr is the problem. I work the night shift and we have a nurse on the day shift who seems to think more is better, and she is flooding the little patient with a whole 1000ml bag in a 12 hr shift, plus will have a new bag hanging when we get there with about 100 cc's gone. Another nurse and myself have repeatedly tried to talk with her about how the patient is overloaded but she only tells us "I don't think he is getting too much, 25cc's an hour isn't enought to keep a kitten alive, that's just a little more than a cup per shift!" Instead of having the IV flow rate at 25cc she keeps it up around 100 at all times, even when he is drinking adequate fluids.

I came in last night to find the patient with severe congestion in his chest, as well as 2+ pitting edema to his lower extremities and in his sacral area. After talking to our supervisor (who runs the case from out of state) I d/c'ed the IV at once and by this morning he still had some congestion and a wet sounding nonproductive cough but the swelling in his feet and sacrum had gone down though not all the way. When we tried to talk with the nurse again she got very defensive and said the man is dying, you expect he is going to be in perfect shape? If his sacrum and legs were swollen last night why are they not swollen now? (saying this all in a very condescending tone)

What's worse, she is not charting that the patient is receiving all the extra fliuds and has faxed a written request to the doctor to allow the fluids to be increased from 25cc's because it is not enough. Also, the man's kidneys are not working all that well and he is having a hard time excreting all this extra fluid.

Other than charting, what can you do?

Have you talked to the doc about this? I "assume" you both work for the same organization, why can't you go to your supervisor? Something needs to be done before she kills the pt for sure. Even if he is dying that doesn't give her rights to do as she pleases! Just my input!

Jo Dirt

Has 9 years experience.

Supervisor was notified last night after I came in for my shift. The company that hires us is out of state and that makes it difficult for the supervisor to actually know what is going on. You expect a certain degree of intelligence from people but after this I don't think I would trust this nurse working on me.

Last thing the supervisor said to me was, "D/C the IV altogether and tell (blank) to call me in the morning. If the order says 25cc/hr that is what he *will* receive."

We will see what happens.

This would be like her giving pills that were not prescribed. It is practicing medicine and she very well could lose her license over this.

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