CST drew up and administered medication....and it was wrong amount

[Alyk3309]

So I had a crappy situation happen to me today and I just need some clarification on some things. I am an RN that works in LDRP. I had a CST draw up and administer Tylenol to a neonate, that I was taking care of, after a circumcision. We generally get the lidocaine and Tylenol from the medication distribution machine and give it to the CST's so the doctor can administer the lidocaine before the procedure and we generally keep the Tylenol in the bassinet for us (the RN's) to administer after the procedure. Not only was I shocked when she said she gave it but when I asked her how much she gave, it was the wrong dose.

I had pulled her aside and let her know that that was out of her scope of practice and only RN's are able to draw up and administer medications. I also said that giving a wrong dose of any medication to a neonate could result in an overdose or even death. I told her that I had to report this. I reported it to my supervisor, manager, and they had me fill out an RL solution.

What should happen to this CST? Is she going to get fired? Will she lose her certification due to going out of her scope of practice?

[LovingLife123]

What is a CST? Is it a tech?

[Daisy4RN]

15 minutes ago, LovingLife123 said:

What is a CST? Is it a tech?

Certified surgical tech?

[Daisy4RN]

Yes the tech needed to be reported if out of their scope. I would assume she would be fired. How is the kiddo?

[klone, MSN, RN]

Why the hell is the scrub tech even TOUCHING medications?? I have worked in OB for 14 years, so I am pretty well versed in anything OB-related, and I can tell you, the scrub techs should have nothing to do with meds. Further, it should be the NURSE, not the scrub tech, who is assisting with a circ.

Honestly, if anyone should be disciplined, it should be the nurse, who is delegating inappropriately. Seriously, this is "stand before the state board of nursing" stuff.

[klone, MSN, RN]

But yes, the scrub tech should also be disciplined, and probably fired for working grossly outside of her scope.

[LibraSunCNM, BSN, MSN, CNM]

24 minutes ago, klone said:

Why the hell is the scrub tech even TOUCHING medications?? I have worked in OB for 14 years, so I am pretty well versed in anything OB-related, and I can tell you, the scrub techs should have nothing to do with meds. Further, it should be the NURSE, not the scrub tech, who is assisting with a circ.

Honestly, if anyone should be disciplined, it should be the nurse, who is delegating inappropriately. Seriously, this is "stand before the state board of nursing" stuff.

This. I've never heard of such wildly inappropriate delegation in this setting before.

[Daisy4RN]

Doesnt sound like the RN delegated. Maybe the tech took it upon themselves.

[klone, MSN, RN]

She shouldn't have been giving the meds to the CST in the first place. There is no situation where I can think it necessary for the CST to be responsible for the medications, even if it's just giving them to the physician for administration. That's why an RN should be assisting with the circ, not a CST. There is a timeout that needs to be done, and assessing of the infant during and immediately after the procedure that should be done by the RN. THAT is the inappropriate delegation I'm referring to.

[klone, MSN, RN]

OP, I understand this is probably the practice you're used to, and it's "always been done this way" but please, the practice needs to stop. The CST should not be the one assisting the physician - that is a nursing responsibility.

[JKL33]

Sounds like there has been a decision to have CSTs involved, doubtful that it was a lone-RN decision (based on use of "we"). So I would call this the new and crappy unofficial version of delegation: UAPs and/or non-nursing personnel performing duties as assigned by management and everyone referring to that as "delegation" (supposedly by each individual RN).

[MunoRN, RN]

I completely agree that a CST shouldn't be the one administering Tylenol to a neonate, but to clarify, it's not outside the scope of a CST to administer medications. The regulatory requirements relating to this are set at the state level, but from what I can tell all state's allow CST to administer medications "under the supervision" of a Physician. What "under the supervision of" means does vary from state to state, with many having fairly laxed requirements for what counts as being supervised while administering medications.