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?

[Rose_Queen, BSN, MSN, RN]

15 hours ago, MunoRN said:

what I can tell all state's allow CST to administer medications "under the supervision" of a Physician

I would think that internal policies should limit that to those that must be administered as part of a sterile procedure, and only when the RN is not part of the sterile team or the physician isn't administering themselves. We don't allow STs to administer meds in the OR- they may only draw up from a labeled container into a labeled syringe and the surgeon or advanced practice provider is the one to actually administer the medication.

OP, what happens to the CST in this situation is through their own fault- don't feel guilty about that.

[CharleeFoxtrot, BSN, RN]

18 hours ago, Daisy4RN said:

How is the kiddo?

^this, hoping it turned out well for the little one

[PollywogNP, ADN, BSN, MSN, LPN, NP]

What is an “RL Solution “?

[Rose_Queen, BSN, MSN, RN]

On 1/4/2020 at 6:17 PM, PollywogNP said:

What is an “RL Solution “?

Since it's something management requested, my guess would be an internal form of some sort. Perhaps their terminology for an incident report?

[crazin01]

I don't think OP delegated administration in this case. If OP was shocked to learn med was administered & about the dose, it sounds like CST took it upon themselves to do without OP's knowledge.

Am I reading wrong OP?

[Just me.]

It is ultimately up to Management on how this situation is handled. I don't know what the scope of practice is for CST in your facility. And what led the cst to believe he/she had the right to do this. I'm surprised they had access to the medication in the first place. Sadly, years ago I worked with a very intelligent and skilled tech that who was a former corpsman. This person was warned about doing things out the scope of his license and was ultimately fired for it.

[jupitercrash, LPN]

I guess I don't understand why the medication was taken out by the nurse then left unsupervised with the CST, if the intention was to be given later by the nurse. Obviously, this opened you up to the possibility of someone else giving the medication inappropriately. I know this may be the way it is "always done" in that facility, but never ever leave a med out for someone else to touch, that falls back on you.

[klone, MSN, RN]

18 hours ago, crazin01 said:

I don't think OP delegated administration in this case. If OP was shocked to learn med was administered & about the dose, it sounds like CST took it upon themselves to do without OP's knowledge.

Am I reading wrong OP?

No, I'm saying the delegation of assisting/assessing an infant during a circumcision should not have been given to the scrub tech. This should be a nurse role, not a scrub tech role.

[LPN Retired, LPN]

Sounds like an investigation is in order. There are questions that haven't been answered. What prompted the CST to give the medication? Did the Dr tell CST to give it, did Dr say how much to,give? Or was there a MAR with the instructions on it? Did the CST document on the MAR that the Tylenol was given? By what method did CST give it? When you said "drew it up" it sounds like it was given IV. That's just so crazy. If she gave it IV, let alone just touching meds, she's messing with IVs. I worked as an LPN and we were not allowed to mess with IVs at all. That was strictly done by the RNs. Of course anybody can be trained to do so, but that sounds like some stuff going on that shouldn't be. I thought meds were to be administered by licensed personnel so you always know what has been given, how much and when.

[Just me.]

"Drew it up" it sounds like it was given IV." I don't think she meant that, probably a multidose bottle or medicine cup and a syringe like mechanism was used to draw it up. I saw a few circumcisions, no comment, and the little ones were healthy in the nursery, no iv involved, just an anesthetic was used

[LPN Retired, LPN]

On 1/7/2020 at 12:11 PM, Just me. said:

"Drew it up" it sounds like it was given IV." I don't think she meant that, probably a multidose bottle or medicine cup and a syringe like mechanism was used to draw it up. I saw a few circumcisions, no comment, and the little ones were healthy in the nursery, no iv involved, just an anesthetic was used

That sounds bad too. Liquid Tylenol strangles me I can't imagine trying to get a dose down a small baby PO.

[Just me.]

Or a dropper? I saw the procedure done a few years ago when I did a very short stent in the post-pardum area. They didn't even use tylenol, it was glucose of sorts delivered with a pacifier like thing? Anyways, I'm not sure about all the details of this.