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?
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.
I'm sure when the OP used the phrase "drew it up" they meant in a syringe to be given orally, that's how it's generally given. Definitely not IV Tylenol for a neonate! A glucose pacifier is often given as well. AAP recommends giving either a local dorsal penile block or EMLA cream for anesthesia, plus a glucose pacifier and/or oral Tylenol for circ pain. Regardless, I'm still baffled about this situation and how it occurred!
I'm sure when the OP used the phrase "drew it up" they meant in a syringe to be given orally, that's how it's generally given. Definitely not IV Tylenol for a neonate! A glucose pacifier is often given as well. AAP recommends giving either a local dorsal penile block or EMLA cream for anesthesia, plus a glucose pacifier and/or oral Tylenol for circ pain. Regardless, I'm still baffled about this situation and how it occurred!
I agree.
Oral Tylenol for neonates is stocked in little prepackaged cups like this:
You do 'draw up' the dose, like you would draw up an IV med.
In the smallest size cup, the full dose contains 160 mg, which is the dose for a 30 lb child (so a 3 year old). The exact amount a patient gets is weight-based, but the neonatal dose is usually about a quarter of the full cup.
I wonder if the nurse set the cup of Tylenol in the baby's bassinet and the CST gave the whole thing (mistakenly thinking that one cup was a single-use infant dose); in that case, the baby would have gotten four times the appropriate dose.
Unfortunately, I could totally see this happening if the provider told the CST to 'give the Tylenol' and the CST just gave the whole thing.
Oral Tylenol for neonates is stocked in little prepackaged cups like this:
You do 'draw up' the dose, like you would draw up an IV med.
In the smallest size cup, the full dose contains 160 mg, which is the dose for a 30 lb child (so a 3 year old). The exact amount a patient gets is weight-based, but the neonatal dose is usually about a quarter of the full cup.
I wonder if the nurse set the cup of Tylenol in the baby's bassinet and the CST gave the whole thing (mistakenly thinking that one cup was a single-use infant dose); in that case, the baby would have gotten four times the appropriate dose.
Unfortunately, I could totally see this happening if the provider told the CST to 'give the Tylenol' and the CST just gave the whole thing.
I was also wondering about the med being left in the bassinet. Is that a common practice? Are other meds left in bassinet of other babies as well? Just seems like that is not a good practice, or good way to keep,up with meds. Unauthorized people coming in being around meds not locked up. And this is in an NICU. I equate that to leaving meds in a LTC patients nightstand which state inspectors would come in and shut the place down for.
I was also wondering about the med being left in the bassinet. Is that a common practice? Are other meds left in bassinet of other babies as well? Just seems like that is not a good practice, or good way to keep,up with meds. Unauthorized people coming in being around meds not locked up. And this is in an NICU. I equate that to leaving meds in a LTC patients nightstand which state inspectors would come in and shut the place down for.
LibraSunCNM, BSN, MSN, CNM
1,656 Posts
I'm sure when the OP used the phrase "drew it up" they meant in a syringe to be given orally, that's how it's generally given. Definitely not IV Tylenol for a neonate! A glucose pacifier is often given as well. AAP recommends giving either a local dorsal penile block or EMLA cream for anesthesia, plus a glucose pacifier and/or oral Tylenol for circ pain. Regardless, I'm still baffled about this situation and how it occurred!