Digoxin Error, What should have been done?

[WVStarFish]

I had another question that is bothering me to no end.

I have been "orienting" at the LTC home and have been pretty much passing meds on my own.

There is a situation where one day, I had to hold a residents Digoxin dose d/t an AHR of 50.

According to the MAR, he had been getting the dose every day and an AHR was recorded every day. (I know for a fact that the nurse doesn't even check HR on him, as I shadowed with her)

Anyway, the next day, I caught a discrepency in the MAR and what was actually in the med box. (I know I should have caught it my first day, but I did catch it on my second day)

The MAR and Drs order calls for 0.125 of Dig

The pharmacy has been sending only half of that. 0.06

So, he has only been getting half of his Dig AND with that, he had the bradycardia. Without that one days dose that I held on him, his HR was too erratic for me to count properly.

The RN that has been "orienting" me did nothing. Even during shift change, at report, I had to remind her of this. The nurse getting report was irked that the RN didn't try to fix the meds.

And I am irked that no one seemed to care about his health, or checking on him at all that day. All that RN thinks she has to do is pass meds and do paperwork. She says the Aids check the residents, but I feel a personal responsibility....Is it unreasonable to go in occasionally and check on my residents to make sure they're still breathing?

Am I being anal? Am I being a newbie? I have to ask you guys on here because I don't think I would get a good answer at my job.

Thanks again!

[nightmare, RN]

No you're not being anal,you're being a good and conscientious nurse.

[texasbsn]

I am a new grad,I have always continually during my clinicals and my practium,which was at a LTC checked on my patients as much as possible.I think you are right to keep a close eye on your patients.

[CoffeeRTC, BSN, RN]

This response is a bit late.....

That nurse was being lazy. Sorry. Yeah... I work LTC and when I do 7-3 (rare) they look at me crazy when I go to do an apical, so I bet it wasn't being done.

What should have been done...a med error/ incident report. Doc and family should have been notified and pharmacy. Doc will probably make a change in the med order. Some of our pts get low doses every other day or 3 times a week. Some will still give the low does for a HR of 50.

What happened...did she do this? IMHO...it would have been a good learning experience to show you how to deal with situations like this.

[LovingNurse, BSN, RN]

Kudos to you wvstarfish, for doing what is right...For doing what you were taught to do... For doing what your are expected to do...For doing what you'd want a nurse to do if it were you or your loved one in the bed. :redbeathe:nurse::redbeathe

You have a good head on your shoulders and a good heart. It irks me to no end when nurses intentionally skip safety steps or document things they didn't do when you know darned well that's not the care they'd expect if they were the patient.

Your patients are fortunate to have (((you))) as their nurse.

Keep up the good work.

[andrewmccute]

You are just being a careful nurse that way. BTW you should watch your pt closely before and after administering Digoxin to check for toxicity. Check also the apical pulse honestly since it is your basis before giving Digoxin.