Do you think I did something wrong here? Advice?

by ellebee87 ellebee87 (New) New

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Conqueror+, BSN, RN

Has 28 years experience. 1,457 Posts

Don't worry and when you go to work please don't start asking around to see who is mad etc...Just go in and do your job as if nothing has happened.



Specializes in Oncology, Rehab, Public Health, Med Surg. 392 Posts

Good job, OP! You were really watching out for your patient!



10 Posts

Thank you. :)



Specializes in LTC. 46 Posts

Well done! You have the makings of an excellent nurse, keep it up! You are in NO danger of losing a license you have not obtained yet. NO CHANCE! Don't you sweat that. This situation was a mess and you did the right thing. I would have liked the doc to order an INR, immediately if you have the hand held unit or ASAP via the lab, just to be safe. Otherwise....

Your Unit Coordinator dropped the ball here on several levels...

1.) Why was it not CLEARLY evident on the chart that this patient had a unique Warfarin set up?

2.) The units paper MAR was INCORRECT.

3.) WHO does she think she is telling your co-workers that she is upset with you?!?! That is so unprofessional! She should be written up for her errors.

Please lose no sleep over this and frankly, I would have a REAL talk with the DON, if she calls you back, that you do not appreciate how this was handled and what second checks can the Unit Coordinator put in place so that you do not find yourself in this situation again, where you have to double check her work because patients are at risk.


Chaya, ASN, RN

Specializes in Rehab, Med Surg, Home Care. Has 15 years experience. 932 Posts

"If it wasn't written down, it wasn't done". (I'm guessing you've heard this a time or two). I don't know about your nursing curriculum, but mine did not include psychic divination of patient care delivered on previous shifts but not recorded. You had no way to know what doses were actually given; plus to further complicate the issue, future doses of warfarin would be based on how well the assumedly correct dose regulated coagulation. Even if you had been able to verify that the actual dose being given differed from the recorded dose, this is a med discrepancy and your only safe option was the one you chose, to present the situation with as much info as you could obtain to the covering MD for evaluation (not in your scope of practice as an RN.

Chaya, ASN, RN

Specializes in Rehab, Med Surg, Home Care. Has 15 years experience. 932 Posts

"If it wasn't written down, it wasn't done." You can't be expected to read minds re: what previous doses were actually given but not recorded accurately (not to mention how future doses of warfarin are based on knowing accurately what dose received caused a given response). If you have a med discrepancy the only safe option is the one you chose; notify the MD for any change in the order since prescribing is NOT in your scope of practice.

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience. 5,047 Posts

You absolutely did the right thing! Having a MAR that has an old Coumadin order left active is a hemorrhagic stroke waiting to happen...because no, not everyone is going to assume that that one dose shouldn't be given. Not that they should have to assume -- MARs are supposed to be crystal clear. And then the fact that the MD did d/c the old order confirms that he should not have gotten those doses, so shouldn't have been on the MAR...let alone signed off as given.

Good job!

jadelpn, LPN, EMT-B

51 Articles; 4,800 Posts

Bingo. You looked at the orders, thought "This doesn't seem right," and you did something about it. Critical thinking and and advocacy make for a great nurse.

AND when this patient bleeds out or has an INR of some astronomical number from receiving 12mg of Coumadin for 5 days, I would not want to be the licensed nurse responsible for the UAP's who gave this dose for days on end....

AND because one signs it, it is "given" therefore, it is false documentation if one is signing off on meds they are not given. And "the unit coordinator told me to" is not a valid argument.

You brought it to the nurse, the nurse got the order clarified, and now the follow up begins...which the mechanism of action of Coumadin is 48 hours or so.....what did we get for an INR?

In any event, you did the correct thing. The unit coordinator (and is this person a nurse, or another UAP?) can be as mad as they would like to be, however, you can not explain away 12mg of Coumadin. For 5 days. Or signing off on meds that you don't give that could cause patient harm. 7mg for a few days to get therapeutic is about as high as I recall ever going. You did the right thing. And the licensed nurse who is responsible for your work thanks you I am sure.

littlelimabean01, LPN

Specializes in Geriatrics, Trach Care, Diabetes. Has 5 years experience. 69 Posts

I am going to agree with everyone here. If I would have saw a total of 12mg of Comadin to be given daily. It would have set a red flag off in my mind too. Sure, that could be a one time dose, but daily?? I would have done what you did went and got order clarification. I do that anytime I see things of that nature. It only takes a minute to make sure you are doing the right thing, the consequences of doing the wrong thing can impact a patients life forever. You are going to do well as a nurse. If you are in trouble, they are a retarded company to work for and you should leave promptly. You did NO wrong!

gonzo1, ASN, RN

Specializes in ED, ICU, PSYCH, PP, CEN. Has 19 years experience. 1,737 Posts

You very well may have saved that patients life. I've been on coumadin and 12 mg daily is a massive dose for almost any patient. The other people are mad at you because they are now on the hook for fraudulent charting, having charted it given when it was not. The fact that the wrong doctor was called is on the RN, not you. But kudos to both of you for addressing this problem. Hold your head high at work and do not speak of this issue further with anyone, you are legally in the right and don't owe them any explanations.

Your future patients are lucky to have you as their nurse and their advocate.



39 Posts

Good catch!!! Be proud !


Jolie, BSN

Specializes in Maternal - Child Health. Has 36 years experience. 6,375 Posts

If anyone else addressed this, I missed it.

You did the right thing by using your critical thinking skills to question a seemingly inappropriate set of orders. I don't believe that it is within your scope of practice as a medication aid to contact the physician for clarification, and certainly not to take a verbal order altering or discontinuing the medication.

You went as far as you could by calling this to the attention of the nurse, and she met her responsibility by clarifying the order with the physician. You both considered the patient's well being, which is the ultimate goal.

Those who are running around panicking are doing so because they have a poor understanding of of their legal and professional practice obligations, a poor understanding of the medication in question, or because they know they screwed up and are trying to deflect attention.

Not your circus.