Shot time

emsboss · May 30, 2008

The policy at "my house" plainly states a 20 min wait. To me, it is NOT safe to send a patient out without the wait, even if they have had the meds before, ie. Tetorifice. Just my $0.02.

nursebrandie28, BSN, RN · May 30, 2008

okay....this is my experience..

i started in the er as a new grad (well 6 month tele) and did not know much, but anywho, a frequent flyer came in who normally comes in by ems, well this time she actually drove. i gave her a shot of demeral/vistaril. cannot remember dosage and sent her on her way without wait time. due soley on my ignorance, the hospital policy states 20 minutes.

well she got pulled over, got a dwi (driving while influence), told the cop that, she just got pain medication and the hospital got fined. i got written up and almost lost me job..... (which i deserved)

moral of my story...

always wait for shot time!!!

ER-RN2 · May 30, 2008

I agree with you all too..Thanks for your input. I just can't understand the reasoning behind the "no wait shot time".......

morte, LPN, LVN · May 30, 2008

I agree with you all too..Thanks for your input. I just can't understand the reasoning behind the "no wait shot time".......

money.....

sissiesmama, ASN, RN · May 31, 2008

:banghead:

I'm glad I am not the only one who feels this way!! While I was working in a BUSY ER, the powers that be decided that the only patients that had to wait "shot time" were the ones that received IM antibiotics. Their rationale was that we could "move them in, move them out" faster. They showed no concern for that fact that a patient could have an allergic reaction to pain meds or any other shot administered. So I opened my big fat mouth about it and got labeled a trouble maker. My patients still waited shot time for im meds, especially narcotics. After all, we are supposed to document relieve of pain meds to monitor pain and/or nausea relief. How can they expect this to be done if they were already at home? Just my opinion.

Anne, RNC

santhony44, MSN, RN, NP · May 31, 2008

I once saw someone go down, hypotensive, and darned near code after a Toradol IM, very near the end of her 20 minute wait time.

Could you talk to your Risk Management department, or maybe your medical director? It sounds dangerous to me.

Larry77, RN · May 31, 2008

We have mandatory 20 min with revital except for tetorifice...normally the doc or NP rights ok for dc after tetorifice...never had a problem with it before.

IV we are supposed to wait 15 min and revital as well...

TriageQueen · May 31, 2008

I hate to be a PITA, but waiting for shot time wouldn't have made a difference after injection with demerol. The half-life of demerol is somethinglike 3-5 hours, so she still would have gotten a DUI. Our ED has a policy of a 4 hour wait time to drive after narcotics, although this fact is not advertised or our WR would be constantly full! According to our policy, shot time is 30 mins for IV/IM, including Td. Oh yeah, and if you do happen to hop in the car with narcs on board, we will call the cops on you!

northshore08 · Jun 1, 2008

20-30 minutes has always been the rule for me, and it was always backed up by ED policy. Wonder what studies/documentation they are using to say now it is safe for immediate discharge after decades of requiring waiting times?

Narcotics still wait like all the others, but they must be discharged with another alert/oriented/taking them home right now/able to drive adult. OOH boy the shenanigans people will go through to get out of the ED so they can drive home...fodder for another thread. :typing

The only reaction I have seen was angioedema after a shot of Rocephin; about 15 minutes after administration. She said "I'm having a little problem swallowing...." Her uvula looked like a water balloon! But a little benadryl and solumedrol later she was good to go. Wonder what would have happened if she had already left? :eek:

MassED, BSN, RN · Jul 30, 2008

absolute negligence to provide a shot and send them on their way. You have to be able to note if there was a reaction (particularly anaphylactic) within a 15-20 minute time frame, otherwise how would that stand up in court if that person was injected then left (by you discharging them) and they keeled over... what if, after the fact, the patient would state they had a reaction to some component and tried to sue... what then?

http://www.health.gov.nl.ca/health/publications/immunization/S4/procedureforintrainjection.htm

MassED, BSN, RN · Jul 30, 2008

okay....this is my experience..
i started in the er as a new grad (well 6 month tele) and did not know much, but anywho, a frequent flyer came in who normally comes in by ems, well this time she actually drove. i gave her a shot of demeral/vistaril. cannot remember dosage and sent her on her way without wait time. due soley on my ignorance, the hospital policy states 20 minutes.
well she got pulled over, got a dwi (driving while influence), told the cop that, she just got pain medication and the hospital got fined. i got written up and almost lost me job..... (which i deserved)
moral of my story...
always wait for shot time!!!

patients can't drive after being provided demerol im anyway, even if they waited 20 minutes - it is on that person if they drive, as they are told it's a narcotic and if they receive it (a doc should have made sure they weren't to drive before the order was given) they need to find a way home, or if they are caught driving, it's a dui.... that is a common statement upon discharge. we have had to call the police when we see patients leaving the er and getting into their car. they know better - but if they choose otherwise, whether you made them wait one hour and then let them leave, they still have that choice, despite being told not to drive (i'm assuming you did.) i can't see how the police would cite the hospital or write you up. give me a break.