Exhausting families and exhausting shifts

[stacylethani, BSN]

Last night was my first night of three and I was floated to a different floor. I had a mom who was refusing midnight and 4am vitals on her kid, she was getting super frustrated every time I went to assess him because she just wanted him to sleep. All night she kept making comments saying he was healthy and didn't need all these interventions and assessments and pain meds and that he just needed sleep (she was an RN herself which made it more difficult). It was just super frustrating to deal with.

Additionally, I hung a piggyback med wrong and spiked it with primary tubing instead of secondary tubing (med error?) but then I just hooked up the patients med rinse to the primary and flushed t that way. Not sure what I was thinking that I spiked it with primary tubing.

Anyways, every time I get floated up to this other floor, I always feel so incompetent and like super busy with tasks and I never get my breaks till 5am. The worst part is that this floor has much more stable patients than my normal floor does so it literally makes no sense that I struggle so much on this floor only.

😩

[Triddin]

Thankfully "right tubing" isn't one of the seven rights. The only time I can see this being an error is if you didn't include a filter on a medication that requires one (ie amiodarone)

I think most people feel less confident on wards they are less familiar. You didn't do anything wrong with the interaction with the mother if it is the protocol to check vital signs q4h, but the mother also can decline care within reason. If he child was indeed stable, it's probably more beneficial to allow them to sleep. Document that you tried, your conversation with the mother and how the patient looked (sleeping, easy breathing etc).

[LovingLife123]

You know, many places don't even use secondary tubing. I've never used it.

[ellisjl, BSN, RN]

I only use secondary tubing when using a separate bag of fluids as a driver. The pharmacy at the hospital I work for supplies our ABX with diluent either pre-mixed or ready-to-mix so there's no need to use a driver unless you choose to, which I only do when there already a bag hanging. It's not cost effective to hang liter bags all willy nilly. Also, could be bad for the patient, like a patient with CHF also having an infection needing an IV ABX.

[ellisjl, BSN, RN]

I only use secondary tubing when using a separate bag of fluids as a driver. The pharmacy at the hospital I work for supplies our ABX with diluent either pre-mixed or ready-to-mix so there's no need to use a driver unless you choose to, which I only do when there already a bag hanging. It's not cost effective to hang liter bags all willy nilly. Also, could be bad for the patient, like a patient with CHF also having an infection needing an IV ABX.

[AceOfHearts<3]

I only use secondary tubing when using a separate bag of fluids as a driver. The pharmacy at the hospital I work for supplies our ABX with diluent either pre-mixed or ready-to-mix so there's no need to use a driver unless you choose to, which I only do when there already a bag hanging. It's not cost effective to hang liter bags all willy nilly. Also, could be bad for the patient, like a patient with CHF also having an infection needing an IV ABX.

Some IV tubing can leave as much as 10-15ml of the med in the line. If you aren't running a flush after wards the patient is not getting all of their medication. One of the places I worked stated we had to run at least 13ml of a flush. Hang a small 100ml or 250ml bag with the med and program the pump just for 15mls with the flush bag and you won't have to worry about fluid overload with a CHF or renal patient. Just unhook the line once the flush is finished- you don't have to keep it infusing continuously, just enough to ensure the patient gets all the intended med.

OP- getting pulled to another unit can be disorienting. You're routine is off, you don't know any of the nurses or ancillary staff, the doctors and other providers might be different, layout of the unit and supplies is probably different, etc. I always feel like a fish out of water- doesn't matter if I'm pulled to a lower acuity unit or another critical care unit.