fed up and set up

momdebo, BSN, RN · Aug 20, 2006

I feel your pain. Sounds like maybe you recieved some erroneous info in report? Sometimes you can gauge the accuracy of report according to who is giving it. There were a few people that I would only half listen because I would have to go educate myself on the patient anyway. Sounds like you need a hot bath, soothing music, maybe a really funny movie and a LOT of chocolate usually heals my wounds!:icon_hug:

Daytonite, BSN, RN · Aug 20, 2006

Sorry you had to learn a hard lesson. Report is just that, a report. It isn't a substitute for doing our own assessments and reviewing doctor's orders. No matter how much I admire any colleague I still, to this day, check doctor's order myself, and go in and check the patient's physical status myself despite what I was told by any previous nurses. To do anything else is at your own peril.

CapeCodMermaid, RN · Aug 20, 2006

Sorry you had to learn a hard lesson. Report is just that, a report. It isn't a substitute for doing our own assessments and reviewing doctor's orders. No matter how much I admire any colleague I still, to this day, check doctor's order myself, and go in and check the patient's physical status myself despite what I was told by any previous nurses. To do anything else is at your own peril.

Are you saying you double check EVERY doctor's order? If we did that, the 4 o'clock med pass wouldn't get started till 6! I'll check orders if they look out of whack to me, but none of my nurses would have the time to check all the new orders....especially on the days the docs do rounds...or ANY day on the sub-acute floor for that matter.

knockandhello · Aug 20, 2006

Thanks for the words of comfort and advice.I have always checked orders before dont know why I didnt apart from being shortstaffed and filling in for someone else as well as doing my own duties.The lady ended up getting a double dose of antibiotics.My fault in the end .I have always before this double checked what ive been told at report and this day didnt.Could really kick myself and only discovered the error when i came home and was thinking about things.Should have known better as this other girl is always leaving things undone or partly done for the next shift to complete.Oh well feel better after finally being able to get to sleep last night.Once again thanks for listening.

Daytonite, BSN, RN · Aug 21, 2006

are you saying you double check every doctor's order? if we did that, the 4 o'clock med pass wouldn't get started till 6! i'll check orders if they look out of whack to me, but none of my nurses would have the time to check all the new orders....especially on the days the docs do rounds...or any day on the sub-acute floor for that matter.

a charge nurse has the responsibility of prioritizing his/her duties. for a subacute unit i would definitely prioritize the checking of newly written doctors orders over getting a med pass started. it would only take a few minutes to open each chart and make a quick cursory check of the new orders. i've done this many a time and returned after a med pass to finish taking orders off. i would hate to miss a stat order to the detriment of a patient's well-being, particularly on a subacute unit where the patients are most likely skilled patients.

chris_at_lucas_RN, RN · Aug 21, 2006

Thanks for the words of comfort and advice.I have always checked orders before dont know why I didnt apart from being shortstaffed and filling in for someone else as well as doing my own duties.The lady ended up getting a double dose of antibiotics.My fault in the end .I have always before this double checked what ive been told at report and this day didnt.Could really kick myself and only discovered the error when i came home and was thinking about things.Should have known better as this other girl is always leaving things undone or partly done for the next shift to complete.Oh well feel better after finally being able to get to sleep last night.Once again thanks for listening.

If the second dose of antibiotic was given without consulting the MAR and the MAR was accurate, the nurse who gave the second dose was at fault. If the nurse did consult the MAR before giving the second dose and it wasn't accurate, both she and the nurse who gave the first dose are at fault: the first for not charting a med given and the second for not noticing that the med should have been given and double checking whatever system you have for documenting that meds hav been given (i.e., pyxis).

If there isn't a better failsafe system in the facility, you might look for another place to work. Your license will more likely be jeopardized in a system without basic documentation and communication practices.

Good luck to you.

sister--* · Aug 21, 2006

When I notice something new, different, or odd I always go to check the original orders/labs/test results myself. I've become a real doubting Thomas....I'll believe it when I see it.

...was a time that the unit secretary notified me while I was in a pt. room that another pt. had a low blood sugar just reported from lab. She started by saying, "____(charge nurse) told me to tell you......"

I immediately went into action, found the patient alert and appropriate, gave snack, provided an early dinner tray, and monitored closely only to find out after the fact that the unit secretary was incorrect in reporting the value. (She shouldn't have been the one to report it in the first place!) Furthermore, when I questioned my charge nurse she said, "No she didn't." No discussion; end of story.

A few other incidents have occured, however, this is the one that made me eternally suspicious of the things that I'm told. Now I say, "Thanks, I'll check the chart."

TheCommuter, BSN, RN · Aug 21, 2006

About two months ago I received report that a hospice resident was started on Flagyl 250mg TID. I looked in the nurses' notes and the evening RN had written, "Medicated resident with Flagyl."

I immediately became suspicious because no doctor notification was documented in the nurses' notes. This nurse should have called the doctor with the positive C-diff result, obtained a telephone order, and documented it all. Instead, she pulled Flagyl out of the ER box on her own accord and administered it without an order from a physician. I ended up calling the doctor and getting the Flagyl ordered. The evening RN was disciplined by the DON and ADON. Also, all other nurses who overlooked this error were written-up.

hellonurse36 · Aug 21, 2006

I work ICU so only have 2 pts. I do an entire chart check and verify EVERY med on the MAR before I give it. In the end it is my licence no matter what I was instructed to do in report.

Terri in Greenville, NC

catlady, BSN, RN · Aug 24, 2006

I work ICU so only have 2 pts. I do an entire chart check and verify EVERY med on the MAR before I give it. In the end it is my licence no matter what I was instructed to do in report.

Big difference when you have *sixty* patients. Even one minute to check each resident's chart is an hour out of your shift.

TheCommuter, BSN, RN · Aug 24, 2006

I work ICU so only have 2 pts. I do an entire chart check and verify EVERY med on the MAR before I give it. In the end it is my licence no matter what I was instructed to do in report.

Most LTC nurses, myself included, have anywhere from 20 to 60 patients to care for. Chart checks would, in reality, not be realistic if you have an outrageously large amount of patients. I worked at one facility where only the NOC nurses performed chart checks since they had more time on their hands and, hence, less patient care to perform.