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by jinct jinct (Member) Member Nurse

238 Profile Views; 33 Posts

I am an ER nurse.  I came on shift and received report on an elderly pt. with dementia.  There was an order for 2.5mg haldol IM.  I was told by the provider not to give the pt. the haldol because she had a history of "going downhill fast" and that the pt.'s husband was on the way to pick her up anyway.  While I was in another pt.'s room and without asking me,  a coworker of mine gave the pt. 5mg of haldol IM and didn't document it. I only found out after finding the empty vial and finding 2 other staff members who admitted that they witnessed it.  The pt's husband showed up to take her home.  Should I have said anything? 

Heres what I did... I asked the nurse who gave the injection to let the provider know it was given, to let her know that twice the ordered dose was given, and to document it.  She got mad at me, but she told the provider.  She refused to document it.  The provider held the patient's discharge to observe. 

Was I wrong?  I'm looking for serious feedback.  The other nurse is really mad at me because the provider "reported" her.  And to top it off, management told me that it was I who failed to communicate.  The other nurse wasn't even working in my area; she was just passing through!

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Davey Do has 35 years experience and specializes in Psych, CD, HH, Admin, LTC, OR, ER, Med Surge.

15 Followers; 1 Article; 6,341 Posts; 77,864 Profile Views

No, jinct, you were not wrong.

I had sort of a similar situation happen with me, and I did pretty much the same as you.

While working in a community mental health center, I saw that a non-licensed staff member, intentionally and with knowledge, gave a non-prescribed med sample to a client. I called the staff member aside and informed her what she did was illegal. I instructed her to retrieve the med and inform the psychiatrist of her actions.

She did what I had instructed her to do but it weighed heavy on my mind, so I contacted a JD RN with my liability insurance. The JD RN instructed me to terminate this staff member and I informed her that I was not the staff member's supervisor. I was told that I needed to "see this to the end" and inform management of what transpired.

I did so and the staff member, a seasoned and well-like individual, was terminated. It really, really bummed me out, for I truly liked the staff member. After her termination, I could not have won a popularity contest at the mental health clinic had I been only contestant. But I did what I had to do.

I was terminated two weeks later for other bogus reasons, but, once again, I did what I knew I had to do.

You, jinct, did what you had to do. Good for you.

The best to you.

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Crash_Cart has 11 years experience and specializes in ER OR LTC Code Blue Trauma Dog.

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The fact haldol was given and wasn't documented just makes it look bad and it's even unethical to do this in the first place as far as i'm concerned.

Who cares if she gets mad.  It just doesn't matter. 

Edited by Crash_Cart

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30 Posts; 503 Profile Views

You did the right thing. It's unfortunate that many times the person who does the right thing isn't treated well in health care and I'm sorry you were put in this position by others. Be proud though- you showed integrity in this situation!

My opinion, from a root cause perspective, is that the order should have been either discontinued or put officially on hold in the EMR so there should be some provider education/ practice change there in addition to counseling the RN who gave the drug on the 5 rights. Is it common in your ER for people to give meds while walking by? If so, that practice may need to be changed as well because it is not reasonable to expect you speak to every nurse in the ER every time you get a new med order so that it is communicated. 

Edited by egg122 NP

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33 Posts; 238 Profile Views

Thank you everyone. I appreciate the support. And yes, egg122, I thought the order should have been discontinued as well. I should have seen to it that it was. I still don't think that justifies my coworker's actions of giving it without asking first, giving a double dose, not telling me or the provider, and refusing to document it. What gets me the most is that I tried to approach her professionally and keep it pretty much under wraps, and she turned it around on me.

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TriciaJ has 38 years experience as a RN and specializes in Psych, Corrections, Med-Surg, Ambulatory.

12 Followers; 3,318 Posts; 34,246 Profile Views

People who take it upon themselves to medicate patients without proper authorization are dangerous.  It was not a breach of etiquette to give the patient 5 mg of Haldol without a proper order or documentation; it was illegal.  There should have been an incident form completed.  I don't know why management is covering for this person; they need to look at Vanderbilt and the hospital in Ohio.

Same goes for you, Davey.  A person like that on staff was on target to kill someone one day and bring a heap o' trouble on your employer.  Nice way of showing their gratitude.

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115 Posts; 2,847 Profile Views

I feel the other nurse's practice sounds fishy, but..

If you were told to discontinue the order of 2.5mg haldol for discharge by the provider, you should have documented it so on MAR. There should not exist an order of 2.5mg haldol. You were the only one who knew the medication was discontinued while MAR was saying the medication was to be given. It's a clear discrepancy.

On 7/21/2019 at 1:27 AM, jinct said:

There was an order for 2.5mg haldol IM.  I was told by the provider not to give the pt.

 

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33 Posts; 238 Profile Views

Hi Green Tea, 

I was not told to discontinue the order. In fact, RNs at my hospital are not allowed to dc doctors' orders. The provider has to discontinue the order.  Also, I let everyone in my area know not to give it. I didn't expect someone who wasn't working anywhere near me to come give the med. I understand your point, but that still doesn't explain the double dose and her refusal to document giving it.

 

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Davey Do has 35 years experience and specializes in Psych, CD, HH, Admin, LTC, OR, ER, Med Surge.

15 Followers; 1 Article; 6,341 Posts; 77,864 Profile Views

On 7/21/2019 at 1:12 PM, TriciaJ said:

People who take it upon themselves to medicate patients without proper authorization are dangerous. 

Same goes for you, Davey.  A person like that on staff was on target to kill someone one day and bring a heap o' trouble on your employer.  Nice way of showing their gratitude.

Thank you, TriciaJ, and lucky enough, I saw the writing on the wall, and it all worked out for me in the end.

I was in the process of applying for an administrative position at another community mental health clinic at the time my employer showed "their gratitude".

When I was terminated, I got a really nice severance package and contested the termination with the department of employment services. I won the contestment, got benefits, took a vacation, and had a small surgery before beginning the administrative position.

It all came out in the wash.

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kp2016 has 20 years experience.

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8 hours ago, jinct said:

Hi Green Tea, 

I was not told to discontinue the order. In fact, RNs at my hospital are not allowed to dc doctors' orders. The provider has to discontinue the order.  Also, I let everyone in my area know not to give it. I didn't expect someone who wasn't working anywhere near me to come give the med. I understand your point, but that still doesn't explain the double dose and her refusal to document giving it.

 

The Doctor who took the time to tell you not to give the Haldol should have immediately discontinued the ordered. Their failure was really the start of this incident, not your communication or alleged lack thereof.

As for RN-2 who gave an incorrect dose of Haldol to a patient who wasn't their patient, then refused to document the medication. That is a gross medication error and she has no right to blame you for the fact that the Doctor chose to report her error. Honestly if I was you i'd be more concerned that a manager blamed your "lack of communication" instead of addressing the Doctor and RN-2 who's lack of action and actions respectively actually caused this incident.

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9 hours ago, jinct said:

I was not told to discontinue the order. In fact, RNs at my hospital are not allowed to dc doctors' orders. The provider has to discontinue the order. 

Hi, jinct -

For your own future benefit, consider carefully the interplay of rules and nursing standards at your workplace. You say you are not allowed to d/c doctor's orders, but you also would not be on solid footing as a prudent nurse by taking and following a verbal medication order that you did not document - which is what happened.

If you are never allowed to enter or cancel any orders, that also means that you cannot accept and act upon verbal orders. To do so while following your workplace rule of not being allowed to officially document these is a major patient safety issue. There are other angles, though, too: What happens when you someday run across the physician who says s/he never ordered you to hold the med and now the patient has experienced some ill effect from not receiving it, for example?

I realize some of this has already been addressed and I'm not at all trying to flog you, but it sounds like you sort of think what you did was okay except for this other busybody messing it up. I'm just encouraging you to see it a different way. 🙂

You did right by asking your coworker to do the right thing after the fact. Regardless what s/he did next, I would've filled out an incident report. In cases like this I might ask someone to do the right thing, but I would also (without sounding punitive or threatening) inform them that under the circumstances and incident report is necessary and that I am going to file one.

 

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TriciaJ has 38 years experience as a RN and specializes in Psych, Corrections, Med-Surg, Ambulatory.

12 Followers; 3,318 Posts; 34,246 Profile Views

1 hour ago, JKL33 said:

You did right by asking your coworker to do the right thing after the fact. Regardless what s/he did next, I would've filled out an incident report. In cases like this I might ask someone to do the right thing, but I would also (without sounding punitive or threatening) inform them that under the circumstances and incident report is necessary and that I am going to file one.

 

It doesn't matter whether the order was discontinued, or not discontinued.  There never was an order for Haldol 5 mg.  The coworker gave a med for which there was no order and then did not document it.  This is egregious malpractice and absolutely requires an incident report.

I agree.  No need to be punitive, threatening or conciliatory for that matter.  The facts are what they are and for OP to not respond appropriately by completing an incident report is tantamount to being complicit.  This could put her on the BON radar along with her coworker.  Just something to consider.

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