Feedback appreciated

FolksBtrippin, BSN, RN · Jul 24, 2019

On 7/21/2019 at 2:27 AM, jinct said:
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!

I concur that the nurse should not have given your patient meds without consulting with you, and should not have given double the dose and then should not have refused to document it. All those things are outrageous in my opinion.

However, I would have questioned the doc's judgment in this case, which could mitigate the nurse's actions a little bit IMO.

What was the haldol for? Was it for psychosis or was it for agitation? PRN or not? I am assuming the patient has a psych history because doc says the patient goes downhill quickly. But discontinuing haldol because the patient goes downhill quickly? That's why we give haldol not why we don't give haldol. Unless doc was referring to EPS? I would question that. Was the physician planning on treating the psychosis only in case the patient was staying in the hospital and not to treat the psychosis if the patient is being discharged? That's not okay. Was something else going on, like the patient refusing the med and not meeting criteria for an IM against his will?

So while the nurse was still wrong, outside her scope, and failing as a team player, she may have been acting in the best interest of the patient, I'm not sure.

From a broader perspective, there are serious communication issues that need to be addressed on a systems level.

NurseBlaq · Jul 24, 2019

Who just randomly passes through a unit and starts medicating patients and who thinks it's OK to do so and refuse to document it? Did she really give it to the patient or did she divert it? There's so much wrong with that and you were absolutely right to report her. How it became your fault for not communicating with someone randomly medicating patients they're not assigned to is lost on me. Sounds like a disaster waiting to happen.

Oldmahubbard · Jul 24, 2019

This is all very strange. What was really happening with the pt, and why was she being discharged? Giving haldol or any antipsychotic to a person with dementia is sometimes necessary, but it is very controversial. There is a a Black Box warning.

Somebody coming along and randomly medicating a pt not assigned to them? very strange. What was the nurse's motive?

The provider put you in a bad spot by telling you not to give it, but not writing an order.

The nurse gave double the dose. Very strange.

It sounds like your ER could use a policy update on medicating demented people with antipsychotics. Normally, it is only done when there is imminent danger. That doesn't seem to be the case here, from what you wrote.

allnurses Guide · Jul 24, 2019

I have not read through all the replies, but my first thought is "There needs to be a safety post on this". Risk management should be informed there was a med error. Hopefully you documented that you were told this was administered to the patient but that you did not witness it being administered, so there is at least that legal coverage for what happened.

What an unbelievable situation. Wow. To be honest, I hesitate to even call this a "med error". That was practicing medicine without a license and the refusal to document is just.....baffling? amazing? Terrifying? I mean, if someone can do that, what leg do ANY of us have to stand on? HOW can your employer back this person up??? And if the patient crumped, how exactly was that to be explained if there was no documentation of what was done to her?

Forest2 · Jul 24, 2019

10 hours ago, MSO4foru said:
In my current workplace when pharmacy reviews Pyxis activity, nurse 2 would be called in for an investigation of why she administered a medication without an order ,who she had no involvement with and reported to state board of nursing.

This strikes a cord. At the very end of a morning med pass a patient went bad and the doctor was giving verbal orders and all sorts of activity going on as you can imagine. I asked another nurse on my unit if they would give my last patient their routine morning meds(oral) since I couldn't. She said she wouldn't do it unless she got report first. I just told her I didn't have time and the patient would have to wait till I could get to them.

TriciaJ, RN · Jul 24, 2019

13 hours ago, jinct said:
Honestly, because she butts into other people's business all the time. That, and she thinks she is smarter than everyone else.

Today Haldol; tomorrow vecuronium. Loose cannons like this need to be selling shoes somewhere. I'm glad your hospital is investigating. Before they find themselves being investigated by the DA's office.

Jkloo · Jul 25, 2019

I've never had someone give meds to my patients without consulting me first. Much less an IM injection of a anti-psychotic. I don't know why anyone would blame the doctor or primary nurse for any of this.

That nurse is a loose cannon and is working well beyond the standard of care for our profession. Giving an IM injection, an overdose from what was prescribed, to a patient that you aren't responsible for, without documenting it or notifying anyone. Holy crap.

Xance · Jul 25, 2019

8 minutes ago, Jkloo said:
I've never had someone give meds to my patients without consulting me first. Much less an IM injection of a anti-psychotic. I don't know why anyone would blame the doctor or primary nurse for any of this.
That nurse is a loose cannon and is working well beyond the standard of care for our profession. Giving an IM injection, an overdose from what was prescribed, to a patient that you aren't responsible for, without documenting it or notifying anyone. Holy crap.

Right? That whole situation is rather odd, and only reinforces the value of documentation. In that situation you know that hospital management and perhaps even the BON may get involved and proper documentation saves the original assigned RN from any wrongdoing. Proper documentation will save lives and your career.

Forest2 · Jul 25, 2019

8 hours ago, Jkloo said:
I've never had someone give meds to my patients without consulting me first. Much less an IM injection of a anti-psychotic. I don't know why anyone would blame the doctor or primary nurse for any of this.
That nurse is a loose cannon and is working well beyond the standard of care for our profession. Giving an IM injection, an overdose from what was prescribed, to a patient that you aren't responsible for, without documenting it or notifying anyone. Holy crap.

I thought, "oh" not that I was particularly surprised because crazy things happen all the time in nursing. However, a corrective action is needed in the system and to correct the ways the "loose cannon" nurse is functioning. I do believe in giving people a chance to explain themselves and to make good, that is learn from the experience and become a better nurse. I would want to avoid condemning the nurse immediately. It is important to help each nurse grow and improve as we are able to. Nurses do make bad judgements and nurses do dumb things sometimes, that doesn't mean they are a terrible nurse. There must be a sensible way to fix the problem and not use the blame game and it will take some people with wisdom to do that.

This would require gathering information. Hopefully, the powers that be where the OP works is willing to do what they should do.

jinct · Jul 25, 2019

Update:

Unfortunately, apparently the reason they are pulling security footage, which I thought was odd, is because the other nurse is now claiming she never gave the med and that I intimidated her into charting that she did something that she didn't do, which is TOTALLY false. I actually feel really bad about this whole situation, but it's her unwillingness to admit her mistake that is going to end up getting her in trouble.

NurseBlaq · Jul 25, 2019

11 minutes ago, jinct said:
Update:
Unfortunately, apparently the reason they are pulling security footage, which I thought was odd, is because the other nurse is now claiming she never gave the med and that I intimidated her into charting that she did something that she didn't do, which is TOTALLY false. I actually feel really bad about this whole situation, but it's her unwillingness to admit her mistake that is going to end up getting her in trouble.

Wait, didn't she admit giving it to the doctor and there was an empty vial in the patient's room?

jinct · Jul 25, 2019

1 minute ago, NurseBlaq said:
Wait, didn't she admit giving it to the doctor and there was an empty vial in the patient's room?

Yes, apparently I intimidated her into admitting it.