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 think she realized the dosage error after having administered the most commonly-ordered dose of Haldol. Then all the other factors together made it look overwhelmingly bad:
Made an error
Not my patient
Not even my area/pod
Oh, and the kicker: Now I'm hearing that the order which appeared to be in full effect actually had been verbally put on hold and not documented as such???
I think she freaked given all those factors.
I don't think she meant to murder anyone by leaving the empty vial and the witnesses there...
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!
Just my take on this, but you were NOT wrong. But, an incident report is required for an event like this. It sounds like the provider filled out the incident report, but you should have filled out one too.
Your management members sound like they're missing the main point. Someone decided to just administer a medicine without knowing the patient. How could you communicate verbally if the next RN just took it upon herself to do it without checking with you first? Now, there should have been some documentation done about how the provider said to hold the medication. When that happens to me, I usually go to the MAR and document on that one instance and mark it "not given" with a comment about how the physician said to hold it.
However, even if you had put a note in the system to hold it per the doc, who's to say this second nurse would have taken the time to read it? I'm more concerned about your coworker's seemingly cavalier attitude about med administration and her lack of taking responsibility for this med error. She gave the drug.
I've made some mistakes along the way. And I've turned myself in when it happened. Someone else's life is on the line. Your coworker scares me.
Of course there could be something nefarious or much less innocent with this nurse's actions, but those problems are rare (even though everyone has "heard of someone who...."). My money is still on basic 2019 ED craziness.
I think the hospital is playing games with the OP because they know they encourage this kind of behavior, and now it has gone wrong.
Ok, I can understand that. I had to help out in the ER a couple times, and the staff always tried to help each other by giving meds and doing discharges for each other. But they all documented their meds, at least from what i could tell.
Update: Today my manager asked me where this all happened. They are investigating it and are going to review security footage. This is a little strange to me, because even if they decide the patient's condition warranted the meds, they still aren't addressing the overdose or the refusal to document. You don't need security footage for that. I'm wondering if the other nurse is either claiming that she never gave it or that it was I who gave it. I don't know, but if that's the case, they'll see the truth on the tape.
Sorry, didn't read all the replies. I'm still of the mindset that you were right. Hold your ground with management, just like the others have said.
I think she realized the dosage error after having administered the most commonly-ordered dose of Haldol. Then all the other factors together made it look overwhelmingly bad:
Made an error
Not my patient
Not even my area/pod
Oh, and the kicker: Now I'm hearing that the order which appeared to be in full effect actually had been verbally put on hold and not documented as such???
I think she freaked given all those factors.
I don't think she meant to murder anyone by leaving the empty vial and the witnesses there...
I think part of the problem is we now have a system-blaming tendency that is transitioning back to people-blaming.
That kind of mentality is on the way out. The nurse at Vanderbilt is being charged with homicide and will need to have a defense team to try and find another aspect to blame (the "system").
Every action you do you need to honestly consider, if I was in court and the prosecution called an expert witness in my field to the stand, would they agree that my actions are "within the standard of care and practice." Will the jury buy that my actions are acceptable and within the standard of care? Physicians have been doing this for years now. Our field is now experiencing this, and many people are being caught off-guard that they can't just "blame the system" and be done with it.
CNs are expected to call one nurse to go do something for another nurse if that nurse can't implement an order within minutes basically. It's nothing to be asked to go give someone else's meds or to walk into your own room and find someone pushing something or doing something to your patient.
Well that's just all sorts of a crazy situation. Even giving the benefit of the doubt and assuming this other nurse was just trying to help still doesn't explain or justify giving a dose that is double than what was ordered in the first place. I also don't get how this nurse could refuse to document that she gave it. Didn't the med come from a pyxxis? That record alone of who took the med out should be pretty compelling evidence that she gave it. I doubt it was just laying around for her to pick up, at least I hope it wasn't! The whole thing makes no sense to me at all.
Well that's just all sorts of a crazy situation. Even giving the benefit of the doubt and assuming this other nurse was just trying to help still doesn't explain or justify giving a dose that is double than what was ordered in the first place. I also don't get how this nurse could refuse to document that she gave it. Didn't the med come from a pyxxis? That record alone of who took the med out should be pretty compelling evidence that she gave it. I doubt it was just laying around for her to pick up, at least I hope it wasn't! The whole thing makes no sense to me at all.
I assure you, it's exactly how nonsensical as it sounds.
There are quite a few different perspectives here, more than I expected. I'm curious how this situation has progressed thus far. It seems to me that there were more details to be considered than I thought about so the actions taken by management would be interesting to learn about given the series of avenues that they could go down in response to this situation.
JKL33
7,038 Posts
I think she realized the dosage error after having administered the most commonly-ordered dose of Haldol. Then all the other factors together made it look overwhelmingly bad:
Made an error
Not my patient
Not even my area/pod
Oh, and the kicker: Now I'm hearing that the order which appeared to be in full effect actually had been verbally put on hold and not documented as such???
I think she freaked given all those factors.
I don't think she meant to murder anyone by leaving the empty vial and the witnesses there...