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!
This is just plain bizarre that someone would stop by from another unit and randomly medicate your patient. Who does that???? You did the right thing.
It wasn't another unit. The ED is split up into different zones. The other nurse was assigned to another zone but still had nothing to do with my assignment. I agree, though, completely inappropriate in my opinion.
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.
Yes, the doc should have discontinued the order, or placed in the comments that they needed to be contacted prior to administration. Especially since it has been on the MAR for more than one shift as an inappropriate PRN.
You also could document a "not given" with the reason "per provider, should not be given" at the beginning of the shift, to document for anyone to look at the MAR that it shouldn't be given, and then it will fall back on the provider that they didn't keep their orders accurate.
Honestly, the whole thing is just crazy. This is exactly how the stuff in vanderbilt happens. Nurses who don't look at MARs, don't talk to others, don't document in a timely fashion.
There are some systems issues that can be addressed to protect from the incompetent nurse, but part of the systems fixes are also to get rid of the incompetent nurse. It's totally unacceptable.
I'm really surprised at the amount of comments putting the blame on the physician. I can't really see how the physician is to blame for someone who isn't involved in the patient's care failing to communicate, administering an overdose, failing to document it, and failing to notify the appropriate people.
Sure, he or she should've updated the MAR. Sounds like an NCLEX "perfect-hospital scenario" question. In real life providers are busy and I figure he or she expected that for the time-being a verbal communication with the primary nurse would suffice.
We want to be colleague on the health care team. We want all members to be seen as equals. Blaming the provider is kind of a cop-out in a case like this in my opinion...
Specializes in Psychiatry, Community, Nurse Manager, hospice.
3 hours ago, Jkloo said:
I'm really surprised at the amount of comments putting the blame on the physician. I can't really see how the physician is to blame for someone who isn't involved in the patient's care failing to communicate, administering an overdose, failing to document it, and failing to notify the appropriate people.
Sure, he or she should've updated the MAR. Sounds like an NCLEX "perfect-hospital scenario" question. In real life providers are busy and I figure he or she expected that for the time-being a verbal communication with the primary nurse would suffice.
We want to be colleague on the health care team. We want all members to be seen as equals. Blaming the provider is kind of a cop-out in a case like this in my opinion...
I would have questioned the physician if I was in this situation. Not blamed the physician.
If my patient had a PRN haldol order that was discontinued, and my patient was psychotic, I would want to know why. And "because he goes downhill quickly" is not an explanation. I would want to know what the physician meant by that.
Specializes in Psychiatry, Community, Nurse Manager, hospice.
On 8/2/2019 at 9:10 PM, jinct said:
Management "investigated" the whole thing and is not doing anything about it. Knowing my management, I'm not really surprised. Thanks for the input, everyone.
I wonder what their findings were. Maybe they did not see evidence that she gave the med.
Of course, if she was disciplined, you would not be informed of that.
Any chance the two of you had a miscommunication and she didn't actually give the med? Maybe something she said made you think she gave the med, and you both got defensive?
Maybe your manager can facilitate a session where the two of you can talk it out to see if you can figure out what went wrong here.
Because if she really gave your patient a double dose of med and then lied about it, I don't see how you can trust her enough to work with her anymore.
It does sound like her ego is a bit of a problem. It's very unlikely that she was diverting haldol which is both cheap and not commonly abused.
If I had to wager a guess, I would guess that the problem really was a miscommunication. Not that this is your fault.
I'm really surprised at the amount of comments putting the blame on the physician. I can't really see how the physician is to blame for someone who isn't involved in the patient's care failing to communicate, administering an overdose, failing to document it, and failing to notify the appropriate people.
Sure, he or she should've updated the MAR. Sounds like an NCLEX "perfect-hospital scenario" question. In real life providers are busy and I figure he or she expected that for the time-being a verbal communication with the primary nurse would suffice.
We want to be colleague on the health care team. We want all members to be seen as equals. Blaming the provider is kind of a cop-out in a case like this in my opinion...
Because it was on the MAR for more than one shift. Not being able to get an order in immediately, that's understandable. But many hours later isn't. I'm a provider and when stuff is crazy, some orders will get missed, but within a few hours, nurses will remind me that x and y still need ordered or discontinued.
Example: our orderset for methadone automatically includes narcan, because it was designed for outpatient use. Neonates on methadone are all being weaned off narcotics and should never be given narcan ever. If they have respiratory depression, we will support them, but not give narcan. It could cause seizures.
Forgetting to discontinue narcan is very easy to do. But it is an accident waiting to happen. All it takes is a float nurse who isn't as familiar with our withdrawal protocols and is used to older children or adults. So as providers, our responsibility to prevent that mistake is to keep the MAR up to date as far as orders. You can put in comments that a provider needs to be spoken with prior to administration.
The nurse was wrong, but the provider could have helped prevent the error from occurring.
I wonder what their findings were. Maybe they did not see evidence that she gave the med.
Of course, if she was disciplined, you would not be informed of that.
Any chance the two of you had a miscommunication and she didn't actually give the med? Maybe something she said made you think she gave the med, and you both got defensive?
Maybe your manager can facilitate a session where the two of you can talk it out to see if you can figure out what went wrong here.
Because if she really gave your patient a double dose of med and then lied about it, I don't see how you can trust her enough to work with her anymore.
It does sound like her ego is a bit of a problem. It's very unlikely that she was diverting haldol which is both cheap and not commonly abused.
If I had to wager a guess, I would guess that the problem really was a miscommunication. Not that this is your fault.
You must have missed the part where the coworker admitted giving the med to the physician and later claimed OP gave the med. The story kept changing and the vial was empty. Somebody got that med and the coworker isn't reliable.
Specializes in Psychiatry, Community, Nurse Manager, hospice.
2 hours ago, NurseBlaq said:
You must have missed the part where the coworker admitted giving the med to the physician and later claimed OP gave the med. The story kept changing and the vial was empty. Somebody got that med and the coworker isn't reliable.
I did miss that part.
What an awful thing to have to work with someone like that.
First document what the nurses told you , the crazy nurse told you and what the provider stated and Did . make an incident report . and notify everybody as in your superiors . Legally if you wanted you could report her to the board . if it hits the fan as in you lose your job . Chances are she is a teachers pet and they are doing a cover up for this nurse. What happens in the real world is nurses tell their supervisor they looked on the boards website and the five rights say shes in the wrong , and they move on . Get my drift
The other nurse did end up getting suspended... for 3 days. I heard through the grapevine that she was put on probation too, but I don't know if that's true. Also, I put in my notice shortly after all this and am now working in a different ER.
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2BS Nurse, BSN
703 Posts
This is just plain bizarre that someone would stop by from another unit and randomly medicate your patient. Who does that???? You did the right thing.