First Incident Report

[gemmi999]

I made my first incident report today and I feel conflicted. Here's the situation:

I'm an ER nurse. I got report from RN about four pts. Of those four pts:

1) one had a potassium level of 2.4 and was not on a heart monitor. Instead, laying in bed with no monitor; when I asked if potassium had been given RN stated oral potassium. I asked why pt. wasn't in room with monitor because he had one open and RN stated that was not the room that had been assigned when pt. first came in.

2) one had new onset facial drooping, expressive aphasia; I asked day shift RN if pt. had had stroke--was told no, had had one four days previously. I asked about new symptoms, RN again stated no CVA. I checked admission orders, admitted for CVA. I again asked RN and RN said no CVA. Had to call MD to get clear pt. history and diagnosis.

That part I was glad to report because I felt the RN had been unsafe with pt. care. However, the evening this happened I asked the Charge RN if I should do an incident report and Charge stated I should verbally talk with RN or Charge RN and not do an incident report.

This is a charge RN I work with a lot and I tend to respect his opinion, but this felt wrong to me so I double checked with ER manager. ER manager stated to write it up. I also documented what Charge RN stated and I feel conflicted about this.

Does this mean I'm a "tattle tale?" and carrying things to management? I don't want to do that but I want to make sure this situation doesn't happen again...So now I feel conflicted.

[FolksBtrippin, BSN, RN]

An incident report does not save a patient if that patient is truly in danger. So the point about preferring an incident report to a patient dying is absurd. If the patient is/was dying and you are writing up an incident report in response than your response is not appropriate.

I am really questioning your use of the incident report, OP. Where I work, an incident report is for addressing a dangerous situation and not for getting an employee in trouble. We don't make incident reports on people. We make incident reports on incidents.

[Dranger]

I could literally write up an incident report on almost every ED admit I get into the ICU. Do I? No. While 2.4 is low (I have seen less than 1) and cardiac monitoring should have been implemented, there is no reason for a report.

Next time, a simple, "Hey I think they should be on tele while being treated for hypokalemia per standard of care". Then hook then up and move on.

Your charge nurse gave sound advice (despite you screwing him over too). Managers don't matter and are barely even a part of the team. They don't care if you sell anyone out. Incident reports are just going to put a target on your back, next time start at the individual if you have an issue or just let it go. I see wrong crap at work all the time and guess what? Incident reports don't fix the issue.

[Susie2310]

The OP said that he/she spoke with the RN twice prior to writing the incident report, and that the RN didn't seem to particularly care about the risk the patient was at. The OP also said that when the patient was moved to a monitor, the patient had continuous PVC's and couplets.

[BrnEyedGirl, BSN, MSN, RN, APRN]

Does your ED not have protocols for treating these patients? I've been with the same hospital for almost 20 years, I started in a cardiac unit and have spent the last 11 years in their Level I ED. We have very specific protocols for caring for stroke patients, you say the stroke happened today,..3 hours ago? 12 hours ago? Did the patient awaken with her symptoms? The answer to those questions determines the protocol followed (however I agree the nurse should be aware of those answers and be assessing the neuro deficits of her patient) My specific ED does not require telemetry with PO K+ replacement (which is the preferred replacement), of course this also depends on why the K+ is low, is the Mg+ ok?, how is renal function? Is the pt on dig? Many other variables to consider. Perhaps the most important is were there orders for tele? Were neuro checks ordered on the patient? These are all part of the protocols in place in my ED. Was the doc unhappy with the care given to these patients? In the 20 years I've been with this hospital I have only been involved with two incident reports and they where both very gross negligent acts that screamed incompetence. I try very very hard not to judge the care others give when I'm not there.