Hi everyone! I am having some severe anxiety about this so I just need to vent.
Last night I sent a pt to the hospital because he had elevated temp. Charge nurse said to send him.
So I did.
I later find out today, that the pt had several nitro patches on him. NOW. Here is why Im stressed, the daylight shift puts the patch on in the morning, and 311 takes it off at night (me). The pt is pretty 'with-it' and often takes the patch off himself. Each night I ask him if he took the patch off. If he says yes, I ask where he put it. He usually will stick it on his newspaper, or some other random place in his room. If he says no, he takes it off hands it to me and I throw it away. SO I am so confused as to how there was several patches on him. Im freaking out because I feel like this is completely my fault and I should have made him take his shirt off and let me strip him for the patch. I have worked the last few nights, and each night I ask him, he shows it to me, or he takes it off. The daylight shift never writes in the mar where they put it, nor they they right the date on the patch which would have been helpful to know that the patch i saw, or he gave me was the one from that day. I am just so upset over this whole situation. Im so scared Im going to get fired, but even more concerned about the pt. Any advice would be helpful =(
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
The thing is, I know I messed up because I didn't search him for the patch... but no one else ever does either. Everyone does it this way. AND I know that's wrong now.. There really is no way to say it was me that forgot to take the patches off... I could have been taking the ones from days ago. But I always threw one away.. each night. Its hard to know because there was no date or anything. Does everyone else write a date on their patches when they put them on?? I think this would make it easier to know if i have the right patch...
I am not familiar with LTC or AL regulations, but I do know that the task can be delegated to UAP's that have proven competence. The nitro patches have only 24 hours worth of meds so there is no deleterious effect there BUT it has shown that to leave the nitro on the patient build a tolerance to the effects of the nitro an he can develop chest pain due to the med being ineffective. The "no one else does" and "everyone does it this way" when you become a nurse is not acceptable...you are accountable for you. Now you know that you need to check closer...the patients temperature has nothing to do with the patches being left on.
In a hospital setting the patches are dated and initialed for this very reason so yes...we date, time and initial them all. One reason is to protect yourself and one so they know who to blame. I am not familiar with the legalities in AL/LTC but you have no license to take away, the nurse is responsible. I am not sure I'd take a position as a nurse with this kind of responsibility and set up but I am sure nurses are needed. I know you are freaking out and love your job....such dedication and caring should be required in all health care givers.
Now.....Take a deep breath, if the patient was living at home this could have happened. As long as you did your best. The system needs to change but that won't be happening....you need to protect yourself. When you become a nurse remember this feeling of freaking out to remind you to be careful and vigilant in your practice.:heartbeat
Awesome post ESME :) There is no substitute for 33 years of experience, well maybe 34 years of experience lol. I too will make sure I follw this sound advice!!!!
Thank you for that, its nice to hear constructive critisim. I wasnt trying to blame other people of my mistake. I take complete responsibilty for what Ive done. Ultimately there is no way to know who 'left' the patches on the pt... I just know other people do this as I do... Im going to speak up to our nurse next time I work, so something changes. I know I will change because I know the mistake Ive made, but I want everyone to realize how serious it is.
Im the only doing the pills, the personal cares, the adls, everything. Just me to the 16 residents.
But it seems that you have the reponsibility of checking/managing the NTG patches. (?)
As to a previous post that maybe the patches were applied en route to the hospital...wouldn't the medics use either a NTG spray (this is all I have seen medics use) or, perhaps a SL NTG tab? Either way, I have never seen them apply a patch PRN.
maybe it would be a good idea to bring this up in a staff meeting, or if you don't have those, to write a letter to whoever the chief nurse is in the establishment or company, and ask for a policy that states clearly that all medication patches (and there are lots of them, not just ntg) are to be initialed and dated and their placement area noted on the mar. this would be a reasonable request and any real nurse would recognize the value in it. meanwhile, go ahead and start doing that yourself (they might have even taught you that in your program to allow you to pass meds)(you in tx? i hear they do that there), and tell the other med aides to do it too. can't hurt, might save someone a world of hurt someday.
As a PCA/caregiver your job is to assist/remind the pt to take/apply/remove his meds. I assume you are not pouring meds into his mouth, just providing them and allowing him to choose to take or not. Thus, you are not legally "administering" them. Along the same lines, you are "reminding" him to take off the patch each eve, not holding him down and prying off the patches.
A full skin assessment is not the daily norm in LTC.
If this fellow is not able to remember when and where the patches are, he should be assessed for needing a higher level of care. This is not your job as a PCA, but as an aspiring nurse it is something to remember and learn from.
An OD of nitro would cause low BPs, not to my knowledge fever. So I dont think his problem had anything to do with the abundance of patches.
First calm down. Now you learned to check. No job is worth crying about.as was said before the patches only have enough med for 24 hours. I forget once in a while to check or even to take it off. But as you know when you have so many meds to give it's easy to forget. The worst is getting fired from what - more nights of worry and tears? The patient is still alive. That's all that matters. Lastly don't ever say that you are just a PCA. Without the CPA's and CNA's the nurses and doctors wouldn't know what was really going on with the patients.
Yes, initial and date your patches. If you are using a MAR (I hope you are) initial and then write the place where you placed the patch underneath (LC, RB, RC, etc.) so that other people can find it when it's time to remove.
I have no idea what was going on with the patches. Is it possible the patient was removing them, setting them aside and then putting them back on? I've seen patients do pretty strange things. Had a patient who covered himself with nicotine patches once.
Also, don't those patches lose effectiveness after 24 hours? Oh, just reread Esme's post. Yes. They only last 24 hours, so probably minimum harm there.
Don't be too hard on yourself. We can't be on top of every weird glitch and twitch, especially when the patient has his own, very personal and peculiar beliefs about how to take care of himself.
Specializes in Gerontology, Med surg, Home Health.
Did I miss something? The resident was sent out because he had a fever? That wouldn't be caused by a nitro patch so the fever is surely not your fault.
Esme12, ASN, BSN, RN
20,908 Posts
I am not familiar with LTC or AL regulations, but I do know that the task can be delegated to UAP's that have proven competence. The nitro patches have only 24 hours worth of meds so there is no deleterious effect there BUT it has shown that to leave the nitro on the patient build a tolerance to the effects of the nitro an he can develop chest pain due to the med being ineffective. The "no one else does" and "everyone does it this way" when you become a nurse is not acceptable...you are accountable for you. Now you know that you need to check closer...the patients temperature has nothing to do with the patches being left on.
In a hospital setting the patches are dated and initialed for this very reason so yes...we date, time and initial them all. One reason is to protect yourself and one so they know who to blame. I am not familiar with the legalities in AL/LTC but you have no license to take away, the nurse is responsible. I am not sure I'd take a position as a nurse with this kind of responsibility and set up but I am sure nurses are needed. I know you are freaking out and love your job....such dedication and caring should be required in all health care givers.
Now.....Take a deep breath, if the patient was living at home this could have happened. As long as you did your best. The system needs to change but that won't be happening....you need to protect yourself. When you become a nurse remember this feeling of freaking out to remind you to be careful and vigilant in your practice.:heartbeat