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 =(
med administration, discharge, assessment, teaching, all are things that cannot be delegated to UAP...
Med admin can be delegated in MANY states.
I amm still confused about these patches. These are typically not given on a regular basis. Who is putting the patches on? What is the providers order for them?
Nitro patches are very commonly prescribed on a routine/daily basis and are designed for such use (the deliver a controlled amount of nitro over a several hour span. Nitro paste is often reserved for prn use.
To the OP, my guess is thet the person who work with the patient on your evenings off hasn't been that through. Removal includes disposal, going forward it's probably in your best interest to personally dispose of the patients used patches to prevent his reapplying them. Your Admin also needs to crack down on day shift not dating them. If the patches had been dated it would be easy to identify who didn't follow through with their removal.
Just like to add that I worked in a SNF and we had med techs that administered meds all except narcotics. Med techs at least have training. At the AL I was talking about the aids don't have to have any training except on the job.
Nitro patches are very commonly prescribed on a routine/daily basis and are designed for such use (the deliver a controlled amount of nitro over a several hour span. Nitro paste is often reserved for prn use.
In the hospital, NTG paste is a routine med also, often q6 hours (yes, I know the OP was not about a hospital setting). In the hospital, we use SL NTG for PRN chest pain and medics usually use spray. [Just wanted to clear that up ] Either way, a patch is not for PRN use.
Anyway, I'm still wondering what the RN's responsibilities are in such a situation. Even if the med tech actually gave a med, does the RN duty have any culpability if something goes wrong re: med administration/side effects?
Just like to add that I worked in a SNF and we had med techs that administered meds all except narcotics. Med techs at least have training. At the AL I was talking about the aids don't have to have any training except on the job.
So wouldn't that be unskilled nursing? I guess the lesson I would take from this, if I had a loved one going to live in one of these facilities, I would make sure a nurse is going to pass the meds.
Nope it was skilled. We only had one med tech that passed mainly to a dementia unit d/t not many pills/residents. Unlike ALs we also had nurses on the floor at all times. In KY its very common to have med techs in all types of facilities.
Specializes in Emergency/Trauma/Critical Care Nursing.
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.
regardless if people aren't initialing the patches appropriately, is there not a form of an MAR (medication administration record) that you are referring to in order to give the correct meds to correct patients?? The MAR alone should tell you who pulled out the previous patch or signed off that they gave it, and if they are documenting appropriately they would document the site it was applied. So BEFORE you ever give a patient a medication, regardless if you have given the same med for weeks to this patient, you ALWAYS look at your MAR. There could be a change in dose/medication/ or that the med is discontinued altogether, but regardless, you can see what the previous dose was that was given, and hopefully the site administered if they know what they're doing. Then when you go to apply the new patch, you know exactly where to look for the old one, and ALWAYS make sure you are checking his BP prior to giving that medication AND afterwards, regardless if the other patches only work for 24hrs, i don't know what other medications he may be taking for his blood pressure/diuretics that could bottom him out.
and PLEASE PLEASE be safe in doing whatever you are doing.. i'm not saying you aren't, but unfortunately theres a lot of times where nurses get rushed, or are lazy.. you ALWAYS advocate for that patient, regardless of how busy you are, you don't walk out of that room until you know medications are correct, patient is OK, and you aren't having doubts about anything you did, otherwise go back and check until you can clear up whatever you're unsure of.
] Either way, a patch is not for PRN use.
kids
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To the OP, my guess is thet the person who work with the patient on your evenings off hasn't been that through. Removal includes disposal, going forward it's probably in your best interest to personally dispose of the patients used patches to prevent his reapplying them. Your Admin also needs to crack down on day shift not dating them. If the patches had been dated it would be easy to identify who didn't follow through with their removal.