Frustrated over a code

Published

I had to code a pt today, only my second code. My issue is for the 30 minutes before there was a ultrasound tech in the room and prior to that pt was in MRI. Family states reporting concern to the tech but nothing was reported. Pt was dusky and sats of 40%, when I went to go give meds. I know they are there to do a job but pt was clearly not doing well. Am I holding the techs to a higher stander then I should or did the ball get drop in a big way for the second time leading to the code? First was the 24hr chart check was not done right, medication dose was triple what it should have been.

Also how do you calm down after a code. I feel horrible and just have a list of what ifs and mistakes. It does not help that I was the one that gave the medication that ended up causing the code. Oh and family was throwing around the sue word well before this.

I'm emotionally drained and needed to vent.

Specializes in Psych/CD/Medical/Emp Hlth/Staff ED.

If techs were expected to assess patients then we'd be out of a job. An U/S tech doing a scan has no baseline to compare to and an ill appearing patient is not that unusual in a hospital. We learned our lesson a couple of years ago following a patient death in an MRI machine and we now send an RN with any patient who is leaving the floor who has recently received narcotics or other sedatives.

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Specializes in multispecialty ICU, SICU including CV.

Medication was extended release narcotic.

I am just very frustrated as this all could have been prevented if the proper checks were done correctly and the fact that I gave the medication that caused the code. We unfortunately rely on others to do their jobs correctly to do ours correctly (ie 24 hour chart checks). We work as a heath care team and to think the RN can have eyes and ears on each pt at all times is not realistic on Med/Surg and when concern is raised it needs to be passed on.

So my question to you is this -- WHEN did you realize that you triple dosed the ER narcotic? That is a really big med error for sure and obviously one that caused the patient harm. Was it after this chain of events happened, or before?

If you realized that you gave the triple dose before the patient went sour, you should have not allowed him to go unaccompanied (meaning without licensed staff) to MRI for one. Patient should have been placed on a continuous pulse ox at a minimum and drawn up narcan should have been put somewhere in the patient's room. Trying to pin the U/S tech for not monitoring the patient, when you know (at least I hope you know) that oversedation and depressed respirations/potential arrest can be an inevitable side effect of narcotic overdosing is not appropriate.

I hope that whole situation got written up. It looks like there were mistakes made on many levels and hopefully something can get learned from that. Hope the patient was ok, too (was he/she?)

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Specializes in Reproductive & Public Health.

where did she say she triple dosed the patient?

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Specializes in LTC.
If techs were expected to assess patients then we'd be out of a job. An U/S tech doing a scan has no baseline to compare to and an ill appearing patient is not that unusual in a hospital.

I think the problem wasn't that the U/S &MRI techs didn't recognize signs of a crashing patient it's that the family told them they had concerns about the patients condition and they didn't bring this up to the nurse.

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Specializes in Med/Surg, Geriatric, Hospice.
where did she say she triple dosed the patient?

1st page. Dose was 3x the amount it was supposed to be.

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Specializes in Med/Surg, Geriatric, Hospice.

OP, I don't think you can blame the overdose on the US tech or the night nurse doing chart checks. You ultimately were the one giving the med that caused the harm, but don't kill yourself over it. You made a mistake, you're human. Can I ask what med and what dose it was? As nurses, we are expected to know appropriate doses of meds we give and what dose will kill our patient. While it is unfortunate that the night nurse missed the dosing error, pharmacy didn't catch it, you didn't think it was a high dose when you gave it, and the US tech didn't tell you about the family's concerns.. It's just what happens sometimes. Things go wrong. Systems are fail-proof and people make mistakes! Thankfully the pt was saved.. go home and take a hot bath!

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Medication error was found during code. I'm not trying to pin anyone just pointing out where I felt the ball was dropped. Yes techs are not responsible for assessments but they should have passed on the family concerns.

I'm at work now and feel better about situation. Like I said before its frustrating as it was a preventable code and I'm being hard on my self as I gave the medication that led to the code. No I did not question the dose knowing pts history.

People are human and do make mistakes. It was written up and I will let what happens happen.

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Specializes in M/S, ICU, ICP.

it is always an adrenalin rush whenever you are involved with a code. i am not sure what standards techs and others are officially held. it sounds like a good opportunity to suggest some basic education classes on how to better communicate a patient's needs between departments.

after a code it is a good suggestion to also review what went right, wrong, or could have gone better. that is how improvements are made. you mention a 24 hour chart check and medications contributing to the cause of the code. it seems there may be some processes that are not being done as they should be.

calming down can be done while charting the event but usually just focusing on another patient and their immediate needs will help put distance between you and the event and you get calmer as that occurs. sounds as if you handled it well.

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Specializes in Critical Care.
OP, I don't think you can blame the overdose on the US tech or the night nurse doing chart checks. You ultimately were the one giving the med that caused the harm, but don't kill yourself over it. You made a mistake, you're human. Can I ask what med and what dose it was? As nurses, we are expected to know appropriate doses of meds we give and what dose will kill our patient. While it is unfortunate that the night nurse missed the dosing error, pharmacy didn't catch it, you didn't think it was a high dose when you gave it, and the US tech didn't tell you about the family's concerns.. It's just what happens sometimes. Things go wrong. Systems are fail-proof and people make mistakes! Thankfully the pt was saved.. go home and take a hot bath!

Opiods are very tricky because the appropriate dose range is extremely variable. A "middle of the road" dose could be a significant underdose for one patient and be a significant overdose for another. The only way to know what is appropriate is to know the nitty gritty details of their medical history and medication regimen. This is particularly true for patients on sustained release-type opioids for chronic pain issues. Catching an inappropriate opioid dose for an opioid-naive patient is much easier.

In this case, it sounds like the more serious breakdowns were due to how the order was written, transcribed, processed, whatever. And the failure of the tech to follow through on a voiced concern was huge in that it was a missed opportunity for the patient to be assessed and intervened upon before crashing.

At any rate, hopefully the event results in changes that address the safety breakdowns rather than pointing blame.

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Specializes in Med/Surg, Geriatric, Hospice.
Opiods are very tricky because the appropriate dose range is extremely variable. A "middle of the road" dose could be a significant underdose for one patient and be a significant overdose for another. The only way to know what is appropriate is to know the nitty gritty details of their medical history and medication regimen. This is particularly true for patients on sustained release-type opioids for chronic pain issues. [b}Catching an inappropriate opioid dose for an opioid-naive patient is much easier[/b].

In this case, it sounds like the more serious breakdowns were due to how the order was written, transcribed, processed, whatever. And the failure of the tech to follow through on a voiced concern was huge in that it was a missed opportunity for the patient to be assessed and intervened upon before crashing.

At any rate, hopefully the event results in changes that address the safety breakdowns rather than pointing blame.

This is also probably very true. I am probably what you'd consider 'opiod- naive' and probably scare more easily than a seasoned nurse who's given many different doses of narcotics and might not question such an order.

Similarly, today a pt. told me she used to take 100mg of morphine TID. I was SHOCKED.

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Specializes in Med/Surg, Geriatric, Hospice.
Opiods are very tricky because the appropriate dose range is extremely variable. A "middle of the road" dose could be a significant underdose for one patient and be a significant overdose for another. The only way to know what is appropriate is to know the nitty gritty details of their medical history and medication regimen. This is particularly true for patients on sustained release-type opioids for chronic pain issues. Catching an inappropriate opioid dose for an opioid-naive patient is much easier.

In this case, it sounds like the more serious breakdowns were due to how the order was written, transcribed, processed, whatever. And the failure of the tech to follow through on a voiced concern was huge in that it was a missed opportunity for the patient to be assessed and intervened upon before crashing.

At any rate, hopefully the event results in changes that address the safety breakdowns rather than pointing blame.

This is also probably very true. I am probably what you'd consider 'opiod- naive' and probably scare more easily than a seasoned nurse who's given many different doses of narcotics and might not question such an order.

Similarly, today a pt. told me she used to take 100mg of morphine TID. I was SHOCKED.

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Specializes in Med/Surg, Geriatric, Hospice.
This is also probably very true. I am probably what you'd consider 'opiod- naive' and probably scare more easily than a seasoned nurse who's given many different doses of narcotics and might not question such an order.

Similarly, today a pt. told me she used to take 100mg of morphine TID. I was SHOCKED.

Oops I read that as 'opiod-naive nurse', not patient. As in a nurse who's not given many high doses of opiods.

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