Frustration with a Provider

[applesxoranges, BSN, RN]

Basically, a provider and I do not necessarily see eye to eye on some things and the other day a potentially unsafe situation happened. A patient almost received a double dose of medications. I was pulled into an emergent situation with 2 nurses but I had medicated my patient and properly performed the sign offs for the meds at the bedside by scanning meds/patient. While I was in the emergent situation, she asked another nurse to give the medications I had already given and signed off in the computer!

I'm sure the RN would have scanned the medication prior to administering, but what if they hadn't? Our ER scanning rate of meds is pretty bad so far since we made barcode scanning mandatory in the ER (which is sort of scary in general since I am not convinced people are performing checks or printing MARs like we used) The patient had thankfully honestly informed the RN that they received both meds. I found out about the situation when we wasted narcotics together because he had stuck a needle into the morphine.

I could see asking someone to give the meds if it had been 30 minutes. Heck, I think our time frame is within 1 hour per the hospital. She asked them at 20 minutes to give the medication. I had already given the medication within 9 minutes of the order being placed so it's not like we were waiting for a long time.

If it was another provider, I would view it as maybe they were trying to help me out since most providers don't do it. However, the meds were already given and signed off in the computer. Why didn't she check first before assuming I didn't give the medications?

It also is sort of scary that our pyxis doesn't block out the orders automatically like it should. I know some places have it set up like that where it will warn you that "this med was pulled on X time." I have also seen orders hang around till about 1 hour after the order was put in.

[Buyer beware, BSN]

I think you have pinpointed the problem here. The fail-safes are either not in place or the ones that are, failed.

You could alert the chain to the situation. If they react to this glitch, or don't quite get it, with a blase' big deal attitude, luckily there's that Narcan stuff.

But seriously if voicing your concerns are not enough to get their attention, maybe after the patient respiratory arrests, becomes brain dead or dies someome will take notice when the lawyers come to exact their respective pounds of flesh from the hospital and the doctor too.

Expect to be labeled "not a team player, though."