Gave a med I shouldn't have given... worried about repercussions

[tired_panda]

This morning I had admission that came up from the ED. Her blood pressure was high with SBP in the 190s and the pulse was hanging around the high 90s/low 100s. The doctor saw her and put in a STAT order for IV labetolol and I gave it without question over the recommended 2 minutes for the dose I gave. She was on a cardiac monitor and I was watching the rate and rhythm closely. No adverse effects were noted, and the vitals were stable a half an hour, 1 hour, and 2 hours after administration. My shift ended and I left. I had no worries about the care I provided .

I am still relatively new on my floor, and during my inevitable post-work anxiety nightmares, I dreamt I was being fired for administering this drug. Somehow, my waking self did not remember a comment that I received once, roughly 6 months ago in orientation, about IV labetalol, but my subconscious pulled it up no problem. We are not supposed to give it on our floor (though IV metoprolol is okay) and it needs to be administered in an ICU/CCU setting.

When I am back at work, I am going to complete an incident report and inform my charge nurse but I am very fearful. I know med errors happen, but I just feel awful and cannot help but think of all the "what ifs" as far as the patient's health and my own job. I doubt any one has been in these exact shoes, but any input is appreciated. I am so worried and full of regret.

[RN4lavida]

I think you should read what she posted. What she was saying is that she gave IV Labetalol and realized that it should not have been given on the unit in which she works; however she can give metoprolol on her current unit. She never said that labetalol and metoprolol were one in the same. Sometimes we should be clear that we know what we are talking about before we criticize others.

[Smellnell]

Med errors happen all the time. A lot nurses are just too complacent to notice or care. Good on you for caring, but don't beat yourself up.

[Susie2310]

I would argue technically, yes, it is because it violates one of the rights in the ever-growing list of medication rights (I've seen as many as 12 at this point). It would be under "right response" which would require monitoring that the policies in the OP's ED do not allow for, hence the need for the drug to be given in an ICU setting.

I believe this is the reason that the drug is required to be given in the ICU.

[KelRN215, BSN, RN]

I have a question. If this particular medication is not permitted to be given on this unit, Why was it in the med room or the Pyxis in the first place? If it is against policy for an RN in her unit to give this medication, how did she get her hands on it? Where did it come from? If it is provided on the unit then maybe the policy isn't as clear as the OP's presenting it to be

This is what I want to know, too. If the medication use is restricted to certain units, why did the Pharmacy dispense it to a patient on a different unit?

And confirming with nurses who've been around for a long time that you're "not allowed" to give it on the floor doesn't mean it's true. Find a written policy that says its use is restricted to certain units.

When I was a floor nurse, EVERYONE believed it was against policy for a staff nurse to plant a PPD on a patient. One day I finally asked our Clinical Nurse Specialist why and she couldn't believe people thought this (they claimed it had "always" been this way) and sent an email out clarifying that any RN can give an ordered intradermal injection to any patient and that only a select few group of people do it on staff for quality control purposes.

[Here.I.Stand, BSN, RN]

I'm confused why this policy? I started my career on a neuro floor, and scads of pts had orders for prn labetalol and hydralazine. This was a floor-floor, not a stepdown or even tele.

[Boomer MS, RN]

They are both types of beta-blockers, but they are not identical in mechanism of action.

Metoprolol selectively blocks mostly beta-1 receptors in the heart. So it lowers BP by decreasing cardiac output (it can lower heart rate and decrease contractility).

Labetolol blocks beta AND alpha-1 receptors. So it does everything that metoprolol does, but also causes vasodilation - decreasing BP further by lowering systemic vascular resistance.

I wonder if that is why they allow metoprolol but not labetolol.

This is true. Lots of interesting comments here. I feel that sometimes there is too emphasis on P & P and not on how we should practice. I realize you have to follow the P &P though.

The nurse said the patient was on a monitor and that she was watching the monitor. In an earlier post, I said it is important to monitor the BP too. That is how it should be done. The nurse seems to me to have monitored the patient. If the BP was the issue, labetolol was appropriate drug. I find it frustrating that there would be such a policy, thus my suggestion to change it and someone needs to educate any RNs who need more training/monitoring in the use and administrating of this drug. I've worked in many facilities, and I have found the P & P differ considerably. And when I had concerns about and called the cardiologist about a pressure lower than 90, he said that's what he wanted. I just don't think the OP did anything horrible. She could open discussion on her unit that no one else ever gave any thought to.

[Boomer MS, RN]

I believe this is the reason that the drug is required to be given in the ICU.

Again, it was not give in the ED; it was given on the floor. The question of it being allowed to be given in the ED is not the issue here.

[DeeAngel]

I don't think I am shooting myself in the foot by accepting responsibility and perhaps inspiring increased awareness about a policy that isn't well advertised to new nurses on the floor like myself. I'm not reporting myself to the board, just putting in an incident report. My floor encourages this and I think it looks a whole lot better to accept responsibility than to wait for someone to notice and call me out on it.

If I had called the doctor, she would have cancelled the med and ordered lopressor. No time wasted, no transfer necessary

Only time will tell if the bolded part is true, there is also the distinct possibility of being immediately terminated and tagged as ineligible for rehire. Do not ever assume in nursing that you will be treated fairly by your superiors, despite their rhetoric to the contrary. Reporting this is a genuine risk to your career. The pharmacist approved the order and you gave it, they are the ones who are supposed to know what drugs can be given where. I would strongly advise you to let this matter drop.

[chacha82, ADN, BSN]

I have never given metop IV push. I have given labatolol IV push on the floor; I believe we were required to monitor HR and BP q 15 x 4. Often there were standing orders for labatolol IV/hydralazine IV push for hypertension.

Talk to your charge or unit education person. Everyone, including the MD, needs to get on the same page regarding which meds can be given on your floor. Share this updated info with the teams of MDs. That way they will know what they can and can't order for people coming to your floor. It's not the first time something like this has or will happen - patients are often sent on gtts that we're not allowed to manage. We find out in report and end up having to reroute them, or they can't come until they're off the gtt.

[la_chica_suerte85, BSN, RN]

I believe this is the reason that the drug is required to be given in the ICU.

So, technically, since it was given in a place that should not be administering it, then it would be a medication error.

[Susie2310]

Again, it was not give in the ED; it was given on the floor. The question of it being allowed to be given in the ED is not the issue here.

Yes, my reading error, but the OP said Labetalol has to be given in the ICU/CCU at his/her facility, and the OP referred to IV Labetalol. This makes sense as neither the floor or the ED have the staff/patient ratios to allow for intensive monitoring of the patient. I just read a very comprehensive well known IV drug guide reference on IV Labetalol, and the patient does require very close monitoring due to the effects of the drug.

[Boomer MS, RN]

Yes, my reading error, but the OP said Labetalol has to be given in the ICU/CCU at his/her facility, and the OP referred to IV Labetalol. This makes sense as neither the floor or the ED have the staff/patient ratios to allow for intensive monitoring of the patient. I just read a very comprehensive well known IV drug guide reference on IV Labetalol, and the patient does require very close monitoring due to the effects of the drug.

The culture of an ED is consistent with monitoring some patients closely. I have given Labetolol IV in every ED I've worked; what is done routinely on some floors is forbidden in other facilities. I still don't see this as a med error. The OP's post has generated different opinions here, and I guess her manager will guide her to some resolution. I hope so anyway.