Can I get in trouble for this????

  1. Please help!!! I recieved a patient about an hour before my shift ended (about 5:15am). In report I was told that she had been admitted for shortness of breath but there weren't any beds available so she had been on hold in the ED since 5pm the previous evening in another room. The patient was alert and oriented x3 and in no respiratory distress. Before my shift ended, i noticed her respirations were labored and she had audible wheezes. I noticed that she wasn't wearing her nasal canula so I reapplied it an her saturations increased. I then gave her a breathing treatment. She was still receiving the treatment as i was reporting off to the next nurse. I also reviewed her orders to check for any NOW orders, which i did not see. She did, however, receive a number of antibiotics and other meds sometime after she arrived to the ED by another nurse.

    Unfortunately, this patient was intubated later in the day. The admitting physician is writing a formal complaint because he says she didn't receive any of her ordered meds. Like i said, i don't remember seeing any outstanding now medications. Daily meds are normally given as early as 8am (i believe) so there was nothing i needed to give her at that time in the morning (6am). Am i at fault, is the nurse who cared for her before me at fault? What happens in situations such as this? Please help...i'm worried sick.
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    About vanurse2b

    Joined: Nov '05; Posts: 2; Likes: 1

    15 Comments

  3. by   SuesquatchRN
    If she had no scheduled meds you did nothing wrong.
  4. by   nrsang97
    The NM will check the orders and see what was ordered to be given was given in the ER. You had no scheduled meds. You did nothing wrong.
  5. by   Ms.RN
    did you call the physician and let him know that she is wheezing? did you get an order to give her breathing treatment? if you did, then you have notified physician of change of condition and you should be covered, not get into trouble.
  6. by   vanurse2b
    No i didn't contact the physician because in the ED we have standing orders for albuterol HHN treatments for wheezing. She is a known COPD so I believed her saturations only decreased because her nasal canula had come off. Once i reapplied the nasal canula, her sats came right back up. As i was giving report to the charge nurse before i left, she was still receiving the treatment. Do you think i should have called the physician?
  7. by   NurseyPoo7
    I dont see why its really a change in condition considering
    1) its what she was admitted for
    2) her NC was off
  8. by   Lorie P.
    if you had standing orders, usually you don't have to call the doc. also if she had a known history of copd, then this could be expected. you did your part, now let the higher ups do theirs!

    seems like you did what most nurses would have done.
  9. by   Vito Andolini
    Unless you have left some details out, I think you did everything correctly. You could ask the doctor exactly what is disturbing him and tell him you would like this to be a learning experience so you won't mess up again, if he actually thinks you did mess up.
  10. by   neurorn6
    First off, take a deep breath. You are not the first nurse, nor will you be the last nurse to second guess themselves. Patient was AAO, you checked the patient's sats, replaced O2 via NC. You reassessed pt. Gave breathing tx. Check orders for any NOW orders. Reported off to oncoming nurse, pt's condition and what actions you took. OK, you felt that you left this pt. in stable condition, and that the oncoming nurse would follow through. (I'm sure they did). Pt's can go into respiratory distress and even failure in a blink of an eye. I work ER and ICU and can tell you that there are times that you walkout of a room and 2 minutes later you come in and their has been a change in condition. As nurses we do the best that we can with the tools and information that we have. Don't let this incident throw you, use it and learn from it. If the physician writes a formal complaint, just remember that you are a professional too. They are not gods. You have the write to rebutt any thing that they say if you feel they are in error in their comments. You also, do not have to sign anything if you do not agree if it. POWER TO THE NURSES!! What can I say, I'm feeling my age.LOL
  11. by   Batman24
    It doesn't sound like you did anything wrong. Sign nothing.
  12. by   BrnEyedGirl
    We are having a tough time in our ER right now with holding pts 12+ hours in the ER waiting for a bed. Our ER physicians do not admit to the hospital, we call the pts reg doc or hospitalists or resident OC. That doc writes admit orders that often include "care paths" that are routinely used on the floors. We don't use those care paths in the ER and most of the staff in the ER have never even seen these care paths. Our problems occur when the admit orders say to use the "community acquired pneumonia care path" the floor prints out these orders and follows them, the ER nurse doesn't have access to these and has no idea what's on them. Then there is the whole issue of who is really caring for this pt now,.the ER doc or the admitting doc?

    There has to be a better way to facilitate that long transition from ER care to floor care. We are building a new ER and are talking about having a holding area for this reason. We're even throwing around the idea of having it staffed by floor nurses. I am a former floor nurse and I know there are many many things the floor does as routine orders that the ER doesn't do. I'm not sure how to fix this. It's easy to say we don't have time in the ER to do the type of care that's expected on the floor but where does that leave our pt? Anyone working for an ER who has a holding unit that works well? Would love to hear what you are doing.
  13. by   icyounurse
    Quote from RN-Cardiac
    We are having a tough time in our ER right now with holding pts 12+ hours in the ER waiting for a bed. Our ER physicians do not admit to the hospital, we call the pts reg doc or hospitalists or resident OC. That doc writes admit orders that often include "care paths" that are routinely used on the floors. We don't use those care paths in the ER and most of the staff in the ER have never even seen these care paths. Our problems occur when the admit orders say to use the "community acquired pneumonia care path" the floor prints out these orders and follows them, the ER nurse doesn't have access to these and has no idea what's on them. Then there is the whole issue of who is really caring for this pt now,.the ER doc or the admitting doc?

    There has to be a better way to facilitate that long transition from ER care to floor care. We are building a new ER and are talking about having a holding area for this reason. We're even throwing around the idea of having it staffed by floor nurses. I am a former floor nurse and I know there are many many things the floor does as routine orders that the ER doesn't do. I'm not sure how to fix this. It's easy to say we don't have time in the ER to do the type of care that's expected on the floor but where does that leave our pt? Anyone working for an ER who has a holding unit that works well? Would love to hear what you are doing.
    One place I worked had an 10 bed admit unit for 24 hour observation patients and floor admits that the hospital was too full to take over night. It was staffed by 2 nurses and they admitted and held them overnight, but the idea was they had to go to a floor bed in the morning cuz there was no staff there during the day. It seemed to work really well, it was a blessing for the ER and Recovery who usually end up having to care for these patients in addition to their regular work load, which is totally unfair to the patient and the staff as well.
  14. by   Roy Fokker
    Start with the basics:
    1. Did you carry out all orders before change of shift? You said you didn't see any "now" orders and there were no other meds ordered other than Protocol-PRN meds.
    2. Was pt. in acute respiratory distress? You said pt. had mild wheezing and some low sats and you took corrective steps (NC, Nebs).
    3. When you handed off at shift change, were you comfortable with it? Pt. was relatively stable and oncoming nurse should be able to assume care.

    1. Check
    2. Check
    3. and Check

    I see nothing wrong.

    The only think I'm slightly confused about is that you mention being worried about 'not informing the Doc' but you also mention 'standing protocol for Nebs for SoB in the ER'. Soooo, where were you working? On the floor or in the ED? If you were working in the ED, why would you need to 'call the Doc' - aren't they right there in the Department? If you were working on the floor, how can you use ER standing orders?

    Just a little confused
    Quote from RN-Cardiac
    Then there is the whole issue of who is really caring for this pt now,.the ER doc or the admitting doc?
    My understanding is that if admitting attending/hospitalist/resident has written orders for the pt., then they are now responsible for the pt's. care. If I need something or if there is a change in pt. condition, I have them paged.

    I don't bother the ED doc unless it's a critical emergency (FDGB type scenario).

    cheers,

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