Did I do the right thing? (long) - page 2
Sorry in advance for the long post, but you need to know the events preceeding. Two days ago we had a Code Blue in our area & pt needed epi SQ. Myself & a fellow nurse were the first to respond.... Read More
Oct 5, '07Joined: Apr '03; Posts: 7,569; Likes: 2,297is what you did legal? no, because you shared a script med with another person.
would you get in heap big doo-doo for it? i seriously doubt it because you were in a situation where the pt was in extremis and something needed to be done. if this were taken anywhere the fact that the pt was given wrong instructions would come out, as would the fact that your carts do not have epi stocked in them. the hospital and pharmacy would be in deeper doo-doo that you would.
i agree with the others....write it up but keep it to yourself. if an issue is made out of it, then do a formal.
Oct 5, '07Occupation: travel Specialty: 16 year(s) of experience in ICU,CCU,Trauma, neuro, geriatrics, telem ; Joined: Jul '04; Posts: 971; Likes: 349Epinephrine for cardiac ACLS is a different concentration than the dose used for anaphylaxis. What is the reason for not supplying anaphylaxis dose in the crash cart?
Your facility should reward you for saving a patients life.
Oct 5, '07Occupation: Staff Nurse Specialty: 18 year(s) of experience in Rehab, LTC, Peds, Hospice ; From: US ; Joined: Jan '06; Posts: 593; Likes: 562I would have done what you did. That pharmacy officer needs to consider what might've happened should it have been him or a loved one of his in that condition and the pharmacy came up 6 minutes later!
Oct 5, '07Specialty: Trauma ICU,ER,ACLS/BLS instructor ; Joined: Jul '07; Posts: 395; Likes: 293Quote from CindyMac58If u r that allergic to bee stings, u really should not "leave it to a first responder". Epi pens r essential in preventing death in severe reactions. I have seen some horrible deaths because people did not have epi pens and waited for rescue. (new benadryl strips,fast absorb will help too,but not replace epi pen) Sometimes they are too late.Epi Pens are one time use. I had one for bee sting allergy and my overly curious daughter deployed the thing. Huge needle, meant to be used through clothes in emergency situation while waiting for more advanced help to arrive. After seeing the needle, I decided I just take my chances with a first responder.
Can't think of one good reason that epi (1:1000 as well as 1:10,000) isn't on your code cart. I'm PALS certified and have been in quite a few codes. Our facility does mock codes and our division (Pediatrics) holds very frequent Code classes. The situation at your facility is a lawsuit/disaster waiting to happen.
In some areas that do not routinely deal with life threatning situations, epi pens r readily available. When I worked in college health,we had a crash cart well stocked, but had epi pens in a draw to get to fast. They can buy u time u can not get back when opening a cart,finding the epi.drawing it up,hopefully finding a vein ,,,,,,,When all that is going on,one can use the epi pen,call for help then open a cart and maybe give some inhalation therapy. Different areas have different protocols.
I would give an epi from my bag in a nano second if it would save a life.
Oct 5, '07Occupation: FNP Specialty: FNP, peds, epilepsy, mgt., occ. med., ed ; Joined: Mar '02; Posts: 1,821; Likes: 1,564The places I've worked where epipens have been kept were outpatient only facilities. One was an industrial site and the other was a freestanding clinic, several miles from the hospital. At the industrial site, we had standing orders for use in case of anaphylaxis. Neither of these places had "code carts" nor full code capabilities.
I'm not sure what the legalities are with using someone's personal epi-pen on a patient, but I agree that there are cases when you do whatever you need to do to save someone's life.
The OP's facility has some problems, obviously, or the issue would never have arisen. Not having what is needed is the issue that should be addressed, not the fact that a physician and a nurse felt that using the nurse's personal medication was absolutely necessary to save a patient's life.
Oct 5, '07Occupation: Jack of all trades Specialty: 20 year(s) of experience in Med/Surg, Geriatrics ; From: US ; Joined: May '01; Posts: 4,438; Likes: 3,919Quote from LilDKesslerSorry in advance for the long post, but you need to know the events preceeding.
Two days ago we had a Code Blue in our area & pt needed epi SQ. Myself & a fellow nurse were the first to respond. Our carts don't stock epi (a whole other issue!:angryfire) so the responding team had to go to an PACU area about 500 feet or so from us to get 2 vials to administer. Pt transferred to the ER with no further incidence. It was commented by several nurses that responded for the code that epi should be on inventory for crash carts.
Yesterday, we had another Code Blue. Once again, I was the first responder. Pt could not get her epi pens to work. Those around her had tried 2 different pens. Attending ER doc comes up & pt is wheezing loudly by this point & on O2. I advised that epi pen malfunctioned & he ordered someone to head to omnicell for dosage. I told doc that I carry one in my purse & asked if he wanted it. I was told to get it asap. Ran back to desk, got pen, returned & adminstered epi per order. Six minutes after I injected epi, the new Officer for pharmacy comes in with epi vials. She was told pt had already received epi & to return med to omnicell. Officer demanded to know how epi was obtained & I told her it was my personal epi pen. She was furious to say the least & has threatened to write me up for the incident.
To make a very long story a little shorter, turns out that the pt was seen in ER by same doc day before for reaction & rx'd epi then. Pharmacy here filled with above mentioned Officer actually instructing pt on using epi pens. Officer gave the pt the wrong instructions for use & that is why the pens malfunctioned!! Had the pt been at home, she would have died. When the doc found out that pharmacy was having a fit, he said in so many words that they could kiss all of our ****. Pt was sitting there & heard the entire discussion which is how we discovered she'd been given wrong instructions. Today, I went down to pharmacy to turn in our order list for tomorrow's surgeries & was asked by a friend in there what happened yesterday with me giving my pen to the pt, he had heard about from the Officer who apparently returned to her unit talking about me.:angryfire
I feel like I did the right thing & would do it again today if the need arises. Granted, if it were any other, non-emergent issue, I would never give out personal med, but it is standard dosage with standard self-admin system. I don't feel like I am in the wrong. Should I file a variance on the Officer for giving the pt incorrect instructions that could have cost her life?
BTW, pt sent me a fruit basket taking with note that says "Thanks for saving my life." I cried.
Thanks & sorry again for the long post.
I am as confused as the others responding. First, what area do you work i? You stated that patient was transferred to the ER? Under what circumstances is that done? Secondly, I can't think of a code situation in which epi SQ is given either and if you don't have epi on your cart then what do you have? That's quite bizarre. Finally, why is the patient trying to give herself an epi pen in an inpatient setting? That's odd. Could you elaborate a little more please?
Oct 5, '07Occupation: Jack of all trades Specialty: 20 year(s) of experience in Med/Surg, Geriatrics ; From: US ; Joined: May '01; Posts: 4,438; Likes: 3,919Quote from santhony44Yeah when I worked in employee health, we had the same but we by no means had a "crash cart", we basically were first responders until EMS could arrive in an emergent situation. It sound like OP is in some sort of inpatient setting? I don't know. As for whether or not, she could be legally liable, I think the greater liability would be for a facility not having adequate emergency supplies available. I worked in an office setting and we had epi pens as well as IM Benadryl available for allergic reactions.The places I've worked where epipens have been kept were outpatient only facilities. One was an industrial site and the other was a freestanding clinic, several miles from the hospital. At the industrial site, we had standing orders for use in case of anaphylaxis. Neither of these places had "code carts" nor full code capabilities.
Oct 5, '07Occupation: RN LTC From: US ; Joined: Jan '03; Posts: 3,760; Likes: 1,820I had a potential situation like this at a LTC center a few weeks ago. I had a pt with blood sugars in the low 40s and needed to give glucagon shot to. Of course our E box only had 2 doses in it and it was used up on that patient. Our pharmacy normally replaces them every night or so I though (I was later told that they are only doing it q m-w-f....that is a whole other issue) Soooooo....a while later we had another potential situation with another pt and of course no med.....the other nurse I work with keeps her own supply for herself. Might have needed to use it if the ambulance didn't arrive in time.
would I have used it....probably.
what type of setting were you in? What is an "officer"?
Oct 5, '07Occupation: Triage RN for 18 MD cardiology practice Specialty: 24 year(s) of experience in ER, Occupational Health, Cardiology ; Joined: Apr '07; Posts: 526; Likes: 172I think you did the right thing. That ERP knew exactly what you were offering, and he knew the condition of the pt there in front of him. If he thought that the pt could wait on meds from Pharmacy, he would've told you not to get your own epi pen to administer to the pt. You and he both recognized the EMERGENCY and acted in a timely manner in the best way available at the time. If, as you had requested, epi was kept on the crash cart, it would've been a moot point, huh?
Are you on a military base, or in a VA hospital? I've never heard the head of Pharmacy referred to as an Officer, but that is the person who should be in fear of being reprimanded. If he/she can't do proper pt teaching of how to use the meds they are dispensing to them, they should not be in such a position.
As one who has "flown by the seat of my pants" in many an emergent situation, if I'm ever in a tight spot, I'd want YOU and your ERP on my side-not the Pharmacy Officer!
Oct 5, '07Specialty: 5 year(s) of experience in ICU, telemetry, LTAC ; Joined: Apr '04; Posts: 1,483; Likes: 1,003I think that when the doc gave the OP the go-ahead to use her personal supply, the doc is in effect overriding pharmacy and the nurse is operating under an order. The patient still needs to be charged for the use of the drug, so the pharmacy should, really, hand the nurse an epi pen to replace her own. They should be free to inspect the used one to make sure it was what it was supposed to be.
Of course it doesn't sound like this pharmacy will be that nice. They don't stock the code cart like it needs to be, and they have issues with people needing to get drugs to patients in a timely manner, and they don't respond fast enough. I'd say the OP could ask the doc for a script for her replacement epi, and he probably would help. And yeah, it does sound a bit like they call a code prior to the actual respiratory or cardiac arrest of the person, but hey, if it prevents a death, I'm not going to tell them they're wrong.
Oct 9, '07Occupation: Navy Contracted Nurse Specialty: Ob/Gyn, Ped & PACU ; Joined: Mar '07; Posts: 47; Likes: 3To clear a little bit of confusion, I work in a military facility, not a civilian hospital & the incident did not happen in an in-patient region of the hospital, but in an administrative area. I work in an out-patient region of the hospital & this event happened down the hall from us. Our crash carts do not carry epi in any form, but I really don't expect it to carry the pens. Pharmacy was able to inspect my epi pen for expiration & lot number information. I also brought in a copy of the label from the box itself with the Rx info on it so they could see all the info on the script itself.
For the poster who wasn't sure how the pens work, there is a rubber stopper covering the needle end of the pen. To give, you hold the rubber piece firmly against the thigh, arm, etc until you hear a click (this is the needle coming down into the tissue) then hold in position for 10 seconds. There is a standard dosage for epi pens & a standard method of administration. Basically, there aren't many ways to mess it up. ) The pharmacist had told the pt to remove the rubber stopped then admin like you would a normal IM injection. If you remove the rubber stopper the needle will not engage, that is why it malfunctioned. Hope this helps clear eveything up & thank you all for your responses.
Oct 9, '07Joined: Jul '07; Posts: 261; Likes: 277Lil D, you're my hero. You exposed yourself to some criticism/liability, sure. But you did it so save someone's life. That's what it's all about, in my opinion.