Does it ever stop?

  1. Okay so I am a "newer" nurse. I worked in a rehab to home for a few years and became an RN and went to an observation floor. On this floor, we get chest pain patients, post cath lab patients, and some med surg over flow. But we do have parameters. I was handed off a patient this morning and was told they were put on a cardizem drip because they had converted to Afib. she was also on a heparin drip due to the chest pain. So this patient was scheduled to go to the cath lab at 11:30. Which she did. They were not able to obtain access! The cardiologist said we would just treat it medically. Well when she got back, she had a written order to d/c the heparin, but nothing about the cardizem. I noticed she was in normal sinus. At shift change, the oncoming nurse treated me like I was completely ignorant because I didn't call and get the cardizem discontinued. I'm not very familiar with IV conversion drugs because we don't deal with them very often. She made me feel horrible.
    •  
  2. Visit YoungRN93 profile page

    About YoungRN93

    Joined: Dec '17; Posts: 1; Likes: 1

    12 Comments

  3. by   canoehead
    Sounds like a reasonable mistake to me. You can't read minds.

    Usually once a patient converts we give a po dose, wait an hour and dc the IV med. The oncoming nurse could have informed you without being a douchecanoe. (Wondering if allnurses accepts #douchecanoe#, lol) Maybe she was stressed and irritated in general but not specifically at you? I think you did fine.
  4. by   Been there,done that
    "The cardiologist said we would just treat it medically. Well when she got back, she had a written order to d/c the heparin, but nothing about the cardizem. I noticed she was in normal sinus. "
    Oncoming nurse was correct that you should have obtained the order when the doctor failed to dc the Cardizem. That is critical thinking skills. Did a patient in NSR need a Cardizem drip?
    Best wishes, it takes time to develop those skills. But THINK.. does this patient still need a a calcium channel blocker? WE are responsible for the doctors orders, or lack thereof.

    That is why they pay us the big bucks.
  5. by   EGspirit
    Yeah, just chalk this up as a learning thing. No one was hurt, the MD may have wanted the Cardizem continued for other reasons. We are not MDs, so we call the MD to clarify, but no one was going to die from it, if she was being monitored, so you're good to go. And it never stops, to answer your question. We learn from mistakes and near mistakes, and this goes on and on, and it never feels good. But this is no big deal and a real argument can be made that if the MD wanted the Cardizem drip stopped, they would have ordered it stopped. They didn't, so you administered it, and the patient was monitored, and she couldn't get a cath done. Cardizem is used specifically for high blood pressure and to reduce pain from angina. So, there could be good reasons why the MD chose to continue it. And the MD did choose to continue it. Just because the patient was back into NSR, is not the sole indicator for discontinuing it. Without any other reason to suspect it, like the MD wrote in the progress notes specifically that Cardizem was being used to convert the pt to NSR, I'm not sure I would have called the MD or questioned it. I would have administered it per the order in place and monitored the pt via telemetry. That's it. And the oncoming nurse if she knows something I don't can call the MD herself. It's just a case of nurses eating their young, in my opinion.
  6. by   Purple_roses
    I can understand why you wouldn't have thought immediately to ask about what drips to DC. Sometimes our jobs get so insanely busy that we barely have time to think, and it certainly doesn't help when it's somethhing you're unfamiliar with.

    Bottom line: you're not a bad nurse for this mistake. The patient survived. And you learned. I think the best way to prevent this is to actually kind of sort of report yourself (at my work we can do "safety call outs" and we don't get penalized for them-their purpose is to recognize breakdown within the system) And your situation absolutely sounds like a system breakdown. Your particular unit either needs more continuing education on certain drips or the parameters need to be changed so that you don't get patients with drips that you're not going to be familiar with. The only other thing I would say is to ask yourself "why" next time you're working with any med you aren't very familiar with. Why was it originally prescribed? Why are we getting vitals more often now? Why is this med affecting this sort of change and what side effects will it lead to? Why is it being DC'd?

    We have ALL been there. I actually kept a cardizem drip running for longer than necessary once too. I knew the patient had converted to NSR and for some reason it just did not click. It happens. Just ignore that other nurse.

    Edit: as far as reporting yourself or bringing the situation to management—don’t do this if management doesn’t generally have your back. My manager is insanely approachable and isn’t quick to play the blame game, so we all feel pretty comfortable admitting to mistakes openly. There are certain environments where this may not be ideal. Just thought I should add that.
    Last edit by Purple_roses on Dec 15, '17
  7. by   hppygr8ful
    Quote from YoungRN93
    Okay so I am a "newer" nurse. I worked in a rehab to home for a few years and became an RN and went to an observation floor. On this floor, we get chest pain patients, post cath lab patients, and some med surg over flow. But we do have parameters. I was handed off a patient this morning and was told they were put on a cardizem drip because they had converted to Afib. she was also on a heparin drip due to the chest pain. So this patient was scheduled to go to the cath lab at 11:30. Which she did. They were not able to obtain access! The cardiologist said we would just treat it medically. Well when she got back, she had a written order to d/c the heparin, but nothing about the cardizem. I noticed she was in normal sinus. At shift change, the oncoming nurse treated me like I was completely ignorant because I didn't call and get the cardizem discontinued. I'm not very familiar with IV conversion drugs because we don't deal with them very often. She made me feel horrible.
    It is a spiritual axiom that no one can make you feel anything! You are the master of your own feelings!

    Hppy
  8. by   ruby_jane
    You learned something. You didn't like the messenger, but you did learn something (and the patient was fine, no?)

    It will get better, and so will you.
  9. by   malenurse69
    Quote from Been there,done that
    WE are responsible for the doctors orders, or lack thereof.

    That is why they pay us the big bucks.
    This triggered me

    But yeah, basically this. Nothing more frustrating than having to chase down physicians who perpetually hide from the floor and refuse to answer pages. This is in a ICU setting, mind you.
  10. by   nursej22
    Cardiazem is used for rate control, not necessarily chemical cardioversion. As long as the rate and BP were within parameters, I am not sure I would have called. If the patient is going to be prescribed po cardiazem chronically, then that dose is often based on what they received in previous 24 hours.

    The cardiologists that I used to work with would have started coumadin and continued the heparin until the coumadin was at a therapeutic level. Or started one of the novel oral anticoagulants such as Xaralto.
  11. by   cleback
    This has come up for me too. I called and they still didn't discontinue it until the next morning (worked pms). I wish I could tell you their rationale but they did not explain why.
  12. by   Jennerizer
    I don't think you did anything wrong at all. We don't d/c the drip just because they convert to NSR. There should be parameters within the initial order...like notify MD when heart rate less than 70 or SBP less than 100.

    I can't stand nurses who purposely try to make other nurses...especially newer nurses feel bad or dumb. It's a great time to educate. Don't take it personally.
  13. by   Workitinurfava
    When I worked on the Tele floor my head was always spinning.
  14. by   canoehead
    I wouldn't have called if there was no po dose ordered. Maybe I'd ask if I was calling for some other reason about the plan for the IV drip. The doc had already reviewed the orders, and decided to continue the IV dose, maybe he wanted another 12 hours to make sure she stayed converted. If he had ordered a po dose AND IV I would have thought there was a mistake, and called.

close