I made a boo boo!!! - page 3
Just before finishing up after a hectic 12-hr night shift the other morning, the charge nurse asked me to witness a waste. She told me what she was giving, how much she was wasting, drew it up in... Read More
Feb 1, '07Joined: Jul '05; Posts: 5,197; Likes: 6,226Quote from AlbertaBlueU.S.'s medical system is very legally oriented, but we as normal bedside nurses are not required to carry liability insurance. Being a critical care nurse pretty much all of my RN career I definitively have a different perspective on patient care....lol.I am interested in reading the chain of responses to the initial posting. I can see your point...however...the point that I was trying to make is that if you know that the medication for which you are co-signing as a waste is a medication that you know you should not administer on your ward, then why sign for it at all without questioning its intented purpose? Purely out of curiousity...do you think that this rule should apply differently for the varied practice areas? In other words...I work on a med/surg floor where there are very specific medications that are disallowed for administration by RN's. It sounds to me that RN's practicing in critical care areas are more accustomed to administering medications that would otherwise be verboten on a med/surg ward. Also, I wonder if nurses practicing in different countries (where personal liabilities are not an issue) would answer this question differently. As a Canadian nurse, I do not require liability insurance. My understanding is that nurses practicing in the US do...do you think this influences the responses to this question? I'm really interesting in your perspectives.
Also, since I am in the military I cannot personally be sued while working at military hospital. As far as why the Versed is not allowed on some floors I would imagine that it is to keep providers from trying to do conscious sedation w/o monitoring by passing it off as something else. My point with Versed is that in many cases it is more benign than a lot of the other benzodiazipines that we often give because of its short half-life. You can easily wait out the effects of Versed, but you are gonna be there a long time with Ativan or some of the ones if you try to wait out the effects..lol
Versed half-life: 1-4hrs
Ativan half-life: 12-13hrs
Valium half-life: 20-50hrs (probably why we don't hardly give it anymore..)
Feb 1, '07Occupation: RN Joined: Apr '04; Posts: 441; Likes: 23Quote from AlbertaBlueLooks like everyone else was right. The NM said for me not to worry about it because I was not responsible for what the other nurse gave and all my signature was for was the WASTE. As for the other nurse, the NM said that he will be talking with her about not giving Versed on the floor, period. However, with the dose that was given, it technically wasn't enough to cause conscious sedation so she's not in trouble either...this time.I'm sorry to be the one to disagree...but...I don't agree with a few things about this...1) Just because it's a 12 hr shift doesn't mean that you should relinquish your responsibility to follow the P & P's of your unit, if you;re tired get someone else to crosscheck the med, 2) The fact that you were not the one who was administering the medication does not mean that you should not question the purpose of the medication being drawn up especially when you know that you are not supposed to deliver it on your unit, 3) the five rights of medication administration is there for a reason...the purpose of which is to avoid situations such as these. I understand that things can get really busy...but the fact remains that signing for a waste means that you should know what it is you are signing for, otherwise the action is simply a token gesture and not what it is meant to be, which is verification of the drug and the amount being wasted. We give Versed on our ward for palliative sedation...but we always use the Riker's scale to gauge the level of sedation that the family and palliative physician have agreed on. I know you would like to feel less awful about this...and believe me...I can relate...but I think that you have learned a very valuable lesson...we are all responsible for the patients we care for. I'm sorry to have been the naysayer...I really was trying to find a positive spin...but having experienced this myself...I just can't!
Feb 1, '07Occupation: Critical Care RN Specialty: 14 year(s) of experience in Mixed Level-1 ICU ; From: US ; Joined: Jan '07; Posts: 404; Likes: 1,984We're forgetting the fact that unless there is a reason to check, i.e. there was a discrepency in the narc. count, the chances of a random check of a perfectly accurate med count is remote.
Now, if the count were off, not only would there be inherent suspiscion but then the particulars of the event and the Versed policy would probably be scrutinized.
Unless, of course, you're suggesting we now send all wastes to an independant labratory to truly confirm that what the nurse says she's wasting, she actually wasting. After all, are you sure it wasn't just saline?
If the profession ever gets that screwed up, I'll run from nursing as I would the plague.
Feb 1, '07Joined: Jul '06; Posts: 557; Likes: 47Glad you did not having any lasting negative effects from this incident, I think a review of P & P would be in order for this floor. This is bound to happen again. I do agree that it seems odd you can access this med even if you cannot give it on your floor. Here, we do not have access to meds banned for floor use.
Feb 1, '07Occupation: RN Joined: Apr '04; Posts: 441; Likes: 23Quote from gitterbugYou might not have seen that part...I later learned she had gone down to pharmacy to pick it up.Glad you did not having any lasting negative effects from this incident, I think a review of P & P would be in order for this floor. This is bound to happen again. I do agree that it seems odd you can access this med even if you cannot give it on your floor. Here, we do not have access to meds banned for floor use.
Feb 2, '07Occupation: RN Er/ ICU Specialty: 11 year(s) of experience in ER/ ICU ; Joined: Oct '06; Posts: 345; Likes: 17Check the policy and see if there are meds that cannot be given. I give fentanyl alot and other RN's wont because it's used for sedation, there is no policy not to give it and it was ordered. Pt already on tele, o2 etc...
Feb 3, '07Joined: Jul '05; Posts: 5,197; Likes: 6,226Quote from AfloydRNFentanyl is a great drug, but with its short half-life why are you giving if not for conscious sedation. Are you using it for break thru pain and then following it up with another pain medication. Just curious??Check the policy and see if there are meds that cannot be given. I give fentanyl alot and other RN's wont because it's used for sedation, there is no policy not to give it and it was ordered. Pt already on tele, o2 etc...
Feb 3, '07Occupation: RN Er/ ICU Specialty: 11 year(s) of experience in ER/ ICU ; Joined: Oct '06; Posts: 345; Likes: 17We use it for breakthrough pain- post open heart, AAA stent, esp fem-pops when the revasc pain is out of control. We start out w/ MS and that sometimes does the trick. If not, we move on to fentanyl.
Feb 6, '07Occupation: home health Specialty: med/surg, geri, ortho, telemetry, psych ; Joined: Oct '06; Posts: 693; Likes: 30Your responsibility is to witness the waste. It's not your job to stand there and ask a bunch of questions about it. That would be an insane waste of time that I don't have.