I'm tired of screwing up at work - page 2

Worked 7a to 7:30 p in our busy PACU today. Reported off on a vascular pt who had arrived hours earlier on a phenylepherine drip from the OR in company of both the service and anesthesia. Both said... Read More

  1. by   PMFB-RN
    I don't understand what your scew up was? The fact that the neo was running when he came out of OR is order enough.
  2. by   fostercatmom
    I know its hard, but this helped me....."slow down...just a bit"
  3. by   MommyandRN
    I completely understand the situation. I am a PACU nurse and used to work in a busy crazy one like yours with communication problems. If there was a drip someone was on when they came out of the OR, we could keep it running since technically they started it in the OR. We were supposed to document in our note that the drip was already on... for example "Pt received in PACU with neosynephrine drip at 5 cc/hr or 1mcg/kg/min" or whatever. However, if it wasn't necessary anymore, we would just toss it with no "DC" order needed since it wasn't our medication to hang. When the pt was going to the ICU or floor, then they would need the "official" order be placed in the computer, since after they leave PACU they are no longer under anesthesia's orders. When they are in PACU we receive orders from anesthesia.
    ANYWAY - no worries, don't beat yourself up. This sort of thing happened all the time. Next time just cover yourself with your documentation. A good note with details about the drip being on on arrival, and that Dr. Whoever aware that drip still running in PACU at that time and states to keep MAP 90 etc. If you have to ask to put it in as a verbal then do that.
    Last edit by MommyandRN on May 9, '13 : Reason: spelling
  4. by   solneeshka
    You know, I have not thought previously about possibly not needing an order for a drip started in the OR. If that's the standard in our facility (and I will need to find out!), then I guess all of my angst has been for nothing. We in PACU chart in the same system that anesthesia charts in, so the meds admin In the OR and the meds admin in PACU is all on the same page, one seamless flow. It would definitely show that anesthesia started the drip. And I made several notes about my call to the MD and discussions with the charge nurse, I even made notes in there about the MAP goal that was on order in the *other* system and how we were doing at various times. Hooray! I think that if I'm not totally saved I at least have a defense, and I don't hate myself or think I'm an idiot anymore! Thank you, fine people of allnurses! And I promise to report the scenario through our risk management system.
  5. by   solneeshka
    I so need to do this...
  6. by   gcupid
    Quote from TakeTwoAspirin
    This is a classic example of why incident reports should be completed. There are clearly root cause analysis issues here with the computer system and how orders are being processed and communicated. These problems are bigger than the individual nurses. I would encourage you to document this because the next time this happens the outcome might not be as favorable.
    Or it may have come out favorable Bc the op didn't do an incident report. Wasn't there a mistake regarding lab specimens not too long ago as well?
  7. by   solneeshka
    Quote from gcupid
    Or it may have come out favorable Bc the op didn't do an incident report. Wasn't there a mistake regarding lab specimens not too long ago as well?

    In our facility, incident reports for lab specimens are automatically done by the lab. When it happened, I also e-mailed my manager to let her know what had happened (so I could provide the information while I still remembered it). This situation is a little bit different in that what I did (leave the neo running to meet a MAP goal) was in fact what the service wanted to have happen. I think what TakeTwoAspirin is getting at is that the way our system works leaves big possibilities that what ends up being done is *not* what the service wanted to have happen.
  8. by   TakeTwoAspirin
    Yup, that's exactly what I was saying. In your particular incident nothing bad happened and it all worked out OK. However, the computer situation you described is flat out dangerous because there is always human error potential when things have to be "transcribed" from one system to another. You should be able to access an integrated system where the bigger picture for the patient is available to you at all times. Anything less leaves dangerous gaps. Sooner or later this is going to contribute to a bad result for someone, it's just a matter of time.