Odd situation-should I be worried?

[wernicke, BSN, RN]

Going to be vague, sorry!

I'm a homecare nurse, still a novice (licensed for 5 months, working for 2.5 months). Off orientation for a few weeks now. Covered a shift for a patient who was not my usual. Assumed everything that happened beforehand was SOP, nothing seemed amiss but apparently I was supposed to get more from the supervisor. Nobody expected me to know that, but I am concerned how that even came up. Would the supervisor have even been spoken to about that unless they thought I was responsible?

The patient had a tube feed that was held for a prescribed amount of time, and when I booted up the pump, the infusion rate was wrong. Far lower than what it should have been-it was at the minimum allowed by this pump. I changed it to the correct rate according to care plan, ran it, figured that was that. This was in the presence of a friendly family member who didn't seem upset. A nurse had been there before me, and the previous nurse had been the last one to touch the pump before this incident.

Apparently the following morning, another family member noticed that the pump was set too low. I suspect the pump is re-setting each time it's being turned off but I am not sure. On top of that, the abdominal site apparently did not look right (being vague on purpose). I had assessed it and it had looked normal to me before. I did have experience with this sort of site before. This was noticed by family probably over 12 hours after I left. Not sure if another nurse came in the meantime.

So someone from the agency calls me. I gave my entire timeline of events, everyone seemed happy but they were also very happy when I offered to give a written account. Thus it seems like they are gathering info. Of course that's just due diligence on their part but I am concerned that more is going on than meets the eye.

What if someone made an error and figured the new grad was an easy mark? I mean I know I'd believe a nurse with 5-10 years experience before I believed me, if I were the manager. I have a perfect, clean record in terms of errors and truth-telling but my record is only 2.5 months old!

So nobody is going to give me the benefit of the doubt if it came down to that. What should I do? What are the odds something funky is going on here?

I've had a great experience with this agency so far but this is worrying me a lot. I've got a tendency to over-worry though.

[caliotter3]

Don't overthink things. Just do what you are supposed to do, the way you are supposed to do it. You can drive yourself crazy playing "what if". But that does not mean you should not give careful consideration to situations and events, such as this one. My first impression is that I would wonder whether or not the night shift nurse was deliberately running the feeding slowly, perhaps to avoid complications that were already becoming evident. What is really interesting is that the agency took interest and contacted you. Does sound as if something is up. If you don't want to be part of the ongoing saga, might not be a bad idea to ease on over to another case. Self preservation should always prevail.

[wernicke, BSN, RN]

Thanks!

This was a one time coverage situation. Not sure if/when another nurse came to replace me before this problem was noticed. I get the impression a family member was the one to call it in.

Looking it up, I cannot find a single case of this pump malfunctioning in this way. Something about this whole situation just seems a bit off to me. I am suspicious that there is more than is meeting the eye.

Trouble is literally everyone directly involved has a reason to lie. I'm hopeful that my story being consistent, matching documentation, and not being 100% flattering to myself (admitted that I had not seen this patient's baseline and thus may not have realized the site was off; I mean I really doubt it was an issue while I was there but still) will help. Liars tend to mix up their stories unless they do it so much that they've gotten to be an expert at it. Spoke to another nurse and this really seems off to her as well. Am worried that this is a cover-up in progress, and that I'm being set up to take the fall. If that happens I'm screwed.

I'm really starting to think they had problems getting coverage for this shift for a reason. Perhaps there's a history of this sort of thing. If that's the case, the agency will know that and I'm hopeful that that plus my clean record will help.

[caliotter3]

Probably best not to work with this case in the future, and be wary of how they do things at this agency. If something was amiss and the agency knew about it, you had a right to be filled in on necessary info before doing a replacement shift. Selective information is not a good practice for keeping good nurses from finding employers that are up front.

[wernicke, BSN, RN]

Probably best not to work with this case in the future, and be wary of how they do things at this agency. If something was amiss and the agency knew about it, you had a right to be filled in on necessary info before doing a replacement shift. Selective information is not a good practice for keeping good nurses from finding employers that are up front.

I think I will to play it safe.

Looks like it's a genuine pump malfunction. I did ultimately find another case of this, did call the agency. I think they think I'm a bit paranoid/intense but they were nice. I've just seen too much go down in the hospital environment to be really too trusting to be honest.

I would hesitate before taking this case again. If nothing comes from this, there's nothing to worry about, right? Or is there more than likely more to this?

As for the site in question, the patient is a very young child and active in movements and may have pulled it themselves. 12 hours is a long time for stuff to happen.

[KelRN215, BSN, RN]

There are 2 feeding pumps commonly used in home care. The Infinity pump and the Joey pump. These are the only feeding pumps my current employer dispenses to patients and the only pumps I ever saw in the home in 3 years of home care before my current job. If this is a small child, I would default to assume he is on the Infinity pump. This pump retains its settings but if I turned it on and saw a rate programmed for 0.1 mL/hr (the pump minimum), I would assume that someone cleared the settings before turning it off, not that someone ran a feed at 0.1 mL/hr. You can check the volume to see how much infused if it wasn't cleared after the last feed finished. If he has the Joey pump, when you turn this pump on it asks you if you want to keep the settings or clear the settings.

If you/the family think the pump is malfunctioning, you should contact the company that dispensed the pump and ask to swap it out.

[wernicke, BSN, RN]

As a quick update: everything is fine, they were just checking. I think it's common for the parent in this case to call in for this stuff. I did advise them of the possible pump problem. It's not either of the two more common pumps, but rather a smaller company, I suspect somewhat regional. They're normally not bad. But that pump appears to be resetting every time it's turned off.

[NurseSpeedy, ADN, LPN, RN]

Im glad everything worked itself out. In the future I would let my documentation speak for itself (plenty of time to chart defensively in private duty). There should not be a need for a written and signed statement. Everything necessary is already in the chart.