Over reaction or justified indignation?

Nurses General Nursing

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I have recently been tasked to add safety checks when administering allergy shots at the office I work in. I have been in nursing 43 years. I have worked in an ICU for 23 of those years. I feel very comfortable with my level of professionalism. Some of the new measures are to have the patient or parent verify the name on the bottles and paper work are correct. That is okay for added safety. My problem is that our physician then wants us to verify the amount drawn up with the patient and that it matches what has been documented. If I was asked to verify with another nurse, I would not have as much heartburn, but feel this step is an insult to me as a RN. Am I making to much out of this, or am I justified in my feelings of outrage, and should I approach the physician with my feelings? Would love some feedback on this to see if I am justified in my feelings.

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Sounds like the physician has had experience with parents claiming the wrong dose was given. I wouldn't see it as insulting my experience but as putting parents at ease and leaving no room for later accusations. And I'd do it in a way that made them perceive me as running a tight ship rather than them running roughshod.

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Specializes in SICU, trauma, neuro.

I have had at least 4 systemic reactions to allergy shots which required IM epi and benadryl, and albuterol nebs. I can't remember the exact number because it's been 17-18 yrs (I was a sr. in HS and a freshman in college when I was getting them.) I do remember that I was miserable, terrified (air hunger does that to people), and thanks to that IM benadryl was out of commission for the evening. And although the meds fixed my symptoms, the simultaneous side effects of benadryl (drowsiness) and epi (tremors and tachycardia) was miserable too.

After this happened a few times I started to get nervous before every appt. Was it going to be a routine get 3 needles and sit in the waiting room for 40 minutes, or was I going to have a reaction?

As a pt I feel like being included as a participant in my care -- vs "just a young patient" -- would have helped me feel more in control. I remember once or twice the RN saying "I'll be using less serum than I did last week," and thinking "Okay good, they are doing something to keep me safe. Not just poking and praying."

Most of your pts are not RNs, but most of them are reasonably intelligent, reasonably educated, reasonably capable people. In the hospital we don't think twice about verifying with an A&Ox4 pt what meds we are giving them, and discussing continued home meds vs. new meds which need teaching on. I'm not seeing an issue with verifying a potentially dangerous med with the pt in the clinic setting.

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Thank you for your response. I can appreciate your experience with systemic reactions. These measures he is instituting are to hopefully reduce the frequency of the reactions we see, which to my mind will not be affected by us verifying the amount in the syringe with the patient or parent. Reactions are still going to occur even with all the correct checks and balances. But, more to the point, I was maybe taking the changes too personally not seeing it as peace of mind for the patient.

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Specializes in SICU, trauma, neuro.
Thank you for your response. I can appreciate your experience with systemic reactions. These measures he is instituting are to hopefully reduce the frequency of the reactions we see, which to my mind will not be affected by us verifying the amount in the syringe with the patient or parent. Reactions are still going to occur even with all the correct checks and balances. But, more to the point, I was maybe taking the changes too personally not seeing it as peace of mind for the patient.

And that's how I'd think of it. It's not like *med errors* cause the reactions; you know it was too much when the reaction occurs.

After introducing yourself, I'd just casually show the pt the order with the syringe and say "we're going to give ___mL today. Sound good?" Or somehow frame it as informing them of the plan, vs. "This is what the dr ordered, and this is the syringe. Did I make a mistake?" (I can see the latter as undermining his/her confidence, or "going in roughshod" as Libby put it.)

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Specializes in Complex pedi to LTC/SA & now a manager.

Parent hat, if my child had an anaphylactic reaction to the serum Id appreciate the nurse including me in checking the dosing as a partner and for peace of mind. Or a mature teen & parent.

Last time we used .05 of bee pollen 123 and Jenny had a reaction so the doctors protocol is to use half dose so we are going to give 0.25. If you look the curve or meniscus is right at the line between 2 & 3 mL. This way for peace of mind we both know the dose.

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i think it is more aimed at complaining patients/parents...

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Oh, wow. I've worked Asthma, Allergy and Immunology, and I can't even begin to see how this is a good idea. I would tell my patients if I'm going up or down and why and what allergen I'm giving them. I draw a line at them checking my needle and paper/computer work for the correct dosage.

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Specializes in Medical-Surgical/Float Pool/Stepdown.

How would this step help confirm anything if the Pt doesn't have a clue how to read cc/mL's let alone different syringe markings? Really...I'm curious!

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Specializes in MCH,NICU,NNsy,Educ,Village Nursing.

Why is he wanting you to do this? It seems prudent to ask the doctor what/why prompted this. There are some great responses here, but I think finding out his rationale would help you. I can see where you are coming from, yet I also understand the perspective of the other posters.

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Specializes in Pediatric Critical Care.

My first reaction is to take offense. But some people have made good points about what the actual reasoning probably is (to avoid unwarranted accusations later) and have given good suggestions on how to go about it without making it sound like you aren't sure of what you are doing.

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I have been working in this office for 7 year. We recently brought a new nurse on board. Last week she experienced her first significant systemic reaction and had somewhat of a melt down. The next time I went into the office, the Dr.approached us with making these changes. I can't help but think these changes are therefore a result of her doubting herself concerning the dosage she administered.

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