Last night we admitted a woman who was sooo manic. She was totally inconsolable for hours on end, finally the doctor wrote her up some orders. I asked the patient if she would like something to help with her nerves and help her relax a bit, she refused. I got the nod from the RN to go ahead and grab her an IM because this patient really needed to calm down. The doctor had ordered ativan 0.5 mg and haldol 1 mg, which i think is actually a small dose as this woman is pushing 300lbs. So i went down to the room with the needle, she got even more upset and combative, there was no reasoning with her at all. Men got on both sides of her, held her, i administered. She was still going on and on and on and finally asked what we gave her and we said ativan and haldol, which made her start up more. She started saying 'you can't give me ativan, i have an allergy' etc etc. We got it out of her that she gets a rash from the ativan. I went and checked the chart and sure enough, in the pages from the medical hospital she was in before coming to us, the allergy to ativan was listed. We monitered her for the rest of the shift, no rash or any other symptom was apparant. I'm willing to take responsiblility, I guess i'm just wondering how much trouble i'm in. I have never thought it was fair that it falls back on nursing that the doctor prescribed something she's allergic to, i think it's just an honest mistake, like he wouldn't have done it if he had known...like i wouldn't have given if i had known. What am I in for and has anyone else ever encountered is situation? basically it was just passed on in report that she has an allergy and that it was administered, i'm going in at 3pm today and am wondering what to expect. any support is accepted
It is a med error....because "current documentation" in patient chart lists Ativan as an allergy....regardless if it is a true allergy or not. Again, it pays to explore patient allergies thoroughly upon intake/admission with the patient (and if possible, with a family member). I consider intake as part of the educational process with patients regarding their meds....to know their meds (name, dose, frequency), why they take them, compliance issues, if any side effects, the presence of any allergies and what allergic responses presented for them, to discuss the difference between allergies and side effects (not the same), et cetera. Intake is an invaluable process...for both the nurse and the patient. It is here that incorrect information regarding meds can be corrected, making the chart reflect more current and more accurate information. Again, in this thread scenario, it was a med error....for there was no "additional chart documentation" to indicate that the Ativan was NOT a med allergy prior to its being given.
So, in this case, the chart currently reflects allergy, med was given...med error.
I thought OP said the current chart did not list Ativan as an allergy. She said it was in the old record, didn't she?
Doc needs to share in the responsibility. Why'd he take so long to write orders?
This holding someone down would be a restraint for us, too, and we'd have to do the whole bundle of paperwork, get the eval, etc. we usually just use a show of force - have enough staff show up to basically convince the patient to go on and take the shot. No restraint used, no restraint occurred.
Weeping Willow
136 Posts
I thought OP said the current chart did not list Ativan as an allergy. She said it was in the old record, didn't she?
Doc needs to share in the responsibility. Why'd he take so long to write orders?
This holding someone down would be a restraint for us, too, and we'd have to do the whole bundle of paperwork, get the eval, etc. we usually just use a show of force - have enough staff show up to basically convince the patient to go on and take the shot. No restraint used, no restraint occurred.