Has anyone ever med errored with geodon

[newtress, LPN]

Hello to all psych nurses. I started a new position at a psych hospital a month ago. I have been the med nurse on several different units at this facility. Most of the days I am the med nurse and sometimes I do groups and progress charting. I had my first ever med error tonight. There was miscommunication between my charge nurse(first time working with her disorganized crazy self) and me. I was busy in the med room getting my 1800 meds pulled, and the attending physician had come by the station after I was behind closed doors in the med room and apparantly he had written some new orders for an unruly disruptive oppositional/defiant bipolar adolecent (that's a mouthful) unbeknownst to me. I went ahead and gave the patient his routine geodon at 1800. I then hear my charge nurse say that she called the doc to do something about this youngsters unruly behavior and said the doc increased his geodon dosage and to give it to him now. She had not taken the order off and put onto the mar. I said "man that's a lot of medication, are you sure he wants that much?" "yes, I have to do something or it will be uncontrollable the rest of the night, please give it to him now." I had already given the boy his 1800 dose, and she knew all 6 o'clocks had been given. I THOUGHT she had fully handled the order and took it off and put it as a new entry on the mar and I just hadn't seen it yet and I trusted her, actually feared her and figured I shouldn't challenge her. I gave the increased dosage right behind the 6 o'clock standing order, and then 10 mins later she said "did you already give the 6 o'clock for him?" "yes, I gave all my 6 o'clocks" (didn't she see me giving all those meds) "Oh my god, you just blew everything and we have a major med error here and the doc will be livid." It ended up being basically a double dose at the ordered time as I was following her order for me to do so. She knew he had a 6 o'clock geodon and verbally gave me the increased dosage to give. Med error report all in my name, VS q2h AIMS and glascow checks q2h and the incident report. No other nurses felt it was entirely my fault and it shouldn't all fall on my name, but it is and I feel tarnished as I have been one of the trustworthy doublecheckers in the med room. I was told she's done this before to new girls. Just sick about it.

[Whispera, MSN, RN]

The most important thing is, was the patient ok?

Everyone makes mistakes. Is your charge nurse the unit manager/director? If not, I think you should talk to the person who does fill that role, and explain about the miscommunication. Who made the med error/incident report? Did you have to sign it? While you're thinking of it, write it all down and ask to have what you write attached to the incident report. By the way, such reports are intended not to punish those who make mistakes, but to correct problems with the system. It sounds like what happened was a system problem, so it needs to be addressed that way.

[Jules A, MSN]

It happens and I'm glad to read that he was ok. If I understand correctly the Doc was in error, imo because the new order should have only included the PRN amount he wanted given not the standing order amount. How much was it? I've kids double their normal dose when you figure in the PRNs without problems, knock wood.

[newtress, LPN]

S/P Next day. I didn't sleep last night, but went in to work and the pt was/is alright with no untoward events. Everybody heard or knew about the incident. Yes I had to write up the med error report and the incident report and sign both. I agree that the doc wrote a questionable order. She was not in a supervisory capacity, just charge on that unit. Turns out that I sort of kind of got validated by the nursing supervisor and the house supervisor on this one. I had full backing and solidarity from all other nurses including ones from other floors. They said they refuse to work with her. The super said she knew this RN does things like this (mentioned she is bipolar, and you know.. on medication) and in the past there was an incident in which a young pt came very close to dying in her care. I was told to be assertive, please challenge or question orders or instructions that do not seem right in your estimation or FLAT OUT REFUSE to carry out a questionable procedure or medication.. For the rest of your nursing career. I grew a new and improved spine overnight.

[Meriwhen, ASN, BSN, MSN, RN]

Usually if a doctor's ordered an stat increased dose for a PT and I've already given the scheduled/PRN dose, I'll let the dcotor know about it and he/she will usually tell me to give just the difference between the two doses. So if the PT just got 20mg at 1800 and the doctor upped it to 30mg stat, I'll talk to the doc and then they'll get only 10 mg so they're at 30mg for right now (instead of 50mg). Your coworkers are right: you need to learn never to be afraid to call a doctor about a questionable order as well as refuse to give it until you sort things out with the doctor.

As far as charge nurses passing along new orders verbally, I have one that does that--fortunately, she's one of the most competent and noteworthy nurses in the hospital so she's not acting out of stupidity or malice. Still, if the order's not in my MAR, I sweetly tell her "sure thing, once I can get the order form so I can take it off for the MAR." And she never grouses when I say that :)

[maxthecat]

Glad to hear the patient is OK. Agree with other posters about not being afraid to clarify with physician yourself if you have questions about an order. Also good idea to have the order transcribed onto the MAR before giving. These things happen--I don't know anyone who has never made a med error.

Sounds like you have some other problems going on on the unit if you have nurses refusing to work with other nurses. And what is up with a supervisor revealing that a nurse is bipolar and on meds--unless the nurse is open about that I would think that kind of info would be a major privacy violation.

[newtress, LPN]

The nurse in this case did tell me toward the end of the shift herself that she is bipolar and didn't think her meds were working well for her. Her behavior was frenetic and had all the little patients all riled up, calling for more meds and dosage increases to the doctor. Confussion will lead to mistakes. I have noticed that a lot of the nurses at this hospital reveal a lot of personal things about themselves. They must think because it is psych and not med surg that it's ok somehow. Not the case anywhere else I have worked for sure. I certainly would have clarified this order with the doctor in person standing there at the station. But, I was ensconsed behind closed door of the med room when the order was written, and trusted that my charge nurse had it squared away before telling me to give the med. I feel the doctor should have written now/or stat or at least put the start date even if it was to be given right away same day. I like to see a date, which he did not write. He wrote it at 5:30 and did put give at 6:00, didn't write now. But still I would have wanted to see 6:00 and the true day or night for increased dosage to be given or started.

[Jules A, MSN]

Sounds like you have some other problems going on on the unit if you have nurses refusing to work with other nurses. And what is up with a supervisor revealing that a nurse is bipolar and on meds--unless the nurse is open about that I would think that kind of info would be a major privacy violation.

I was wondering about that also and whether or not the nurse discloses it I'd let it go. It isn't really a key point to the story and sounds a bit discriminatory especially coming from a psych nurse. Just my

[newtress, LPN]

Personally I'm letting all of it go. Lessons were learned, other employees making mention of her mental disorder etc. My med error and incident report was very generic, no names, just "nurse" and generalized around miscommunication and reading of orders wrong. Myself and the charge nurse felt the documentation was fair, because we both were at fault. I honestly don't want to have to work with her again though. Nice lady and treated me well (until med error) but difficult to work with because of the hyperkenetic disorganized way she runs the childrens unit. I worked with a different nurse last night and it was the complete opposit, like night and day, smooth and easy. Our demeanor kept the pt's more calm and my job was totally managable.