Heparin Drip!

Published

Specializes in Step-Down.

Vent !!

Good day everyone! I want to share a very recent experience and hopefully get some feedback and reassurance. I have recently started working at a local hospital on the Telemetry floor and Love it! I love cardiac issues, the fast paced environment, ect.

I do have to admit that I am a bit of a perfectionist and always make sure all of my charting, my bedside charts and forms are completed, highlighted, and whatnot.

Recently I received a patient and report from one of the frequent charge nurses who is INFAMOUS for not giving a good report, not picking up doctor orders ( as in not picking up STAT orders that were written at 10AM and the 7pm shift has to do it) in addition to numerous other discrepancies.

Well I was told my patient has a DVT, and is going for a green-filter in the AM. I was not told they were on a heparin drip. Thank god I walk into all of my patients rooms after I get report on my patients to introduce myself and make sure they are comfortable. I notice the heparin drip right away! I look to the mar and to our Heparin drip protocol and order sheet. The mar says "heparin rip as per protocol, currently 10cc/1000 units an hour". I look to the protocol sheet which states PTT needs to be drawn every six hours and boluses, drip rate increase or decrease according to results and patients weight. Well I come one at 7pm and notice that the PTT was ONLY drawn once that day at 5 am, meaning it was not drawn at 12 noon, or 6 pm. The results from the morning were EXTREMELY BELOW therapeutic range! So I drew a new set, got the results. By the time all of this was done- OH WAIT did I mention I had a patient in severe pain, and another patient with severe confusion being physically combative and attempting to elope? Anyway by the time I got the results it was almost 12 am and the pharmacy closed, I called the supervisor to get me a new heparin drip because the one flowing was almost done!! I spoke to her expressing the situation and stating to file an incident report. I don't want to point my finger at anyone especially being new but I don't want to get fired or loose my license for someone others mistake!!

of course the next day I give report to the same nurse in the am stating I drew the PTT gave a bolus, and increased the drip. FYI before all the I called the MD just to confirm the orders and they stated to "follow the Heparin drip protocol". Later that day when I came back on the nurse was furious and said; "why did you go to the supervisor?!!??" I said

"I needed a new drip because the one you left me with was almost done, and p pharmacy didn't send a new one and she wanted to know why I needed a new drip and what occurred" She replies with: "well what goes around comes around"...........WHAT!! Now I am scared! I hope shes not out to get me...especially since I am still on probation!!

Advice please!!

Up Vote Up Vote ×
Specializes in Anesthesia, ICU, PCU.

If you're a new nurse you're in a pretty crappy situation. Hopefully with somebody with more experience can weigh in, but I too am a new nurse and have been confronted with similar issues. Not only can't we outright complain about the other nurses sub-par ethic because "we're new what do we know about this facility?" but our job is made that much more difficult and we just have to take it. Patients with low hemoglobins (6.X but still) and pending transfusions for 12 hours, falls during day with no X-ray to r/o injury/hemorrhage, levophed gtt dry AT change of shift with no backup dropped from pharmacy (pt. BP 80s/50s), labs pending, NG tubes clotted ---> lots of catch up with other patients to see. Does being a new nurse preclude you to get screwed over? Even pulled/PRN/float nurses?

Up Vote Up Vote ×
Specializes in Trauma Surgical ICU.

I'm sorry but that nurse and this issue needs to be reported to your supervisor or nurse manager. This is a pt safety issue. If you have any bullying issues or retaliation, time to get your NM and risk management/HR involved. Do not take this and stand up for yourself. You did the right. Nursing is 24/7 sometimes things do happen and are left for the next shift, however, what you wrote should not have happened at all. Did the nurse even go into the room, check orders at all??

Up Vote Up Vote ×
Specializes in ER, ICU, Education.

This is where bedside report comes in handy. Even if your facility does not enforce it, when I have to follow "that nurse," I insist on bedside report. If any issues are discovered, they can be remedied right away. We did this with "that nurse" who always left filthy patients, incomplete orders, etc, and we all refused to assume care until her work was complete. Of course, this is only appropriate for the habitually lazy and NOT the coworker who works his/her butt off but simply had the shift from hell.

Up Vote Up Vote ×
Specializes in retired LTC.
I'm sorry but that nurse and this issue needs to be reported to your supervisor or nurse manager. This is a pt safety issue. If you have any bullying issues or retaliation, time to get your NM and risk management/HR involved. Do not take this and stand up for yourself. You did the right.
YES!!!

Put it in writing and have an interview with higher-uppers when you submit it. Explain your fear of implied retaliation.

I speak from experience.

Up Vote Up Vote ×
+ Join the Discussion