Hoping I did the right thing for my patient

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Hi. New grad here, fresh off of orientation. I had an admission who was admitted to the unit with nausea and extreme pain. Vital signs were ok but respiratory rate was through roof and she was nauseous due to the pain. This patient is in tears and breathing so fast. Doc orders 1mg dilauded and 5mg reglan IVP and tells me to get in an IV and give the meds once they've been verified by pharmacy. They got verified by pharmacy. I get the line in, go grab my meds out of the Pyxis and go scan her to give the meds.. and the medication order for dilauded and reglan that was approved by pharmacy was discontinued and re-ordered with a different frequency and needed to be verified again. Same med, same dosage, same route, different frequency. I gave the med because this patient is in extreme pain and waiting for pharmacy to verify something they already verified but with a different frequency seemed like a horrible thing to do to my patient. Did I make the right decision?

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Yes you made the right decision.

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Specializes in Case manager, float pool, and more.

Ditto. You did the right thing.

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Hi. New grad here, fresh off of orientation. I had an admission who was admitted to the unit with nausea and extreme pain. Vital signs were ok but respiratory rate was through roof and she was nauseous due to the pain. This patient is in tears and breathing so fast. Doc orders 1mg dilauded and 5mg reglan IVP and tells me to get in an IV and give the meds once they've been verified by pharmacy. They got verified by pharmacy. I get the line in, go grab my meds out of the Pyxis and go scan her to give the meds.. and the medication order for dilauded and reglan that was approved by pharmacy was discontinued and re-ordered with a different frequency and needed to be verified again. Same med, same dosage, same route, different frequency. I gave the med because this patient is in extreme pain and waiting for pharmacy to verify something they already verified but with a different frequency seemed like a horrible thing to do to my patient. Did I make the right decision?

Yes and no ...I've done the same thing many times, but when you bypass pharmacy verification, you take a risk. The more rushed and stressed and sure of yourself you are, the more wrong you can end up being.

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Specializes in Hospice.

There will be someone on here that tells you that it was wrong, that you should reverify and then administer. I however, would have done the same as you.

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Wait. Did the scanner prompt you with an error? How did you know they were d/c'ed?

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Wait. Did the scanner prompt you with an error? How did you know they were d/c'ed?

Discontinued meds still show up on many eMARs.

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Specializes in APRN.

Yes .. I would have done the same thing.

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Specializes in Critical Care.

Pharmacy had already reviewed and signed off on the initial dose of the meds, the re-order to a different frequency only applies to when the next doses can be given, so there is no reason to delay the initial dose at all.

However even if you had been waiting on a pharmacy review of initial doses, appropriate policies and protocols leave room to balance the need to give medications in a timely manner with the benefit of additional reviews and the time delays those can cause.

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Specializes in Critical care.

Sometimes I call pharmacy while I'm pulling the meds and tell them I need it verified stat.

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Specializes in 15 years in ICU, 22 years in PACU.
Pharmacy had already reviewed and signed off on the initial dose of the meds, the re-order to a different frequency only applies to when the next doses can be given, so there is no reason to delay the initial dose at all.

However even if you had been waiting on a pharmacy review of initial doses, appropriate policies and protocols leave room to balance the need to give medications in a timely manner with the benefit of additional reviews and the time delays those can cause.

Said so well all I can do is bold and "like".

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Specializes in 15 years in ICU, 22 years in PACU.

So, the doc gives you a verbal order to start an IV and give Dilaudid and Reglan, then writes that order with a certain frequency that Pharmacy verifies. While you're starting the IV and before you give any of the ordered meds, the doc re-writes the order for the meds but with a different frequency. Now you're feeling guilty because technically you didn't wait for the new order to be verified before giving the meds?

Though, strictly speaking, the new order still needs to be verified by Pharmacy, you determined using your critical thinking/nursing judgement/common sense that it was OK to give a patient in extreme pain the medication ordered by her doctor.

I never automatically assume Pharmacy is right. I've caught Pharmacy in too many of their mistakes to blindly go along. If we disagree I always want to know WHY, and if it makes sense to me I will proceed. I am the ultimate monitor of my practice and am always prepared to defend it.

If I make a mistake because I was trying to do the right thing then that's just on me now isn't it?

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