How would you handle this?

[KellyMPH]

How would you handle this situation? I got report from night shift (a fellow traveler) and she said "I was really confused about the PPN and how they do it here so at first I just started the lipids but then I stopped and I didn't finish it, maybe you can look into it and start it." I asked her who she asked for help- she said another nurse who said to just start the lipids only. Extreme annoyance was coming through in my voice at this point and I asked her to put in a note why it was not started and the policy reasoning behind this (if any). She didn't put any note in. Open up patients chart and see no blood sugar was done since 9pm the night before and her 6am insulin was not given or charted against. At this point I'm pissed and go searching for night shift and of course she took off so fast after giving me updates on the patient and I couldn't find her. Going into the patients room I find that neither the PPN nor the lipids were given at all, there's no filter on the PPN yet both are charted as given in the MAR. Patient also is covered in poop up to her shoulders. Spent first 1.5 hours of my shift doing her work. We don't do bedside report because this is a COVID ICU and PPE is not given out immediately so as to not hold up night shift and limit time in COVID rooms. I was so mad that I brought all of these issues up to daytime charge. Anything else you would suggest?

[Hoosier_RN, MSN]

I would have documented all of this, succinctly, in patient chart. I would write a copy for my own records with details and perceptions. Telling the charge was the best. I would have tried to get the charge, or another nurse in there prior to clean up, to witness the initial event

[ljrn135, ASN]

All facilities will have some kind of reporting system that you should use. The chart needs to have specifics about meds, PPN, lipids ect… but putting in there the condition how the patient was left (full of poop) may or may not be pertinent to the actual chart of the patient and would be best dealt with in a report. You don't want to cover anything up, but you want to make sure that if someone reviews the chart, medically necessary items are there. If you don't know of any report system, as that is not something that all travelers are briefed on, I would write a VERY detailed email to ot only the charge nurse that was over that nurse but I would CC it to the director of the unit. That sounds terrible and thank goodness you were there to correct thing and take care of them.

[AtheistRN, ADN, RN]

Report to your supervisor and go up if necessary. No excuse for missed BG and insulin, twice! No excuse for not infusing nourishment as ordered. That nurse is a danger to your patients and should not touch them again until they are straightened out.

It would be different if they documented everything and reported to you accurately. But they didn't. It's like they were never there, except to run an infusion without proper equipment. Sorry you are dealing with this. Protect your patients.