How do I get over this feeling?

[Kp168002]

So last night I experienced my first patient death and I can't help but feel guilty. Pt was admitted with UTI and confusion. Noted expiratory wheezing in lower left lobe upon admission. Pt was drinking bowel prep for a colonoscopy in the AM and unable to stand. Therefore I was in her room hourly checking her brief. I went in to check her brief and noticed she had developed crackles. Her fluids were running at 125ml/hr. I turned them down to 30ml/hour, pulled her up in bed, sat her high-Fowler's, assessed vitals and oxygen saturation. Aside from crackles the only thing not within normal limits was respiratory rate-22. Asked or if she was feeling short of breath- she denied. I immediately left the room and paged her DR anticipating an order for Lasix. Ten minutes went by, he never called. I went to reassess the pt- still alert and responsive, no changes. I paged the doctor a second time. When I went back in to check on the pt roughly 10 minutes later she was unresponsive. I did a sternal rub- no response. Pulse check- no pulse. Called code at that time. She did not make it and I can't help but feel guilty. Asking myself what I could have done differently...should I have ignored protocol and just called the Dr's cell. Did I let too much time pass between pages...just so many questions. How do I get over this feeling??

[TriciaJ, RN]

It seems to be in our nature to feel guilty, but I don't think you missed anything. And while you might second-guess yourself in your private moments, do not let anyone else second-guess you. It's not unheard of for administrators and doctors to throw nurses under the bus. Especially doctors who don't respond to pages.

Remember all the interventions you listed here, and be prepared to list them over and over as you are questioned. You did assess your patient, and you did respond appropriately to her change in condition. Period. If there is something to be learned from this, it is probably to be learned by all concerned. Maybe some policies or practices need to change. Most untoward events are really systems errors, not individual errors.

Is there someone on your unit who can debrief this with you? I once got a call at home from the regular charge nurse after an unfortunate demise. I really appreciated her sympathy and support. I am sending you good thoughts. ((((())))))

[nursej22, MSN, RN]

Agree, you should debrief with someone. It sounds like this patient had multiple co-morbidities (UTI, some sort of lung or cardiac issue) and GI for which she needed a bowel prep.

It sounds like you did everything a prudent nurse would do. Do you have a rapid response team available? Debriefing can help with coming to terms with what happened and learn if there was anything else that could have done.

[Sour Lemon]

I've found myself in a similar situation at least once before. I don't see anything wrong with your actions, but I do understand the guilt and "what if" questions. I wish we could at least get a definitive answer regarding cause of death, sometimes...but that doesn't usually happen.

[Been there,done that, ASN, RN]

Your actions were well thought out and appropriate. I have seen bowel preps kill more than one patient.

You are not responsible.. toughen up... many more patient deaths are coming up.

[missmollie, ADN, BSN, RN]

Why do bowel preps kill patients? I'm dying to know

[jodispamodi]

I'm sorry for your losing your patient, no matter how many you lose, its never a good feeling. Document, Document, Document. The only thing I can say is in instances where I have had a doctor not call back in a timely fashion I have called a supervisor, or if I felt their condition warranted it, a rapid response. I had a patient once that had a BP 280/120, called the doc no response, called again no response. I then called supervisor who asked hospitalist to check patient, hospitalist never came to floor and just told me to give nitro. Patients BP still did not come down, hospitalist did not answer pages, I re-called supervisor and the hospitalist told her to go assess patient. At that point I called a rapid response. Supervisor did a write up on the hospitalist.

So it sux when you see a patient is crashing and can't get the doc to respond. I don't think you could have done anything different.

[dishes, BSN, RN]

Why do bowel preps kill patients? I'm dying to know

Hypokolemia and other electrolyte imbalances can occur from bowel preps, the information is usually listed on the instructions in the package insert.