I can't believe this! Help again Cardiac Nurses!

[RN75]

-A patient comes in to ER for passing out

-has a heart cath

- admitted to cardiac floor and scheduled for CABG

all within 3 days.

MAR says give Plavix 75 mg. Patient says "I never took that before." I say, "you don't have to, let me find out more about it." I take unopened pill with me to verify. I go to get the chart to find order. (earlier I reviewed preop order and notice Plavix is not checked to stop by CV Surgeon). Can't find the chart now, so look in the computer med cart to see when last dose was given. Last dose verified in computer med cart documented as taken out and given to patient the day before. I go back to patients room and tell him he took Plavix yesterday and instruct medication rationale, also informing he does NOT have to take it. He agrees to take it.

Problem:

Nurse Manager says MD never ordered Plavix! Says I am the first one to give it. No one else did. Says Pharmacist made error. She denies previous dose given though I tell her I saw it pulled from computer med cart with my own eyes. I also see it on the previous MAR. She also says the night nurse failed to reconcile the MAR with the orders the night before and insists I am the only one who gave it.

Now, Nurse Manager says I am not a prudent, good nurse because a prudent nurse would have checked the order to see if MD wrote the order. Says because I didn't do that I am being terminated and not eligible for rehire. Says I could have killed this patient by giving him Plavix 75 mg.

Question:

Don't heart patients scheduled for CABG get Plavix? Would Plavix 75 mg kill or harm this patient? Somehow, it seems reasonable to me based on the fact Plavix is an anti-coagulant, clot buster, which inhibits platelets so they do not form clots, would help this patient. Somehow, I get the feeling the MD DID order this med and forgot to stop it preoperatively. So in order to cover his azz, they claim he never ordered it in the first place!

Come on folks, was terminating me for this justified? I am new and orienting in this hospital and the first med error made. I have been a RN 12 years and have NEVER been treated so punitively for one med error! There's gotta be someone here whose a manager, an expert in cardiology, that can help me out here.

I told her Im a good nurse and refuse to let her decision make me feel bad. Ironically, the surgeon had to go back in and reopen this patient finding other occlusions that were not picked up earlier. Something sounds fishy to me. Just seems a bit HARSH to fire me over something like this. She says "I dont get it," yeah, she's right! I don't get her way of thinking! Needless to say, I already had my letter of resignation with me and told her, I am a good nurse! That's just your opinion! And the only opinion that matters is mine, Gods who called and gifted me into nursing, my patients over 12 years, and previous managers Ive never had problems with!

[CHATSDALE]

usually any anticoag is not given preop if there is a choice..some patients will take an asa when they start hurting because that is what is recommended as an emergency measure but you would not want to have a bleeder on the table

check out a md order esp if a patient questions you about, usually it is unfamiliar because med may be made another company in a different shape or color

what is done is done..learn and move on

[YellowFinchFan]

How do med orders go in at that hospital? Are they written orders from MD or are they direct input via computer (by MD) ....

With a CABG scheduled I wouldn't do any guessing - I would call the MD - he may be rude, cranky whatever - but the fact that the patient said he didn't take that drug - and you couldn't find the chart - and it's a CABG - I would've called.

I do believe they are being incredibly harsh to you though

Good Luck

[linzz]

I don't have anywhere near 12 years experience but it sure seems very harsh to to this to you. I doubt that this was solely your fault, the whole system seems confusing to me. Hope that this all works out for you.

[glasgow3]

In general, plavix should be held 5 days before surgery. It probably would have been best if you had followed through your own investigation completely and verified the original order and/or called the surgeon.

But that said, something really stinks here. The above 5 day rule is necessary because these patients have been on those drugs for a period of time. A single, random Plavix was not going to kill anyone or even delay surgery. My point here is when managers start this exaggerated "you could have killed someone" BS in situations such as this, they often have an hidden agenda......that could be to placate an irate/influential surgeon at your expense, to serve as the reason to terminate you when they've been wanting to all along for other reasons, to cover-up a known system problem that they had responsibility to address but didn't etc. This so-called manager's solution has the effect of staff hiding future errors for fear of termination; competent leadership would therefore reject such an approach. She is the one who "doesn't get it."

Did the pharmacist get terminated for entering an order into the system which the manager now says did not exist in the first place?

How was it possible for you to pull an unordered medication from a computer med cart? Was the person(s) who approved this system which allowed this error to occur also terminated?

Was the person who was to check the medication administration record against the original order also terminated?

You know what you saw. Perhaps you made an error in judgment, but your manager is unenlightened at best and most likely patently unfair and a liar to boot.

Damn I hate hospital nursing these days.

[SCRN1]

Patient's are put on Plavix after having a heart cath with stents being placed. But, they should not take it within 5-7 days before having a CABG. If they are already on it, our patients usually remain in the hospital until they have been off of it for that long...called a Plavix washing. With this patient taking it, it cost them an extra day in the hospital. On our PCU floor, that's at least $5,000.00 per day. If the insurance company refuses to pay for that day because of a med error, then the hospital may have to eat that cost and may be a big reason you are being fired. I'm so sorry to hear this has happened to you. I agree with the other poster...I would've called the doctor too to verify that the Plavix was ordered. Even if it was, it's still the nurse's responsibility if they give something ordered when they know it's not safe. I think you have learned a valuable lesson with this and wish you luck.

[nl2005]

if this is your first med error they should not fire you!! that is crazy! i would call the union rep asap!-lisa