I feel so DUMB!!

[raindrop]

I made a really dumb mistake at work, because of my ignorance!

Patient was 20, admitted 23 hour Observation for stomach pain of unknown etiology. All diagnostics were perfect, yet, her pain remained at an 8. The doc wanted her on a Dilaudid PCA. After an hour of initiating the PCA, she began to itch. Our hosp has a Dilaudid PCA protocol that says Benadryl may be given for itching. I have her the Bendaryl, and an hour later, she was still itching her face. I called the Doc at home, he ordered for me to give her another IV dose of Bendaryl now and reassess in an hour. He said he does not believe she is allergic to Dilaudid, because she has had it in the past according to her old ER records. So, I gave another Benadryl push, waited an hour, called doc again because it did not help. And, her pain was still at an 8. He then told me to give her SoluMedrol IV push now. And in 4 hours, give her another dose of Solumedrol and another dose of benadryl. So, I did. I didn't further question him, but I did repeat all of his orders back.

Annyway, she had a decent night after all of this. But come morning, she woke up and complained of itching again. Doc happened to show up at 0700 to do his rounds, and when he came out of her room, he was livid that her PCA was still on. He said "I told you to turn it OFF last night". Which he didn't! In fact, he said he did not think she was allergic to the PCA, he thought it may have been the contrast from her CT, since she's had Dilaudid in the past. I told him I don't recall him telling me to turn it off. He snapped....."A good nurse would know to do it without the order anyhow. What good is solumedrol administration if the patient is still getting the drug that they are having a reaction against" I could answer it, because I DON't KNOW. I DONT KNOW anything about SoluMedrol and allergic reactions. I don't know! Why is it OK to give Benadryl at the signs of an allergic reaction - isn't that just masking the reaction??

I try to question docs, but they get snippy. I ask for other nurses opinions, and they seem just as unsure as I am. I suck!!

[tri-rn]

You made a mistake, a doc yelled - been there, done that! All you can do now is STOP beating yourself up and resolve to learn from your mistake.

Even if an experienced nurse would have "known" to turn off the PCA, s/he couldn't do it without an order. Also, for 8/10 pain a different method of pain control would have been in order.

You should never give a drug without knowing WHY you're giving it. I'd be willing to be that if you'd looked up solu-medrol and seen something regarding allergic reactions, you would have questioned the continued use of the PCA, and in turn questioned the doc, to which he probably would have said "yeah, turn it off and give her xyz instead".

Lesson learned...chin up :)

[mustlovepoodles, RN]

Wait...you gave a very strong drug that you don't know anything about...twice? I would be more concerned about *that* than the fact that the doctor is changing his story.

[livistarr]

Agree with the above...sorry. If your giving Solumedrol and Benadryl both have it's own set of side effects you need to know. So....few lessons learned: Ask the physician to clarify, even (especially) at 2am; know why u r giving something before u give it; document those 2am phone calls verbatim. They get midnight amnesia REAL easy!!!

[netglow, ASN, RN]

So what's done is done.

Look up every detail on the two meds. Pull your pharm book and look for indication/action/pharmacokinetics. Maybe it would be wise for you to look up drugs you don't know on your facility's drug data source. If there isn't one for easy access, I'd go tomorrow and get myself an itouch and download the Davis Drug guide. You will bless the day you got it.

[proudnurseRN]

Don't be too hard on yourself. You'll soon realize that when you call a doctor in between the hours of midnight and 6am, you will usually need to tell them what you want. If you don't know what you want, then go find another nurse that can help you figure it out. I also ask at what point they want to be called back. In your situation I would have asked what they wanted to do about pain medication because it was causing the itching and it was ineffective. Then I ask them if at what point they want me to call back. "At what point do you want me to call you back if the itching does not subside or the pain isn't under control"

Now, I'm by no means an expert on this stuff and still make mistakes. In fact, the last time I called a doctor at midnight it was for a foley order on an unresposive pt (that was sent to our unit 3 hours previous, that the previous nurse let lie in his own urine... but that's another story). The I asked for an order for a Tylenol suppository for fever and something for pain should those issues arise (because they always do at 4am if I don't have an order). He ordered morphine, the moment I hung up the phone I realized the pt had an allergy to morphine. So, of course the morphine wasn't ordered, and thankfully the pt didn't appear in pain... or I would have called back at 4am.

[qt2168]

What is wrong with having the PCA and giving solumedrol? The doctor even said it could be a reaction from contrast dye? I do not see what the nurse did at all was wrong!

[sistasoul]

It is so fast paced on the floor how can one know all of the side effects of every drug that is given. It is one thing to know what the med is for but I don't know of any nurse who knows all of the side effects of every drug. Our patients would never get their meds if we were to look up every single side effect.

[diane227, LPN, RN]

I am sorry that you had such a bad experience. But the fact remains that we are responsible for knowing about the medications that we give and for knowing what to do if a patient has an allergic reaction. The doctor probably did not tell you to DC her PCA but that is not really the point. As a professional registered nurse you have the responsibility of making a decision based on your knowledge base. If you have questions, then you are to consult a more senior, experienced nurse for an opinion. Any nurse should know that if a patient is having an allergic reaction to a medication, that the medication should be stopped, especially after you have reached the point where you have to administer steroids to treat the reaction. I urge you to use this situation as a learning tool. Research your medications and ask advice of another more experienced nurse if you are not sure.

[gryphonler]

Firstly, what's done is done. We learn from our short coming.

One thing you need to know is that, doctors CAN make mistakes too. So always be on your toes, regardless of from the simplest matter to the most complex ones.

Golden rule, if you don't know what's the medication is for, check it out, regardless... whether you have the time or not.. You may not know what will happen or what to look out for if complication arises. You need to always protect yourself first on the knowledge base. Yah? Don't screw up your career just because you gave one wrong medication that could cause the life of the patient.

If others don't wanna protect themselves, so you need to do that for yourself. I've been in nursing for awhile, seen a few things happening. Always remember, to ask, no question is a silly question. That's what I tell the student nurses all the time.

So take good care, don't repeat the same mistake twice or more... good thing is that you have that conscious. You are a good nurse, keep it up. Nursing job is a 24hrs job.

[christinacannonRN]

Bless your heart...everyone has made mistakes. Def always look up your meds and know what you're giving. Also check IV compatabilities and they will begin to stick with you. The important thing is that no one was hurt and don't make the same mistake twice!

There's an old saying that "Nurses eat their young..." This is so true. Many (not all) senior nurses have become cynical/impatient and view new grads as idiots and this should not be how things are. This intimidates the new staff and lowers their confidence level, therefore creating MORE work for the seasoned nurse and the cycle continues. Everyone has been a newbie at some point, although some forget.

As far as doctors and the middle of the night...check your charts FIRST (if able..I know, I know) and if you have a PCA running with no benadryl order, post-op with no anti-pyretic, etc. go ahead and call early on. Many will be happy (and awake) to oblige and appreciate that you were proactive and called early. That way if you call them in the middle of the night it will only have to be if the shizz has hit the fan, lol!

:heartbeatRule of thumb: If there is a suspected reaction to an infusion the FIRST thing you do is stop the infusion (in most cases), no questions asked. You can always turn it back on later

Hang in there!

[christinacannonRN]

..if you waited for an order on every little thing you would never get anything done. Use your autonomy safely!