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!!
Specializes in Acute Care Cardiac, Education, Prof Practice.
Speaking of side effects, itching is a very common side effect of Dilaudid. We have issues with it all the time on our surgical floor. I would not have turned it off without an order. Blood? Yes. ABX? Possibly. However I would have questioned why he didn't give you a new type of pain medication if she was in 8/10 pain despite the Dilaudid.
He made a mistake, you didn't ask a question. The combination of the two + 3am can lead to situations like this.
The patient is fine. Bottom line.
Don't beat yourself up over it. File it away and move on.
:icon_hug: (ack my favorite supportive icon is gone! BRIAN!)
Maybe there should be a section here called "nurses confessional" where nurses can go to confess all their mistakes, bad judgement, etc. and get absolution.
FYI, Benadryl doesn't just mask the reaction, it stops it from happening or getting worse. We give prophylactic Benadryl all the time to patients who have allergies to contrast dye so that they can go to cardiac cath or CT. I also give it to my son (who is allergic to nuts) whenever he goes to a birthday party, just in case someone sneaks something in. He's very diligent about asking, but you never know.
Specializes in ED, Med-Surg, Psych, Oncology, Hospice.
Without a specific order to turn off the dilaudid I would not have turned it off, either. We have policies in place called "TO/RB" that translates telephone order READ BACK. Sounds like that is what you did and that covers you. That being said I agree when a nurse calls a doctor during the night shift she/he needs to have all their information at hand and know what it is they want done. This is a learning experience and you need to let it be that and let it go.
I don't necessarily think you did anything wrong. However, if you are having to give solu medrol for the allergic reaction it is time to get another pain med ordered. The doctor did not think the reaction was to dilauded but how can he really know. It is a guessing game at this point and the most logical answer was the dilauded. Don't beat yourself up over not stopping the dilauded without another order for pain med. You surely did not have anything else that would have relieved pain and it looks like you tried to point the dr in the right direction. You can't necessarily make what you want come out of his mouth. He is trying to make you feel bad because of his inadequate care. Chalk it up to experience, take suggestions in other posts here, and move on.
Specializes in PACU, CARDIAC ICU, TRAUMA, SICU, LTC.
Physicians can be vicious, especially when they have made an error, so they look for a scapegoat. That said, learn from this and try to move on. Be vigilant; if you don't have knowledge about a medication, ALWAYS seek info before
administering it. NEVER ASSUME anything. This was the 1st cardinal rule taught when I was in nursing school in the 70's. Get a nurse's drug handbook and keep it with you at work; it can be a lifesaver, especially if computer systems are down!
Tait, MSN, RN
2,142 Posts
Speaking of side effects, itching is a very common side effect of Dilaudid. We have issues with it all the time on our surgical floor. I would not have turned it off without an order. Blood? Yes. ABX? Possibly. However I would have questioned why he didn't give you a new type of pain medication if she was in 8/10 pain despite the Dilaudid.
He made a mistake, you didn't ask a question. The combination of the two + 3am can lead to situations like this.
The patient is fine. Bottom line.
Don't beat yourself up over it. File it away and move on.
:icon_hug: (ack my favorite supportive icon is gone! BRIAN!)
Tait