I Feel Responsible For A Patients Death

[Flashsomefang]

Just some background, I'm a new nurse, been on my own for about 1.5 months on a Med/Surg Tele Unit. I've been floated to the Covid unit several times, and this particular night one pt I had was there more for renal failure than covid but was positive. He's on RA when I arrive, satting in low-mid 90's. I bump him up at bedtime to 2L because he's desatting a little during sleep (like 88-90) but comes back up to baseline.

3am he calls out saying his sugar's low - 54 - so I go to give him a snack and juice because he's A&O and on a regular diet (no thickened liquids, etc.). First sip of juice he takes he starts coughing, continues for like 15 mins, bumped him up to 4L because he desatted a little but comes back up with the 4l.

I feel terrible after this thinking, "great, I gave this poor guy aspiration pneumonia".

After I let the doc know, he's made NPO, swallow eval, cxr, all that. I go to hang some fluids on him around 0630 and he's satting in the mid 90's again, no more cough, says he's fine.

I was off for 4 days and when I come back in see he's in the ICU now, he was transferred the morning I left because he was in resp distress. Then when I went to work last night after 2 more days found out he had died. I feel like it's all my fault he died, like I should've done more, and I set off this chain reaction all because I gave him a sip of juice. 

[TheMoonisMyLantern, ADN, LPN, RN]

28 minutes ago, Flashsomefang said:

Just some background, I'm a new nurse, been on my own for about 1.5 months on a Med/Surg Tele Unit. I've been floated to the Covid unit several times, and this particular night one pt I had was there more for renal failure than covid but was positive. He's on RA when I arrive, satting in low-mid 90's. I bump him up at bedtime to 2L because he's desatting a little during sleep (like 88-90) but comes back up to baseline. 3am he calls out saying his sugar's low - 54 - so I go to give him a snack and juice because he's A&O and on a regular diet (no thickened liquids, etc.). First sip of juice he takes he starts coughing, continues for like 15 mins, bumped him up to 4L because he desatted a little but comes back up with the 4l. I feel terrible after this thinking, "great, I gave this poor guy aspiration pneumonia". After I let the doc know, he's made NPO, swallow eval, cxr, all that. I go to hang some fluids on him around 0630 and he's satting in the mid 90's again, no more cough, says he's fine. I was off for a 4 days and when I come back in see he's in the ICU now, he was transferred the morning I left because he was in resp distress. Then when I went to work last night after 2 more days found out he had died. I feel like it's all my fault he died, like I should've done more, and I set off this chain reaction all because I gave him a sip of juice. 

 

Don't do this to your self because you're going to have a lot of patients that wind up either needing a higher level of care or wind up dying and if you take on that guilt for every episode that leads to a mountain of guilt over a career. The sip of juice didn't kill him, COVID killed him. People cough and strangle on liquids we give all the time and survive with or without aspirating, it just happens it's unavoidable. You were providing appropriate care to a patient who was unable to tolerate PO fluids, you notified the provider and they initiated appropriate orders in response. You did your job, and that is all we can do. Period. Grieve and then let this go, you can't take on the blame for every bad thing that happens.

Good luck to you.

[JKL33]

1 hour ago, Flashsomefang said:

I feel like it's all my fault he died, like I should've done more, and I set off this chain reaction all because I gave him a sip of juice. 

Do you really believe these things; do you think they are rational? Or do you feel bad that a patient of yours died even though they not appear too distressed the last time you saw them?

[Davey Do]

51 minutes ago, JKL33 said:

Do you really believe these things; do you think they are rational? 

Good question JKL!

A couple of times in my career, I believed that I could have been responsible for a patent's decomp or death.

Reality checks from competent peers, as in this case, really helps.

["nursy", RN]

A patient would have to be pretty severely compromised to be in a state where they  could potentially die from a sip  of juice.   Many things happened, many decisions were made, many orders written and carried out  between the time he had the sip of juice and then finally died, none of which you are responsible for.  

One of the things that sort of irks me (and this is a goofy personal thing)  about modern nursing is that with such a huge team approach for everything, it's sometimes hard to feel like one makes a difference.   But the good news is that with such a team approach to  everything, one can also feel less personally responsible when a patient doesn't do well (unless you really did something wrong).  

[SilverBells, BSN]

If he had no orders for thickened liquids/documented history of dysphagia, there's really no way you could have known he would have a hard time swallowing the orange juice.  Thing is, your next actions were correct in that the doctor was notified and appropriate testing was completed.  I feel like there was more that contributed to this patient's death other than he was given a glass of orange juice. 

With that said, I've had a few situations myself where I've found out a patient I thought was basically doing fine was sent to the hospital a bit later after I last saw them or even passed away.  It's hard not to feel responsible for these events or at least that you haven't done enough.  I still do, sometimes, when  I think about certain patients I've had.   Thing is, sometimes patients are just sick and you can't always prevent them from deteriorating.   It's easier, though, for someone to say that when they haven't been involved in a certain patient's care.   

Just know that you aren't the only or first one to feel this way. Hugs: ?

[JBMmom, MSN, NP]

He may have initially presented with "more" renal failure issues than COVID issues, but don't be fooled- the progression of this disease can be swift, and disheartening for family and staff. You did not kill a patient with a sip of juice. In his compromised condition he may very well have made the same progression without a sip of juice. I'm sorry that this happened, but you cannot take to heart the progression of care for every patient you have, Some will recover and some will not. You did your best to provide competent and patient focused care on your shift, your responsibility ends there. 

[Chickenlady]

Poop happens, and sometimes it happens to the nicest patients.  This is an unfortunate outcome.  You didn't cause it and you took appropriate steps to address the issues as they arose.  We don't win them all, as much as we would like to.

[SmilingBluEyes]

Don't give yourself that kind of power; you did not cause this. It was a cascade of very unfortunate events. Really look at it after some rest. Realize people do die, and sometimes, we can't stop it.

Hugs.

[TiPPs]

Do not do this to yourself. It sounds like you did your due diligence. What would have been the other option, not to feed him or give him fluids? This is going to happen many times during your career, especially if you continue to work with the sickest patients. You will burnout quickly blaming yourself for doing appropriate nursing care. Please access any resources you have to get closure and learn techniques in dealing with these scenarios. Good Luck!

https://www.thepatientpractitioner.com/

[Tweety, BSN, RN]

I agree with the above to not torture yourself.

 You did what anyone would have done, you gave a person on a regular diet with a low blood sugar something to eat and drink.  You feel bad you didn't have magical powers to know the future?

There's not one of us that hasn't been part of a bad outcome or an incident.  It comes with the territory.  

 

[0.9%NormalSarah, BSN, RN]

You did a great job with this patient. You responded when the patient called about his BG, took appropriate measures for a patient with no history of dysphasia, notified physicians of unfortunate coughing fit with the juice, and monitored appropriately and followed orders. These covid patients are often following a quick and unfortunate course of escalating care and many that reach the ICU aren’t leaving. It’s this terrible disease, certainly not one event such as this. Continue being conscientious as you are, you sound like someone who is shaping up to be a great nurse. ❤️