I Made an Absolute 'No-No" Mistake :(

brownbook · May 14, 2016

First I read on All-nurses about a nurse taken off the schedule and awaiting the results of a urine drug screen because she accidentally threw away an half used ampule of a narcotic without anyone seeing it get wasted?

Now I read about a nurse getting fired because she gave benadryl without a Dr. order.

I would never enter the nursing profession after reading these posts!

If I were the nursing director or doctor in charge of the "horrible" benadryl sentinel event, and if the nurse had a three year exceptional record, was being considered for unit manager. I would have said something like...you know what you did wrong, why you shouldn't have done it, don't let it happen again. Now get back to work, your patients (and I) need you!

allnurses Guide · May 14, 2016

That must have been a terrible shift to have compelled you to do that. I hurt for you because I know I have been in the position of being berated constantly by patients. After awhile, you do feel like you are going to lose your mind. You will want to do anything just to get them to shut up!

May I ask how they found out you gave the patient Benadryl without an order? Did you try to get an order afterward to get the doc to cover?

It sounds like you snapped and threw your give-a-damns to the wind.

At least you're not trying to justify it with a million excuses... and I sure as hell hope we don't get a bunch of holier-than-thous coming on here and beating you up... you've been punished enough.

marie.rn2419, RN · May 14, 2016

I second what hygienequeen saysâ€¦ I'm sorry you're dealing with this situation.

Just be careful of any information you're posting online regarding this. Your DON doesn't really have a say in what the Board of Nursing does. Do you have malpractice insurance you can use? Oftentimes, they will represent you if you respond to the Board for a practice or medication error. I know that my policy provides me with representation if I had a situation come up.

jadelpn, LPN, EMT-B · May 15, 2016

First I read on All-nurses about a nurse taken off the schedule and awaiting the results of a urine drug screen because she accidentally threw away an half used ampule of a narcotic without anyone seeing it get wasted?
Now I read about a nurse getting fired because she gave benadryl without a Dr. order.
I would never enter the nursing profession after reading these posts!
If I were the nursing director or doctor in charge of the "horrible" benadryl sentinel event, and if the nurse had a three year exceptional record, was being considered for unit manager. I would have said something like...you know what you did wrong, why you shouldn't have done it, don't let it happen again. Now get back to work, your patients (and I) need you!

And there have been many a nurse who just wouldn't have said a thing about it. Especially if it comes from a community large bottle like some Tylenol or ibuprofen does. But if you took it from another resident's container, your purse, whatever--then that gets sticky. Especially the taking it from another resident scenario--that's a huge no-no in LTC. Especially if Medicare is involved, as that pill is billed to that resident's Medicare. And that could get you in the most trouble of all of this.

There are many general order sets that have OTC meds as a nurse's discretion for a PRN, that doctors check off and sign. For every resident. Which includes everything from tums to benedryl. Should you have done this without an order?--absolutely not. But you know that, and owned up to that.

The only thing you can do is to explain what you have learned about it. In that you will not longer medicate residents without an order or their own supply (unless community bottle).

Benedryl may seem benign, however, can have a paradoxal effect (especially in the elderly) and can be like Sudafed...a semi controlled substance. Would be the same if the CNA's ask for it, or you take one....seems as if LTC is cracking down on that.

All easy for me to be arm chair quarterback when a nurse in LTC has sometimes 50-60+ residents to medicate a shift.

Wishing you nothing but the best in the future. And perhaps something like home health could be a good move for you should acute care not be your thing.

Marisette, BSN, RN · May 15, 2016

Hi Everyone... I have been a nurse with an exceptional record for three years. I was in the process of being hired on as a unit manager in the next few days......and then....I lost my brain in the middle of an absolute hellish shift. One of my patients exhausted all of her available meds that I could give her and I listened to her beg for hours after all trying all available nursing interventions. I had the brilliant idea to give her Benadryl without calling the doctor. I know better than this. I don't even know how to explain or even justify what I could possibly have been thinking. I have never been afraid to fight for orders before. I have no one to blame but myself. I have been surfing the web all day trying to see if there was hope at the end of this tunnel......I lost my job today and I waiting to hear from the board in a month or so. My DON says that I wont lose my license but will have a letter of admonition on my record forever for this mistake. They say that life is all about learning lessons but...... I don't want to do LTC nursing ever again. It is horribly stressful. Im going to pick myself and be dang sure I NEVER make this mistake again. any ideas???

Too bad you had to fight for orders. Perhaps the reason you gave the benadryl? I can't justify your actions, but I question why some providers don't get admonition on their records for failing to respond to calls.

tyvin, BSN, RN · May 15, 2016

Are there any standing orders for benadryl...just a thought. A LTC I worked in had standing orders for everything. Seriously though, you must work for some hard people. If that was your first med error, than getting fired is dumb (I'm calling it a med error, what are they calling it?). Sorry :angrybird10: :banhappy:

jdub6 · May 15, 2016

This makes me wonder if you have seen other nurses do this with otc stock meds...I know in my ltc I was told by pts and staff that at least one nurse regularly gave one pt tums out of the unit stock though he didn't have an order. I could give several other examples from ltc as well (some very small like using moisturizer without an order). I doesn't make it right- but i understand how you could start to think of it as an option if it was a bad shift and you have seen others do the same.

I am curious why you didn't call the doc- in just about every setting except acute care I have seen many who are downright nasty if "bothered"-I have seen them slander nurses to their colleagues, flat out refuse to address the situation and tell nurses "don't call me again, just write what you need and I'll sign it" etc. If that is the case in this situation than I do hope you make someone aware of the doctors actions. Not to make excuses for yourself so much as to stop it from happening to others.

In terms of the public reprimand- you will likely find employers who will refuse to hire you when they find out. You WILL find a job eventually- you may need to settle for something less than ideal until you have built up your reputation again. (Agree though that the DON has no business telling you what the board "will' do. Be prepared for anything. )

Good luck to you.

kbrn2002, ADN, RN · May 15, 2016

Sorry this happened to you. The reaction of the DON seems rather extreme to me. But then my facility allows for use of many OTC meds including benadryl under our house orders.

nursejoy1, ASN, RN · May 15, 2016

In one of my LTC facilities, we do have standing orders, but not for Benadryl. The other, we need an order even for O2 (which I feel is nuts). I am so sorry this happened to you and feel you are doing what a great nurses does, take responsibility for your actions. Personally, I don't feel you should lose your job over this. But likely, instead of a med error, they are calling this practicing medicine without a license. That seems overboard to me, but I bet that is why you lost your job. Best of luck to you in the future and again, kudos to you for taking full responsibility. That is rare these days.

Dikid · May 15, 2016

This is tough. Yes you did the wrong thing but you didn't come hear to hear that.

The first step is admitting you were wrong, you did just that.

Now it's time to say, you are human, you erred, this one error is not going to ruin your life.

Rhere are many other jobs out there. And people do understand that a bad stressful shift can cause you to do things you wouldn't

((Hugs))

CapeCodMermaid, RN · May 15, 2016

We have many standing orders but Benadryl is not on the list. It's on the Beer's list and isn't a good drug to use in the elderly. I've had nurses medicate residents without orders then call the MD and get an order. If it's reasonable...TUMS or Maalox or something, usually the doc will say write the TO.

I did have to sit with a nurse once during state survey because she had started oxygen on a resident without an order. The surveyor was really trying to make an issue of this. Of course we started oxygen. The resident was having chest pain, shortness of breath, and sats in the low 80s. We explained all that to the surveyor and told her the MD had been told we started the oxygen and it was just an oversight that we didn't write the TO. And we explained that the resident was fine. Didn't get sited.

Good luck with this.

nightnurse110 · May 16, 2016

I had a colleague get fired from ltc for giving an aspirin without an order when a patient was having chest pain. As far as I am concerned she did the right thing. Preciously what the paramedics do when they arrive and what one might do at home. Perhaps we should look at circumstances surrounding such events and the need for standing orders and use of nursing judgement in such situations instead of a rule is a rule is a ruke