Worked 7a to 7:30 p in our busy PACU today. Reported off on a vascular pt who had arrived hours earlier on a phenylepherine drip from the OR in company of both the service and anesthesia. Both said they thought he just needed to wake up more and expected him to be able to be weaned off soon. I asked what the BP goal was and service hemmed and hawed, then said how about 110 systolic, and we discussed how the point was just to keep the vasculature nice and open for the first couple of days after the surgery. A few minutes later, our charge nurse looked up orders for me (they are in a separate system than the one we chart in, and we can't access the order system from the computers in our recovery bays - it sounds insane as I write it, but that's how we work). She wrote everything down (e.g. IVF orders, lab orders, etc), including an ordered MAP goal of 80-90 (that's more like it).
I wasn't able to wean him off, and he couldn't go to the floor with the drip. At 7:15, I reported off to the nurse who was taking over, we could take him to an obs unit if we could get the rate to 50 mcg/min or lower, left her my phone number to call if she had any questions. About 10:00p, I check my phone, see she had called at 8:00 (doh!) asking where the order for the phenylepherine was...Didn't even think of it. Double-doh! I think that when I got the list of orders from the charge nurse and it said MAP goal of 80-90, I translated that into a phenylepherine order in my head. But now I'm at home and I don't know for sure that there was a proper order in the orders computer, and I have no way to check (so I can sleep tonight).
On the one hand, I know there was no question that the service both knew that the neo was running and wanted it running, so getting the order in arrears would not have been a problem for the nurse who relieved me, if there was not an order in the computer. On the other hand, dang! I ran a neo drip without knowing I had an active order! How did I miss that?! I know that the way we have things set up is asking for trouble - we have some orders hand-written in the chart, and we have other orders on a computer that we can't access without going to the charge desk, and because it's so inconvenient to do that when you have a fresh post-op, our process is to have someone else look those orders up when the pt arrives and jot down any relevant orders on a sticky note for us - it's a miracle screw-ups don't happen all the time, and for all I know, they do. Still. It feels like such a rookie mistake. Last week, I mislabeled a lab specimen. I won't drag you all through that one too, but it was a similar situation where someone else was helping me and in that case, handed me a string of 8 or 9 lab labels, one of which was not for my patient, and I didn't catch it, which I should have. In the ideal nursing school world, all of this gets caught, i do all my checks every time, but there always seems to be so much chaos all around, and lately I feel like there's something stupid I do like this on every shift. Is it just a streak? If so, is it almost over? Anyone? Because I've had enough!
Thank you, kind (I hope) allnurses. I feel better already :-)
Post-script: I just called PACU to sniff out if anyone knew what the deal was, how it was resolved. I didn't do that initially because I didn't want to draw attention to my mistake, as I knew it was already being addressed. My patient was still there, no surprise to me. I asked to talk to whoever was taking care of him. She was clearly super busy and had no idea what I was talking about, so that was some relief. (No one in report told her, "You wouldn't believe what Bubblehead, RN, did!") Of note, she is the 4th RN he's had in PACU. I left at 7:30, it's now 11:15, and he's had 3 hand-offs in that time. I would ask for your prayers that there actually was a neo order in the computer, but what's done is done and no one's prayers can change it now. Maybe say a prayer that I've filled my quota of doing stupid things for this year?
