IV INFUSIONS

[dmrodri]

I work in a headache clinic. When i joined a year ago they had lost their md, nurse, and one of the ma's. I basically had to train myself. I came from a very busy er. I have had many concerns since starting my position. My job title is nurse educator even though i do nothing besides triage and the occasional iv treatment. I currently work under 2 np's and 1 md (who comes on wednesday from another clinic to oversee the np's). When i started they were not doing iv treatments. I was asked if i was comfortable doing iv treatments (we give ns, toradol, zofran, compazine, benadryl, iv tylenol, and decadron). I said yes. But after seeing some of the patients they were bringing in (pt who has extensive cardiac hx or new type of headache with stroke sypmtoms) and no code cart in the building (building is separate from the hospital) i started to voice my unease. My supervisor basically told us that i needed to do more treatments to get comfortable doing them and that i was paranoid from my er experience. Well today they brought in a patient who i was in the middle of giving an iv treatment to (with medications she has never gotten) when both of my providers left. I called my supervisor and he stated because we had mds in the building (mds that do not cover my providers) it was fine. Am i the only one who finds something wrong with this? I don't know if i am being paranoid, but if they are going to say i can do iv treatments without a provider being there then i can do it on days they are on vacation. It just seems wrong. I would love any advise.

[LessValuableNinja]

Run.

Quickly.

Dust off resume.

It would be one thing if you were in the hospital building, can call a code, etc. You may as well be in a shack on a frozen lake. No one is coming from the hospital to help you if something goes wrong.

To say that they are making "bad decisions" is a euphemism.

You are NOT paranoid.

[IVRUS, BSN, RN]

I truly believe that you want to have in place a crash cart, at the very least given the acuity that you are seeing in some of your patients.

If you are there providing first dosing, much less subsequent dosing, and have no way of giving medications like Benadryl or Epi should an allergic reaction occur, then I would fear for my patient's safety and my license as a provider.

Now, if they provide you a cart which includes rescessitation equipment, then I would feel better, but make sure that THEY have all of the protocols in writing. You want to be able to say that you followed your employers policy for emergency treatment, even if that policy simply meant calling 911. In home infusion, we give many of these medications and more and there is no MD/NP or prescribing doctor in house, but everyone is a call away in case of an emergency. However, I would want firm policies including step by step on each drug to be administered, contraindications for each drug, and what my employer wants ME to do in case of an adverse reaction. Without a policy in place for a specific medication, I wouldn't give it until one was in place.

[dmrodri]

I tried to bring these concerns up and was told that because we are a clinic we do not need policies. My supervisor told me that I could make whatever policy I wanted and it would get signed, but one of the providers dosent trust me (I have given her no reason not to) with protocols. I'm currently 20 weeks pregnant and don't plan on coming back after my maternity leave. I asked for a code cart multiple time (I am acls and pals certified) and was told there is no need to have one. We don't even have Epi in our clinic. I have so far had 1 patient almost pass out on me from inserting an iv (I was told to try agian anyways) and one patient had what looked like phlebitis (was told to keep the infusion going but I refused to do it). I just feel like things are unsafe and I'm unsure how to go about talking to the right people to make policies etc. the reason I want a provider here is because there are no protocols. I would be up a creek if something happend. Our clinic dosent have over head paging, so it would be hard to get help. Ugh.

[IVRUS, BSN, RN]

Every clinic, every facility, every hospital which serves patients must have policies and procedures in place, if for no other reason, liability issues, not to mention if the place receives any type of government funding... If they won't help or attempt to see things they way they need to be then, I agree with nicktexas... get out.

[klone, MSN, RN]

I work in a clinic which does infusion (my particular clinic does not, but the adult medicine clinic does). We do not have a code cart. Because it's outside the hospital, if there is a COR, we call 911 and perform BLS until paramedics arrive.

That said, there is always a physician around SOMEWHERE.

[IVRUS, BSN, RN]

But klone, Do you have policies and procedures in place for the medication administration, and do you have emergency protocals in place?

[xoemmylouox, ASN, RN]

I am amazed that there are healthcare clinics that do not have crash carts. You don't have to have the "full cart" per say, but should at least have epi, an AED, and oxygen on hand. Scary.

[klone, MSN, RN]

Yes to pixies for emergencies. Absolutely.

And yes, we DO have oxygen and an AED. That's not a crash cart, though. A crash cart is for ACLS. We provide BLS, which includes an AED.

And every department is stocked with an emergency kit which includes epinephrine, diphenhydramine and glucagon.

[dmrodri]

We have an aed, oxygen, and an emergency bag (which contains no meds). I am acls and pals certified, from my previous jobs. We just have no policies or procedures in place. Also the other mds will not cover our patient if something were to happen if something were to go wrong and I had no provider in the office.