Lesson Learned!!!!!

[procrastinator911, BSN, RN]

Hello All,

I graduate soon, May to be exact...excited.

As a student nurse on my clinical floor I usually constantly ask my nurse or clinical instructor if I'm doing something right (not necessarily a lack of confidence, i would just rather be safe than sorry). Old saying: don't believe everything you hear and half of what you see. As nurses/student nurses you are responsible for everything and anything, always verify and document.

Scenario: At clinical the other day on a cardiac floor. I was listening to report from the night nurse to my nurse on my 2 patients. My one patient was going down to the cath lab for a procedure sometime later in the day and was NPO from the previous night. Night nurse stated patient is NPO but only takes meds with applesauce.

I thought nothing of it, apparently neither did my nurse (relatively new, 7 months). 9 o'clock rolls around and I'm going through meds. I decided to look up the NPO order on the computer and it says NPO only sips of fluid/water with meds. So i ask my nurse if I am to give her meds with applesauce and she says yes she only tolerates meds with applesauce. So i let my instructor know what the nurse stated b/c she questioned the NPO with applesauce.

So I'm in my patients room with my instructor giving the meds with applesauce (small amounts) . Patient says she may need a sip of water after to help them go down. OK? So as my patient is taking her last pill WITH APPLESAUCE AND THEN A SIP OF WATER, just as luck would have it 3 doctors walk in followed by my nurse. One immediately questions me and asks "what's going on, applesauce and water? she's NPO for surgery." So I explained that was the order passed down from the previous nurse. Thank god my instructor was there to jump in, b/c this Doc was getting pretty hostile. My instructor told him I was a student and that the order was confirmed and verified by my nurse. Keep in mind my nurse was in there the whole time. It wasn't until the Doctor asked who my nurse was did she actually say anything.

The doc asked the nurse if she verified this with cardiology, she said no. Moments later she called cardiology to let them know, they said it was fine.

Lesson learned: always verify regardless of what another nurse or anyone tells you. CYA. And thoroughly assess ur patients, the whole applesauce thing was actually just a preference for my nice but demanding patient.

Just thought I would share my experience :-)

[roser13, ASN, RN]

I'm not sure how any nurse, let alone multiple nurses (the one who gave the report, the nurse you were working with, and your instructor) believes that applesauce or any other food product is allowed under an NPO status. The whole scenario baffles me. As a pre-op nurse who struggles daily to educate patients regarding the absolute requirement of NOTHING by mouth except sips for required meds, I would like to think that other medical professionals "get it."

[Tait, MSN, RN]

NPO for patients who have swallowing issues can be tricky. A lot of the time I will look at what they are taking and then clarify which meds can be safely held until post procedure, or which ones can be changed to a one time IV push or something like that (Lopressor for example, or Lasix). It is quite odd that three nurses didn't catch something like that before it happened. But yep, you learned! Great job picking out the lesson from that one! It will help you in your practice and will save you a butt chewing in the future!

[Morainey, BSN, RN]

Hm. You could also clarify with the MD which meds they want held if they are NPO - sometimes they will say only give cardiac meds and hold the Colace, Prilosec, etc. That way it's a lot less applesauce and sips of water.

[BSNbeauty, BSN, RN]

Roser- I agree that more clarification should have been made, however this is not something that is black or white. There are some meds that must be given before going to cath lab. I've had many patients in CVICU that were pre-cath patients and some of them had to take their medicine in applesauce and the doctor was OK with that. It has nothing to do with "getting it" but everything to do with how to safely administer medication without having any surgery complications.

[roser13, ASN, RN]

"And thoroughly assess ur patients, the whole applesauce thing was actually just a preference for my nice but demanding patient."

This was not a swallowing deficit issue. It was a patient preference issue. "Getting it" was in reference to at least 3 nurses bypassing potential patient safety issues (namely risk of aspiration) in order to humor a patient. At the very minimum, one of those nurses should have called cardiology prior to allowing the applesauce.

[procrastinator911, BSN, RN]

I am just glad that situation didn't turn into something worse...every mistake serves as an opportunity to learn and do better

[sharpeimom]

Just as a helpful hint, I do have some swallowing issues. When I'm NPO except for water for my meds, it helps if I take a sip of water before taking any pills. Not a big gulp, just a dainty sip. It makes all the difference in whether or not my BP med goes down or gets stuck. I actually swallow much less liquid too.

[Guest343211]

Just check with whoever is on covering the interventionalist for that day. I mean was the patient going to be intubated or have a high probability of intubation? Cardiology inteventionalist may well want a patient to take a particular med, or sometimes they just say hold it. It depends on what they are doing and what the med/s is/are.

I check with the the person doing the procedure, or someone working on their service. Then I write the order verbatim on the chart. A tiny bit of applesauce probably wouldn't have been a problem; but what if . . .You just learn to cover your butt over everything in this field.

[amygarside]

That is indeed a lesson learned.

[serenity1]

I learned a long time ago not to take another person's word for anything--nurse, cna, dr., etc. I always do my own thorough assessment and check the chart, hanging IV's, equipment in the room, etc. I was burned at the beginning and it taught me a valuable lesson as well. I am happy this was not anything serious for you.

[nurse42long, RN]

I think this could be the future considering all the fuss about Press-Gainey scores. The patient "prefers" applesauce with her meds even though is NPO. Nurses who know better let the patient have her way. Easier to go along to get along. I was taught back in the dark ages that NPO meant NPO. Checking if any of the meds were actually necessary prior to surgery, if so, you get a sip of water. I'll be happy to explain and teach why but patients can't always have what they prefer. Or you may not get your procedure today.