I work at an assisted living
Theres a Pt that wonders all day
She uses a walker and doesnt have the steadiest gate
The other day she complained of chest pains
I went and talked to her although she doesnt speak very good English
I then went into the med room to look at her MAR and saw that she has an order for PRN nitro
I charted that I gave the nitro
totally regret this
Then I second guessed my decision
Considering I cannot completely communicate with this Pt I thought I would wait till the other nurse came for shift change
Of course my shift was just about over
The other nurse came to the med room
We started talking and we hear a loud bang on the door
The pt fell and hit her head on the med room door
We had to send her out
Her BP was crazy low and she was completely out of it
I was able to reset my computer charting but I had also logged that I gave her the nitro in the 24 hour book
I crossed it out
Im completely freaking out
I feel like this is all my fault
This was on Thursday and I go back to work on Tuesday
Do you think Im going to get in trouble
I would think my supervisor would have reached out by now
I had to remove all punctuation otherwise it wouldnt let me post
So did you give the nitro or not?
First off breathe!!!! I had some trouble understanding what happen. You went to give the nitro, but than decided not to? Than the pt fell? Sadly people fall in the line of work. We cant always prevent it.
I decided not to give the nitro because I wanted to ask the other nurse what she thought. The pt doesn't speak very good English. So I was thinking she could have heart burn.
I just feel like my supervisor is going to say that I shouldn't have left the pt considering she was complaining of chest pain
I know my original post is difficult to read. It wouldn't let me post it without removing all the punctuation
Always lessons learned in failure. I'm sure you will be fine.
Aw jeez, I feel for you Jen and Larry. Whenever anything happens to me like this, I would beat myself up saying "You shoulda..."
Thank goodness I've got a level-headed wife who's a nurse and some good co-workers who give me reality checks. Otherwise I would do a lot of self-flagellation before getting a grip on it.
We can't be everywhere at anytime or control everything. We only have so much control over situations...
Good luck and the best to you Jen and Larry!
These situations are so incredibly difficult for nurses to process. So many of us personalize and go with what we didn't do right. Yes your manager could talk to you about leaving your patient who was complaining of chest pain, yes you shouldn't have charted ahead of time.... but accidents and falls happen. We learn. We are human. You fixed your charting to reflect accuracy in the medication administration. You sought guidance when you just weren't sure. Take a deep breath. You too are human.
It's okay. You are human. All of us nurses learn from mistakes at some point in our careers. Some of us go home and stay up all night worrying about the consequences of our mistakes and how we can improve next time. This will pass.
Always check vital signs with a chest pain complaint and ask the patient to show you the area where it hurts. Sometimes they will point to an area that isn't the chest and it ends up being a digestive issue. But it's good that you didn't give her the nitro if her blood pressure was low. I'm sure you know all this. I'm just rambling.
My thoughts are with you. You are gonna be okay.
One of the biggest take aways from this incident should be to never chart that you gave a med if you didn't actually give it. From an outsiders perspective (I'm not accusing you of this), but it may seem in this incident that you're trying to cover something up.
It's not uncommon for places where medication administration isn't charted at the bedside, where your choices are to chart it before you go in the room or after you leave the room, to have a policy where you chart the med before you go into the room, so charting it before you gave it is not necessarily concerning.
I've never come across a policy or expectation that you can never leave the room of a patient with chest pain/discomfort, as a blanket rule that seems pretty silly.
In the end, the patient fell due to gravity, not you, nurses can juggle an amazing amount of things, but altering the basic laws of physics isn't one of them.
Honestly I would be much more concerned that your facility doesn't have a good way to properly assess a patient with chest pain if there is a language barrier (or that you didn't use it if it exists). In the end, this patient had chest pain, hypotension, possible/probable syncope, head trauma, and altered mental status either preceding or following the syncope and head trauma. Since you didn't give the nitro none of those things were caused by nitro. But you do have a patient with potentially major problems.
This patient needs a plan of care that accommodates the language issue so that proper care can be given.
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