Made a mistake, help!

[Alovesmusic z]

I did not get a consent from a patient's parents for a PRN oral medication. This is my first day on the Unit. I did realize that PRN medication does not have a consent.

I administered the medication. 

I was so worried. I called the parents later and was told that medication was not allowed to use again.

I put the note on the MAR and messaged the MD.

What do I need to do next?

So anxious and worried, please help. 

[JBMmom, MSN, NP]

I'm not familiar with pediatric nursing, nor getting permission for PRN medications but it sounds like you did all that you can do after the mistake. It sounds like you know it shouldn't happen again in the future so you learned from it. Unless some harm came to the patient, I don't think you will have more trouble, although being so early in your work relationship with your management, they may have someone more closely follow you as you get acclimated. Good luck!

[Been there,done that, ASN, RN]

Here is an example of one of the biggest problems in nursing. The provider orders the medication. Now it's up to the nurse to assure it is safe and legal to administer.

[chare]

Been there,done that said:

Here is an example of one of the biggest problems in nursing. The provider orders the medication. Now it's up to the nurse to assure it is safe and legal to administer.

It's always been the nurse's responsibility to ensure the medication is "safe;" thus the 5 rights of medication administration. 

As for "legal" I'm unsure where @Alovesmusic z works and in what context administering an ordered PRN medication requires consent.  Perhaps he or she will return and amplify her or his post.

[canoehead, BSN, RN]

When I worked pediatrics, the admission consent included all the meds the doctor ordered. If the doctor ordered something the parents told them not to, thats on the physician.

[R. J]

Reminded me of when I first started.. you did nothing wrong, you used your nursing judgement to give the PRN with a one line progress note-if required (don't blab your mouth to the family --for no reason, and making them unsure about your hard earned skills---girlfriend :) ..always show confidence to family even if you are not sure and better to consult with your supervisor when in doubt. (You don't need consent for PRN oral medication, only if it is for Narcs, Psych  or  those specifically mentioned by your facility. If you are a new nurse, just observe and learn from one confident, experienced nurse- mentor in your unit.  You got this!!

[hppygr8ful, ASN, RN, EMT-I]

You will be OK. If this goes up the magement ladder (and I doubt it will) just own it. State what you learned from this mistake and move on. Fortunately this was not a critical mistake. I work with children and adolescents in the psych setting and we rourtinely consent for every PRN usually on admit when we give a call state each med Tylenol, MOM Tums and what they are for and ask if it's OK if we give those things. Record their response in the EMR and move on.  

Parents are one of the worst aspects of caring for young people.

Hppy

[adventure_rn, MSN, NP]

canoehead said:

When I worked pediatrics, the admission consent included all the meds the doctor ordered. If the doctor ordered something the parents told them not to, thats on the physician.

Yeah, I've worked in inpatient peds my whole career, and I've never heard of getting 'consent' for any routine medications (PRN or otherwise). When kids get admitted, their parents sign a blanket 'consent for treatment,' which includes most medications. In my prior hospitals, the only meds that have required explicit, opt-in consent are a) vaccines, or b) specific high-risk medications requiring consent per hospital policy (I.e. chemo); it was the responsibility of the provider to obtain consent before ordering them, not the nurse.

Granted, a lot of pediatric parents can be extremely particular and micromanage every aspect of their kid's care, and it's not unusual to have a parent get upset; however, I don't think you were in the wrong for giving the med as ordered, so long as it was for an appropriate indication. In general, if my pediatric patient needs a PRN while the family isn't present, I'm giving them the medicine they need and then telling the family the next time I communicate with them; I'm not going to delay care.  If the parents are mad that a certain med was given, that can be discussed with the team, and the providers can make a note in the chart not to order it again. If anybody is at fault, it's the provider and/or nurse who were caring for the patient at the time the med was initially ordered; ideally, the family should have been looped in at that time, and the parents could have voiced their preferences before the med was given.

[BeatsPerMinute, BSN, RN]

In summary: you were following orders. That's it. Forget the rest. Thats not on you. 

[Leader25, ASN, BSN, RN]

That is what  a hospital is for.Was there a notation on chart ,an alert about this consent business.You did the right thing,now don't take that patient anymore,because when you get one incident or event with a family ,you will have a target on your back,ignore them,get a different patient, document notes for yourself,and carry on..there is still the press ganey survey to get over,sorry  this happened to you.

[londonflo]

If you are in a "Magnet" hospital - take it to the Nursing council...otherwise take it to the MD Council...I am serious ! The MD should ask the parents for acquiesce  when writing orders. Hopefully the parents are both there,, what a nightmare if mom say yes, dad says no. What a dysfunctional system you have when a child is suffering and you can't assist with the parents obstructing. Why did they admit the child into the hospital if they think they should call the shots, ergo choose the medicines?

[lifelearningrn, BSN, RN]

What type of setting are you in?