I heard a very disturbing story tonight and thought you guys would have some input on the idea....
My mom works at a local hospital here in my area......anyway...she said that there was an agency nurse on her floor the other night (i only say agency just to point out that she wasn't familiar with this nurse since she was a temp)....well anyway..
the charge nurse went into the med room and found this nurse searching for something...she said that she had numerous med drawers out and syringes all over...sooo she asked her what she was looking for...well...and this is the scary part...
she says "im looking for a 130ml syringe so that i can give insulin to my patient".... well the charge nurse knew immediately that something was wrong...seeing as though 130 ml of insulin is enough to kill someone...but before passing judgement the charge nurse asked her, well is this a brittle diabetic? or is the patient really heavy? the agency nurse answered "no" to both...
come to find out, the nurse from the previous shift took the order off wrong and instead of 3 ml she had written 130 ml....HUGE DIFFERENCE...ok. so not the agency nurses fault technically...BUT...she didn't check her MAR with the DRs orders and the charge nurse confronted her about it and asked her why she did not check before administering meds...the agency nurse's response was "well its not my fault, i didnt write it, why should i have to check it"....
so i have a few questions....
1. is there even a syringe that holds 130ml??? i mean one that you would commonly use to admin meds?
2. Im just a nursing student, but ive always been taught that the first thing you do before admin. meds is check the MAR with the dr.s orders...or is this not common practice?
3. the agency nurse was a seasoned nurse...she is in her mid 50s and has been practicing since her early 20's (no breaks)...or so she said...why didnt that automatically send up a red flag??
4. I was under the impression that insulin needles were usually only 1ml...would there ever be an incident that you would give such a large dose?
5. to me this seems like such an odd mistake....dont you think that a nurse practicing for that long would have caught a mistake like that? I mean 3ml and 130 ml is a HUGE diff...if the charge nurse wouldnt have caught her then the pt would have been dead...although i cant imagine trying to get a 130 cc out of those little insulin vials.....wouldnt it take like a ton of vials to even make 130 cc? it just seems like such an obvious mistake..maybe im missing something? confused... :uhoh21:
Could it have been 13units? 13 is a really odd number, but there have been problems in the past with using u for units instead of writing the word out. If written sloppily, the u could end up looking like a 0. I always write out units to avoid that problem and the doctors are supposed to, also - not like they actually do, though!!
She HAD to have been simply looking for a larger insulin syringe. I don't think insulin syringes come any bigger than 100 units, though. On the rare occasions I have to give a big dose like that, I will draw up 100, transfer to a 3cc syringe, then draw up 30units and transfer that. Then use a the needle off a TB syringe since the insulin syringes we use do not have removable needles. There's just NO WAY anybody who went to nursing school would ever think about giving someone 130mls of insulin, let alone someone who has been a nurse for any length of time.
That's usually what we do...and I think you are right..I don't think they make an insulin syringe bigger than 100 units, they do make them smaller, depending on the company..I know BD makes 4 or 5 different sizes..some with even 0.5 unit marks on it for those who have to administer in .5 increments...but I think 100u is the biggest one
well im not so sure...bc i know the charge nurse questioned this nurse pretty intensely...i mean the charge nurse and my mom discussed how if the agency nurse were to have given the dose that the patient would definetly died...that and i know my mom questioned the charge nurse about sanctions...and if she should be reported to the board...i will find out tomm exactly what was marked and what was supp to be marked...
i dunno..i practice and practice those dosage calcs..im so paranoid about making a med error...its just so scary to think that one little math error could kill someone...yikes...do you guys still worry about making a med error or do you just get so good at it that it is second nature?
Just my opinion... even though it wasn't asked...
If it was as we suspect... 130 units... and she was looking for a larger syringe... I don't think that she should be reported to the BON. I think that maybe some more education is in order if the dose was WAY off and she didn't even want to question it... but do I think she should be reported? Probably not. That's pretty harsh, don't you think? 130 units, from what it seems, is within the realm of possibility for some patients.
I think that agency nurse get the short end of the stick a lot of the time, honestly. Sad but true! Maybe some encouragement and education would be better... for example: "You know, at this hospital, its ok to question orders... and our docs very rarely order this large of an insulin dose for our patients. Let's review the insulin policy at our hospital. Let's review the amount of insulin that is on the sliding scales used at our facility. Let's review..."
BTW... you should always be worried about med errors. When you become "relaxed" and it becomes "second nature" is when mistakes become easier to make... and, you're less likely to catch yourself. You should always be constantly questioning yourself when you're administering meds. The five rights plus the two "new" ones:
come to find out, the nurse from the previous shift took the order off wrong and instead of 3 ml she had written 130 ml....HUGE DIFFERENCE...ok. so not the agency nurses fault technically...BUT...she didn't check her MAR with the DRs orders and the charge nurse confronted her about it and asked her why she did not check before administering meds...the agency nurse's response was "well its not my fault, i didnt write it, why should i have to check it"....
2. Im just a nursing student, but ive always been taught that the first thing you do before admin. meds is check the MAR with the dr.s orders...or is this not common practice?
If I were to speculate I'd think the nurse was in a panic (overwhelmed) by her patient load in a new setting or something like that. the largest syring I've seen is one of those peg tube 60 CC syringes, so imagine this nurse attempting to draw 2 syringes full of insulin. I have to believe she would have realized her erred thinking when she was on her 7th vial of insulin to get the 130 cc as the MAR read.
And a good little lesson to learn here is that when another nurse or pharmacy tech or unit receptionist incorrectly transcribes a med and u administer said med, and something real bad happens, plan on appearing before the BON and in a court for a civil or even criminal case as the defendant. As a nurse you are 100% accountable for you reactions regardless of what anyone else says, or does.
I had to give 60 units the other day, and you can bet your sweet bippy I checked the doctors order, checked with the patient to ask if this was a home dose (he was obese and alert). His capillary glucose was 260, so I gave it. But I never would give 130 units without calling the doc. I would risk getting screamed at, because that is too much to blindly give. Insulin syringes only go up to 100 units. EVERYONE knows this. (Or at least most med-surg and critical care nurses do). I would have went to BON website to make sure she had a license. :stone
But no, I don't check the doc orders with all meds I pass. I wish I could.
I had to give 60 units the other day, and you can bet your sweet bippy I checked the doctors order, checked with the patient to ask if this was a home dose (he was obese and alert). His capillary glucose was 260, so I gave it. But I never would give 130 units without calling the doc. I would risk getting screamed at, because that is too much to blindly give. Insulin syringes only go up to 100 units. EVERYONE knows this. (Or at least most med-surg and critical care nurses do). I would have went to BON website to make sure she had a license. :stone
But no, I don't check the doc orders with all meds I pass. I wish I could.
at the beginning of your shift do you check the MAR and DR's order, i mean we werent taught to check every time we give a med but our profs say at the beg of your shift before the first time you give the meds you should compare the two...that is unless you are the one who took the order off then you would know it was right...at my moms hospital the unit coordinators dont take the orders off anymore, the nurses do.
i will call my mom and ask her what she said...i think that she works again tonight so she will prob know the outcome of the situation as well....
jeepgirl-i knew that there was 1 "new right"-right documentation, but i hadnt heard of the 7th one-right reason...thats interesting...im going to go add that to my list:):)
oh one question...a little off topic...but i noticed last night that when we were discussing insulin that the ads at the bottom of the page were all about insulin and diabetes...how do they do that???
to me this seems like such an odd mistake....dont you think that a nurse practicing for that long would have caught a mistake like that? I mean 3ml and 130 ml is a HUGE diff...if the charge nurse wouldnt have caught her then the pt would have been dead..
Regardless of the mistake of the previous nurse, there is one huge bottomline here. Part of your responsibility as a nurse is to be aware of the guidelines for administering a medication. If I had come across an order to administer insulin and I never administered it before, my first responsibilty is to consult a drug book for guidelines or at least a coworker. If she was aware of the guidelines for administering, she would know that insulin is written in units and a syringe that measures units would be necesssary. She is actually in my view more accountable. The first nurse made a mistake in transcription, however the second nurse made a mistake in nursing practice. She clearly was going to administer a med without knowledge of administration guidelines. That is a huge problem. Secondly, to place blame on the first nurse demonstrates a lack of accountability for her own practice. A second big problem. However, I find it very difficult to beleive that a nurse with her years of experience had never encountered insulin before. I have to wonder if there is a bigger problem with her. I would strongly suggest that the manger report her to the agency that hired her and request they she no longer be accept assignments at that institution. As a manager, I would not allow her back to practice on my nursing floor.
ok, so i just talked to my mom and here is what happened....
the order was originally supposed to be written for 13 units...so it must have looked like 130 with no measurement after it...
BUT...when the charge nurse found the agency nurse looking for a syringe the agency nurse cleary said, "i am looking for a 130 ml syringe"...which what really confused the charge nurse, seeing as though insulin is measured in units...that is when the charge nurse questioned her on how long she had been a nurse and why she didnt check the order with the MAR.
I guess i'm more disapointed that her attitude was that it wasnt her fault bc she wasnt the one who took off the order...sigh...
at the beginning of your shift do you check the MAR and DR's order, i mean we werent taught to check every time we give a med but our profs say at the beg of your shift before the first time you give the meds you should compare the two...that is unless you are the one who took the order off then you would know it was right...at my moms hospital the unit coordinators dont take the orders off anymore, the nurses do.
i will call my mom and ask her what she said...i think that she works again tonight so she will prob know the outcome of the situation as well....
jeepgirl-i knew that there was 1 "new right"-right documentation, but i hadnt heard of the 7th one-right reason...thats interesting...im going to go add that to my list:):)
oh one question...a little off topic...but i noticed last night that when we were discussing insulin that the ads at the bottom of the page were all about insulin and diabetes...how do they do that???
Hello,
I guess that they've had problems with people giving PRN's for what they are not intended for... for instance, giving Tylenol for pain when it was really only supposed to be for a fever... etc.
ok, so i just talked to my mom and here is what happened....
the order was originally supposed to be written for 13 units...so it must have looked like 130 with no measurement after it...
BUT...when the charge nurse found the agency nurse looking for a syringe the agency nurse cleary said, "i am looking for a 130 ml syringe"...which what really confused the charge nurse, seeing as though insulin is measured in units...that is when the charge nurse questioned her on how long she had been a nurse and why she didnt check the order with the MAR.
I guess i'm more disapointed that her attitude was that it wasnt her fault bc she wasnt the one who took off the order...sigh...
Was she really saying ML and not asking for units? I just can't find that believable... I guess it is beyond me. Don't be offended by this question, but is your mom a nurse? Why I am asking is I was wondering if she is maybe mixed up as to what the nurse was wanting or saying, etc... I'm not saying that as a dig (honest). I just find it sooo unbelievable, I have to wonder if there was some big mix up. Of course, then other staff gets wind of what happened... and then it gets all mixed up and blown out of the water. Just wondered!!
mommatrauma, RN
470 Posts
That's usually what we do...and I think you are right..I don't think they make an insulin syringe bigger than 100 units, they do make them smaller, depending on the company..I know BD makes 4 or 5 different sizes..some with even 0.5 unit marks on it for those who have to administer in .5 increments...but I think 100u is the biggest one