Med error???????

[prostreetrig]

Ok, I am an LPN with Hospice. THe other day I went to do an assessment on one of our PT's. She was constipated from Morphine and had been four days or so without a BM. PT asked me if I could give her an enema. Now, She had positive BS, no N/V, etc. I told her I couldn't give one without an order but her family could. She didn't have anyone to do it. I called my charge nurse to see about getting an order. She called me back and said to give it and she would get the order. Everything was fine then two days ago my DON asks if I had given an enema without an order. I was honest and said yes, but I am used to PT's having standing orders, one of which is normally an enema. THe charge never got **** and I had to fill out an incident report and a late entry for giving it. Any opinions?

[jmgrn65, RN]

Well not much you can do about it now. Just make sure you have an order. Maybe tell your Don what your charge nurse said and apparently didn't do. you have to be able to depend on your charge nurse and she let you down.

[clee1]

yup.... a med error alright.

Sorry, but I never give a med w/o seeing (or taking) the order myself and the docco should have been done immediately s/p administration.

You have just learned the hazzard of doing something on someone else's "say so". Your charge nurse was also dead wrong for instructing you to give that med w/o an order. S/He was practicing medicine w/o a license, and you went along with it because it "seemed normal". How much was the pt eating? Is it possible that this hospice pt didn't need to BM? I have personally observed that many elderly are excessively concerned with a daily BM, w/o cause.

C-Y-A is the name of the game; especially with hospice and/or home health.

[jmgrn65, RN]

the patient hadn't gone for 4 days it doesn't matter if she wasn't eating the bowel still makes stool.

[mandykal, ADN, RN]

I don't know if I would ever tell a pt that "I couldn't give one without an order but her family could." After all, the facility is ultimately responsible and the nurse is liable. A family member should not give anything po or pr medically without the physician's approval. Perhaps, offer some prune juice too. I do understand that this pt is hospice and still can converse the need to be relieved from constipation. Take this as a lesson learned. For your safety, get this little note pad and make your check list at the end of your shift to double check things that need to be followed up. The ltc I work at, the supervisor's (RN's) contact the physician's, and write the orders, the floor nurses' transcribes the orders and follows through. At the end of shift, I do find myself resolving issues similar to yours but it was my check list that reminded me. Who knows maybe your supervisor forgot.....

[Lacie, BSN, RN]

I lost my license for 4 months and 2 years probation for something as simple as giving mylanta in lieu of a standing order for maalox. Pt refused it preferring the other and it was 4am in the morning in ICU. Doc didnt mind but I forgot to get the order written. Should you have done this without recieving at least a t.o. order from the doc? NO NO NO. I had to learn the hard way so take it from experience. Dont do it no matter how simple you may think it may be. Not worth it.

[sydylo]

If the doctor told you it was ok to give mylanta, why did you get your license suspended? I would think the most you would get would be an incident report, but to have your license suspended when the doctor said it was ok to give mylanta?

[TazziRN, RN]

Yes it's a med error but the charge nurse was also involved. I hope she had the grace to admit to her part in it.

[k3immigrant]

what i learned in my 4 years of nursing, DO NOT trust anybody especially if you are going to put your signature/initials on it. if somebody or a charge nurse tells you that she got an order, do not do anything until you see a written order on the chart or probably write the order itself & have that person sign a T.O./R.B. order or better yet, get the chart yourself & open it infront of that person that got the report & let her write it right there.