Meds or Beds?

I'm a nursing student, about to graduate in two months, doing clinicals on a Med-Surge floor. This morning was soooo busy. My patient had many requirements and took up a lot of my time, including a couple of stage 4 pressure ulcers and a pool of diarrhea to clean up. The patient was completely immobile and it took 4 people to complete the task of dressing change and cleanup. I did the unthinkable and let a med (protein supplement) go over 2 hours overdue.

Is there ever a time when it is acceptable to tell the other people assisting with patient care, "I have a med to give for this patient. Can you take over for a few minutes while I get the med?"

I accept responsibility for missing the med, but I also want to know how to avoid missing a med like this in the future in such situations.

Thanks!

Yes, there are times. Honestly, though if you think back to your Maslow's hirarchy of needs, skin care due to diarrhea is a higher priority than the protein supplement. Sure, maybe you could have been faster or more efficient, but the important thing is that you prioritized correctly

There will be times in the real world meds are late. Codes, rapid responses, post op checks, CBI, total care patients, etc. all take up a lot of time. Taking proper care of these patients (and drips and such too) is more important to me than someone getting their protein supplement, colace, lisinopril (so long as their BP is okay) with the "window" they give you. Yes most days I would do fine with med pass timing but some days I just had to do what I could when I could.

Don't sweat it if there was no ill effect on the patient. Things happen so just do your best. **** happens lol.

yes, there are times when assistance or delegation is essential. You made the right choice though, in this situation. Knowing how to prioritize is the major task for nurses.

Did you forget that the med was due and not remember until later because you were busy? Or did you realize at the time that the med was due, but not say anything because you didn't want to be perceived as incompetent (by asking for help) or lazy (by asking someone else to take over for you)?

If you forgot, that's understandable, especially as a student. You might find it helpful to develop a method for remembering the meds you have to give when you can't always get to the computer to check. Personally, I have a report sheet for each patient where I jot notes, comments, important values, labs, etc. I also number one side from 7am-7pm and write out all the meds that are due each hour. This way I can quickly look through my report sheets and see what meds I have to give for each patient throughout the day, without logging into the computer or checking each MAR individually.

If you realized that the med was due at the time but chose not to ask for help or make arrangements for the med to be given on time, there is room for improvement there. You're a student. The patient has a primary nurse who should be in the loop about the patient's care. If there was some kind of ill effect from the medication being given late, then he or she is the one who would ultimately assume the responsibility for the error. The primary nurse should have been communicating with you regarding what medications you had given and when. However, it's also your job as the student to keep communication open with the RNs, especially if there is a scheduled task that you can't complete. There were several options available to you including asking the primary RN to give the medication, asking your nursing instructor for assistance, asking another nursing student to help with the patient care while you gave the med, etc.

Ultimately, a protein supplement isn't a medication that is terribly important to give on schedule. However, it could have been a different medication that was more important to give. The big thing to think about here is why you didn't ask for help, and use it as a learning experience for how you could respond differently in the future.

In a perfect world, you would have given the protein supp at the correct time. But we don't practice in a perfect world. We must put on our RN cap and apply a little critical thinking and prioritize. The diarrhea combined with pressure ulcers are more important than the protein supp, so I think you did OK in this situation.

Now, what would you do if the med was a PO pain med: Do you continue to clean up the mess knowing the previous pain med is slowly wearing off?

What if your patient's BP has trended up significantly? Do you stop the clean up to go grab the PRN IV push betablocker?

This is the beauty of nursing, using your noggin to create the clearest path to the best outcome for your patient. You chose well this time, now think of tougher situations to stretch your abilities to think critically.