mistake on heparin??

demylenated, BSN, RN · Jun 25, 2011

If it was in the order, "PTT q 6 h x 24 h" then you should have made sure 4 PTT labs were put in, not only one. The next shift would not necessarily look at the noted orders and catch it.

You will be reprimanded, I'm sure... maybe a write up. I don't think it would go beyond a write up...

Just remember, take the FULL order you noted, or don't note it at all. That would be like a patient is supposed to have a drug every 6 hours for 24 hours, and you only gave the one on your shift and didn't do anything else about the other ones, but noted the order. This is potentially life threatening... Esp when dealing with a blood thinner. Just be COMPLETE and ACCURATE in EVERYTHING you do.

Good luck, I hope it HAS been a learning experience, hopefully no one was hurt, and hopefully it is only a write up.

BacktoBasics · Jun 25, 2011

if it was in the order, "ptt q 6 h x 24 h" then you should have made sure 4 ptt labs were put in, not only one. the next shift would not necessarily look at the noted orders and catch it.
you will be reprimanded, i'm sure... maybe a write up. i don't think it would go beyond a write up...
just remember, take the full order you noted, or don't note it at all. that would be like a patient is supposed to have a drug every 6 hours for 24 hours, and you only gave the one on your shift and didn't do anything else about the other ones, but noted the order. this is potentially life threatening... esp when dealing with a blood thinner. just be complete and accurate in everything you do.
good luck, i hope it has been a learning experience, hopefully no one was hurt, and hopefully it is only a write up.

i absolutely agree with what you said. but one thing is that at my hospital, our heparin protocol will say how often/when to recheck the ptt dependent on the value for each draw.

demylenated, BSN, RN · Jun 25, 2011

i absolutely agree with what you said. but one thing is that at my hospital, our heparin protocol will say how often/when to recheck the ptt dependent on the value for each draw.

yes, that is the other side... always know your protocols at your facility, because they are always different... and, as b2b said, the protocol may be the one to address the labs, not the dr orders (i said the dr orders because op mentioned s/he noted it and that further labs were not drawn, i assumed it was in the doc's orders).

usually, in my facility, when that would happen, we'd put in 24 hours worth of labs and state that hep protocol was initiated, and ptt is to be drawn every....4,6,8 hours.

good call! great learning experience :)

marriednextmonth · Jun 25, 2011

it does say q6h until therapeutic levels and then q24h. i believed that you were supposed to look at the ptt level and determine if it was therapeutic before putting in another lab. this is why i did not put in another one. was i wrong?

tyvin, BSN, RN · Jun 25, 2011

The other nurse probably assumed you knew that it would have to be continued as per orders and assumed you only needed help with the setup. Sorry this has happened to you.

Hopefully the suspension will be enough. It all depends on the faciltiy. Check the facilities protocals I read it as 4 draws in 24 hrs whether or not they would be continued would depend on the result.

marriednextmonth · Jun 25, 2011

lastly, can I lose my nursing liscense because of this?

divaRN* · Jun 25, 2011

You gave report to another nurse. There was a heparin gtt running on that patient. So regardless of whether or not the order for Q6 PTTs was put in correctly the other nurse should have been looking for a PTT Q6H because this is policy. Im guessing her shift was 8-12 hrs, which would mean 1-2 PTTs. You also told her in report the next PTT was due in 30 minutes. If she did not check for a PTT for her entire shift and kept the gtt running without checking a PTT to titrate she should be written up too. I have had a nurse give me a pt on a heparin gtt and tell me the next PTT was at 2200 and that the order was in the computer. When i looked in the computer it was ordered for 1000. Simple mistake and I corrected the order. I told her the next morning that she put it in wrong and I fixed it just so she would be aware. That is why I always double check and make sure the lab has drawn the blood if i didnt do it myself. Mistakes happen. Nursing is a 24 hr job. This is why we have to be on top of everything. I always look at all of the orders my patient has REGARDLESS of who noted them or when they were ordered because sometimes things get overlooked. There is no way you should loose your job over this.

Also where I work we only put in for the next PTT. We do not put in 24 hrs worth. It takes at least 1 hr to get results after the draw and if it is not therapeutic you need to change the gtt. The next PTT would be 6 hrs after you change the gtt. Not after the last draw (unless it is therapeutic).

Dont worry. Heparin gtts are confussing at first but you will get the hang of them. Always have another nurse double check.

demylenated, BSN, RN · Jun 25, 2011

Hmm... well, in my case, we'd do 24 hours worth of labs, then cancel if needed,

HOWEVER, if THAT is the protocol, and you reported it was a new heparin drip, this was the first PTT, and it needed to be evaluated, then, according to the protocol - it seems like you did what you were supposed to... it has a lot to do with your facilities policy. There are so many variations, and without seeing the complete policy, it is difficult to get the entire picture.

Based on the little info you provided, it appears (to me) you did what you needed to do, as long as you passed on the information (every 6 h until therapeutic, new hep drip, etc.)

demylenated, BSN, RN · Jun 25, 2011

lastly, can I lose my nursing liscense because of this?

I am going to go out on a limb here...lol...

No, I don't think this is near what you would lose your license over dear. You can sleep well tonight

carolmaccas66, BSN, RN · Jun 25, 2011

I am so scared and need advice... I am a relatively new RN. I started my first heparin drip the other day. After looking at the policy for it I still did not feel comfortable starting on my own. I asked a seasoned nurse for assistance. together, we went over the policy and started the drip. to the best of my knowledge we looked at the ptt and started the drip (I'm sorry I am upset and doubting myself right now) After setting it up I asked the secretary to put in a ptt for 6 hours from now. 6 hours later was change of shift, i gave report, told the oncoming nurse that the new ptt would be drawn in 30 minutes. i saw the lab come in and draw blood before i left. when i returned the next day the 6 hour ptt's had not been continued. I was pulled into my supervisors office and told i was suspended until the investigation was complete because i signed off on the orders. can i lose my job over this? can i lose my liscense? please help me, if i made a mistake i want to learn from it, not lose my liscense...

A few questions: why didn't the 'seasoned nurse' go through what you do re PTTs at the time, if she was carefully going through the whole protocol?

Why didn't you tell the shift coordinator/NUM that you didn't feel comfortable doing this on your own and/or didn't have the experience?

Why on earth was the secretary putting in an order for PTTs? To me that just seems weird - is this an American thing?

Why didn't you ask the other nurse you reported to why the PTTs were not done?

I don't think you should be blamed for all this. When you handover a patient, you also handover WHAT HAS AND HAS NOT BEEN DONE YET. Why should you be the only one who gets the blame?

Re-check the protocol with your NUM and ask why nobody else is being disciplined - and get the secretary out of the loop - that just adds to the confusion. Your NUM needs to look at all these factors and you need to tell him/her re the above.

Tait, MSN, RN · Jun 25, 2011

Guess it depends on the hospital. We time each PTT from the last result. It is the next RN's responsibility to put in the next PTT. Therefore if you were at our facility it would have been the next RNs issue, not yours.

Each place is different.