mistake on heparin??

marriednextmonth · Jun 25, 2011

Thank you for all your help everyone. I am very upset first of all because I could have harmed the patient. I really am trying my hardest to be the best nurse I can be. I just really hope that won't lose my liscense over this or my job because i truely enjoy taking care of people.

tyvin, BSN, RN · Jun 25, 2011

You will not lose your license.

3dayRN · Jun 25, 2011

You will not lose your license over. Also, the nurse caring for the patient should have been watching for the next ptt result. If none resulted the nurse could have simply put in the lab correctly. Obviously this needs to be brought to your attention but just for education purposes not discipline.

Nurse_Hagatha · Jun 25, 2011

It sounds like the nurse who followed you dropped the ball. She should have taken the heparin drip as seriously as it sounds like you did. You reported off to her when the PTT was due, and she should have cared enough about her patient's health and her own job and nursing license to follow-up on such an important issue. A heparin drip is very serious...you don't just not follow-up.

I once received report from a nurse when I was a new grad, who said, "The patient is on a heparin drip and the bag finished a couple of hours ago." She was thinking a heparin drip was like a scheduled antibiotic...no big. Lol. Oy!!!

tokmom, BSN, RN · Jun 25, 2011

I doubt you will lose your license. The worst that would be at my facility would be a write up. Also the other nurse would be responsible for putting in the PT/PTT. Anti XA

As for the other nurse, what is her excuse? She looked at the heparin drip the entire night! Did she not put 2 and 2 together??

suanna · Jun 25, 2011

I kinda think that is why we give report. The nurse that took the patient was responsible for checking that the ordered labs were done and the values. Yes, you did have some responsibility in seeing that the labs were put in as ordered, but you passed on that information to the oncomming nurse. The- HEY- what's my PTT and what do I run the heparin at now should have lit up in her head 6hrs after the last titration. All the blame game aside- it's a heparin drip- did the patient stroke,bleed out,infarct.... An error occured but being punitive about it sserves no purpose. If that is your hospitals response to error management I think I would look into changing employers as soon as the opportunity presents itself.

Mommy&RN, BSN, RN · Jun 25, 2011

Our Protocol is set to where you can't put in Scheduled PTTs until pt is theraputic. When there are boluses/rate chages happening, it is the current RN's responsibility to order next lab draw.

ckh23, BSN, RN · Jun 25, 2011

So why is this other nurse off the hook? It is as much Her responsibility to make sure it was done. And she would have figured out when she went to look at the ptt results from the am. Double check your protocol as well. Our states a ptt 6 hrs after a change and not just 6 hrs.

steelydanfan · 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?

Actually, this is usually not the nurse's call to make, rather the pharmacists, and yes you were right, but you were also wrong.

Here is why. After the 2nd PTT, the heparin dosage adjustment should be prescribed by the pharmacist. They will prescribe the changes and write for the next timed PTT draw. HOWEVER, it is the nurses responsibility to contact the pharmacist and tell them, "The PTT was such, what are you going to prescribe"?

THEY think your a PITA, but you are doing due diligence. And sometimes they forget. I have NEVER not called the pharmacist with the results of a vanco trough before hanging the next dose; because, you know what, they MIGHT not have seen it. And I really don't want to kill a pt's kidneys for such a stupid reason.

mama_d, BSN, RN · Jun 25, 2011

I wanted to chime in that at my facility as well we time the PTT from the time the gtt rate was changed. So unless you brought your crystal ball to work with you, you would have no way to know when the next would be needed.

That said, get ahold of the policy for the hep gtt at your facility and see what it says...maybe even call up your friendly hospital pharmacist and get their input. Not on the entire situation, of course, just on what the standards are industry wide as far as they know.

Mommy&RN, BSN, RN · Jun 25, 2011

THEY think your a PITA, but you are doing due diligence. And sometimes they forget. I have NEVER not called the pharmacist with the results of a vanco trough before hanging the next dose; because, you know what, they MIGHT not have seen it. And I really don't want to kill a pt's kidneys for such a stupid reason.

Huh? The question is about heparin gtt. Our protocol has a sliding scale for heparin.

For example: ptt >100, turn off gtt x 1 hour. Decrease dose by 50units per hour (or 100 based on wt). Then redraw tPTT 8 hours after change in dose.

TonyaM73, ASN, RN · Jun 25, 2011

It sounds like there are a variety of protocols out there from heparin gtt. At our facility, the pharmacist has no role to play in our heparin protocol. You get the ptt results and adjust the heparin gtt according to the ptt. If it is low you will give a bolus heparin and adjust the rate up. If it is high, you put the heparin on hold and adjust the rate down. Once the rate is adjusted, you put the next ptt in for 6 hours after the rate adjustment.

As far as the OP is concerned, she started the heparin gtt and put the ptt in for 6 hours after the adjusted rate. That 6 hours fell outside of her shift to the next shift. She passed it on in report that the ptt was 30 minutes after when she gave report, so it is the next nurse's responsibility to adjust the rate according to the ptt results. At no time, with the information given by the OP, do I see where any of the failure to adjust the heparin or ordering of the ptts was the OP's fault. I have no idea why the manager would suspend the OP or even give a verbal warning. This makes no sense unless the policy is different from my facility or there was something else wrong that the manager did not inform the OP of.

I would definatley get a hold of the heparin protocol and review (and document) the steps the OP took regarding the heparin protocal for the patient. After that was done, I would ask for an appointment with the manager and bring your documentation and the protocol with you and ask what you were missing concerning this.

Good luck OP! Heparin is a very dangerous drug and we need to take special precautions with it for the safety of our pts, but at the same time: you are a new nurse, you asked for help with it and it sounds like you did it right. I think a suspension due to this is very heavy handed, unless there was a step missing with the potention for patient harm or the patient was harmed, but like I said, it sounds like the OP took all the steps that were required on her shift.