Mistakes

[Ferniato]

Hi, this reminds me of something, I was giving a patient pills at night, I asked her to choose between po and sc and she chose po, I sat her up and put the pills in her mouth and put the straw on her lips, after taking a sip, she started coughing, I don’t vividly remember if she was drowsy or not, however I feel I remember her eyes were closed, later on I asked her if she remembers herself coughing after taking water, she said yes, and then I asked her if she knows why she was coughing, she said she took the water too fast, I asked if she knows why, she said it happens sometimes, I feel really bad because I don’t know if I missed the fact that she might have been drowsy although I had a conversation with her just before giving her the medication, I said it in report that she coughed on fluids for me, I just feel really bad and would like some advice, the last thing I want is to make my patients have complications 

[Davey Do]

1 hour ago, Ferniato said:

I asked her to choose between po and sc and she chose po, I sat her up and put the pills in her mouth and put the straw on her lips

This is not a mistake,. Your actions were prudent.

Sometimes these things just happen, Fernito. We cannot be aware of every situation all the time.

 

[JBMmom, MSN, NP]

It happens. Sometimes I cough on water, too. Or, even my own spit, as embarrassing as that can be. 

Unless you think the patient choked or had significant aspiration, and it doesn't sound like she did, it's very unlikely that anything bad happened. You set her up to take them correctly and everything is probably fine. 

[Hannahbanana, BSN, MSN]

Make sure somebody in bed, even if she's already sitting up, leans her head forward when taking anything PO. This makes the swallowed bolus go down the esophagus more directly. When you lean backward, it opens your airway more ... that's why they teach you to do a neck extension in CPR, to open the airway better. Not the point when you're encouraging a swallow, especially of a very thin liquid like milk, juice, or water.

[heron, ASN, RN]

Another strategy that works well for me in LTC is to float the pills whole on a small bite of applesauce, yogurt or the like. The bolus is easier to control when swallowing than a sip of thin liquids. I’ll also sometimes ask the patient to take a small sip of water before taking the pills - it wakes them up a little, gives you a chance to assess their swallow, moistens the mouth/throat and triggers peristalsis - all of which make getting pills down a lot easier.

[Wandering-night, BSN]

Did you do an initial bedside swallow eval? Did the prior nurse tell you about their alertness prior and medication swallowing abilities? Unfortunately sometimes we have to be mean and provide a lot of stimulation to wake people up from a dead sleep especially for important medications. I believe you did the right thing by sitting them up prior to giving meds and giving the next shift a heads up!

[Ferniato]

Hi wandering-night, yes I have given her pills prior and she has never had difficulty. Providing that she was able to decide what she wanted, I felt she was awake which she stated she was, but I will definitely take your advice for next time. 

[CommunityRNBSN, BSN, RN]

On my first day of clinicals, my first patient, I was paired with another student. The RN told us to go in and assist with feeding lunch to a patient. We gave him one bite and he started hacking like he was going to die. I still remember the other student and I locking eyes in silent panic, thinking “It’s our first patient, and we killed him!” We ran out and got the nurse and she said “Oh he always coughs like that, he’s fine.”  It was very memorable.