Nurse Manager Write-Up

[Girlygirl69]

Question to all of the experienced critical care nurses- EEG results showed pt having seizures without any visible evidence of seizures and MD orders Versed drip. RN questions another experienced RN and the ordering MD the need for versed. Response from ordering MD is that after reading results Neuro fellow states this is the drug of choice. I hang the drip and get chewed out by nurse manager and ICU attending because this particular unit does not "like" to use versed. There is no policy in hospital showing which drugs are first and second line choices and which drugs should all together not be used. Can I be written up for this?

[nursesaurus]

IMO you were following doctors orders. end of story. im not experienced in this field but if the dr was second guessed by other RNs and he stood by his order then you had no choice but to hang it. just because they dont "like" to use it is no reason to not hang it. i hope it all works out for you.

[llltapp]

Their beef should be with the ordering physician, not you. TYPICAL . Make the nurse the fall guy

[nurse2033, MSN, RN]

No, in the absence of written policy you are solid following reasonable nursing practice, which you did. Versed tends to drag on and over sedate many patients, but an excellent choice for seizures. It is a higher priority to stop the seizures than to worry about over sedation I would say in this case. My guess is that's also what the MD was thinking. You should write them up for giving you a hard time.

[shoegalRN, RN]

Did you chart that you verified the order with the doctor? I don't see how you can be in trouble for this if you double checked with the ordering physican AND there is no written protocol for Versed not being used for seizure patients.

[Girlygirl69]

Thanks guys. You really don't understand how your words have given me the strength to fight this. I won't take his lying down. I'm going to work tomorrow and I will speak with my manager. I will make sure to give you guys the update.

[Elvish, BSN, DNP, RN, NP]

Well, there is still some RN responsibility even if it is a doctor's order; that line of reasoning won't stand up in a courtroom if it's a bad order.

But if it's just a matter of preference, versus an actual contraindication in that particular clinical picture, then don't worry about it. If it's the former, what it sounds like to me is that 'something' has happened with the use of Versed (a bad reaction, bad outcome, something along that line) that has made your ICU folks skittish about using it. I'd go to the NM or the attending and ask for clarification as to why it's not preferred. But as long as you were not going against hospital policy nor sound nursing judgment, I wouldn't worry about a formal write up. (and you could probably dispute it if you did get one...)

In any case, it sounds like there should have been communication between the neuro fellow and the ICU resident should have discussed the plan of care, and if the resident was not sure about the order, s/he should have run it by the attending as well. (ICU isn't my specialty, full disclosure, but this is what I'd say if something similar happened on my unit.)

[Altra, BSN, RN]

Completely agree with Elvish's post above.

If neuro is consulted for your patient, there is no reason not the implement an appropriate order from them. And in my experience the Versed gtt was appropriate - it is our first line choice for frequent/continuous seizures.

Different physician groups will always have different preferences, but I can see no policy or standard of care that you failed to follow with the information that you have given us here. This is for the docs to hash out.

[steelydanfan]

With 2 MD opinions, one a neuro consult, I see no reason to object on medical grounds, especialy if there is no hospital policy refuting the order.

I can only fathom an objection based on the fact that a versed drip mandates a stay in ICU, thus "tying up" a bed.

[Batman25]

You did nothing wrong here. Were you written up or are you fearing one? You should absolutely not be written up here.

[eriksoln, BSN, RN]

Nurse Manager needs to grow a set and educate the doctors on what is 1st and 2nd choice. Yelling at you about it won't help. Even if you convey this to them, a great many will fluff you off and order it anyway. Not until they see someone with admin.'s backing saying it can't be done will they change their ways.

[TickyRN]

I actually thought this post was about how to write up your nurse manager.