Of course, it's always the nurse's fault.

[vbarger28, BSN]

So we started a new computer system about 2 weeks ago, which has had a MAJOR impact on patient care. NOw, there is no paper charting at all, and all orders go through the computer, and documentation on such orders is also done in the computer. Now, of course, the nurses all went to training even on how to input orders for the providers, because of course, they could not be madated to learn the new system. Which has also caused quite a commotion with patient care. (I work in Urgent Care)

I have been at the same location for over 2 years now, and have worked with one provider in particular for those 2 years. Never had an issue, not one. Never been written up, never have had a coaching or even a 1:1. Never had even had a med error/procedure mistake.

That is, until this new system came in...

"Mistake" #1

Provider puts in an order for a CT scan. Order reads exactly: CT w/contrast.

In our job, unless otherwise annotated or commented on, CT w/ contrast is always oral.

So, of course, I gave the patient their cups, and they complete 2/3 contrast drinks. I annotated in the chart, and put a flashing comment for the provider to see on their computer screen, that stated "CT with oral contrast started 1400"

Around 1630 I am notified by CT that the doctor has inquired to him just now why did the patient get oral contrast. Of course, I inform the Doctor that unless otherwise specified, ct w/contrast is always oral. Doctor wanted IV. When I inform the doctor that he put the wrong order in, of course I was given the 3rd degree on how I am supposed to be a mind reader and just "know" that he wanted IV, even thought I told him he must put in the administration instructions or at least an annotation that says IV contrast only, which he did not.

I file an incident report, no harm done. Lady had better kidney function that I did so there wasn't anything to worry about. Management sided with me of course after reviewing the order, and the fact that there was a bold faced comment of the time I started the 'oral contrast' that the provider neglected to acknowledge. Management informed him that had he gone to the training, he would have known which order to place, and I was not at fault by any means.

"Mistake" #2

About 2 weeks pass since the contrast incident. Now, the doctor orders routine blood and chem orders for a pt with abd pain. Blood is ran, easy draw without complications. Blood shows a potassium level of 5.1, while other numbers were in range. Per my charge nurse, I was instructed to re-run the same blood, because had it been heamalyzed, she stated other values would be off. So I ran the same blood. Again, potassium level is 5.1is to 5.2 without other abdnormal ranges.

Provider comes to me and asks why there are 2 ranges, and I inform him that per charge, I was instructed to re-run the same blood. He orders me to draw new blood just to triple check. I use a different arm, easily draw a second sample and run it. Strangely though this potassium level is 4.3 without nothing else out of range. I inform my charge nurse. I also PRINTED a copy of the latest 4.3 result, and give it to the doctor who acknowledges I gave it to him.

20 mins go by and here sed doctor comes stomping from the office demanding to know which potassium level is correct. I let him know the 4.3 level is the latests, and he was given a copy of it, which he took from my hands himself.

He had treated the patient based off of the 5.1 range, and again, blamed me for his carelessness.

My charge nurse was by my side, and told him to be more careful and that it was not my fault, as she witnessed me give him the new blood results.

Now, this jerk off has threatened to report me hahahaha....

What a day...

[sailornurse]

"Mistake" #2

About 2 weeks pass since the contrast incident. Now, the doctor orders routine blood and chem orders for a pt with abd pain. Blood is ran, easy draw without complications. Blood shows a potassium level of 5.1, while other numbers were in range. Per my charge nurse, I was instructed to re-run the same blood, because had it been heamalyzed, she stated other values would be off. So I ran the same blood. Again, potassium level is 5.1is to 5.2 without other abdnormal ranges.

Provider comes to me and asks why there are 2 ranges, and I inform him that per charge, I was instructed to re-run the same blood.

Let me make sure I understand. The second test you used the same tube of blood that was hemolyzed? The one that gave the potassium level of 5.1? If that is what you said you did because the charge nurse told you to) that makes no sense. Hemolyzed blood means the RBC has ruptured and the potassium has leaked out of the cell into the plasma and you will get false high level. Typically, when double checking "funny lab results" it is customary to re-draw the blood sample to re-test.

As to changing form paper to computer charting, some hospitals I have seen that they transition gradually by either doing "hybrid" charting to test the system & allow staff to get used to computer charting by doing both paper chart & computer chart on say 1 patient for each nurse. This helps to get the glitches, evaluate before going "live" completely.

[vbarger28, BSN]

No our wonderful system was thrown on us all at once, no beta testing, nothing nadda. Providers were not mandated to attend training, and nurses were only given 2 hours to learn outside of work in a small workshop. We are not assigned patients. Yes I agree the blood should have been redrawn the first time, I am an LPN, that's why I had informed my charge nurse to begin with that we may need to do something about the blood because of the abnormal result. She however, stated because it was only the potassium level that was off, the blood probably did not hemalyze, otherwise other portions of the chem panel would have been off as well, and so she thought the tube should just be mixed again and re-ran.

It's hard being an LPN in Urgent Care, our RNs all have the final say, and we have to report everything odd to them, which is why I told her to begin with. I am frustrated because I had brought to her attention that the blood should have been re-ran, and she had wanted me to just flip the tube around a few more times and re run the same sample, then re-draw a new sample if the second one was weird. I am just glad she at least had my back when the provider tried to blame me for him not paying attention.

[sailornurse]

No our wonderful system was thrown on us all at once, no beta testing, nothing nadda. Providers were not mandated to attend training, and nurses were only given 2 hours to learn outside of work in a small workshop. We are not assigned patients. Yes I agree the blood should have been redrawn the first time, I am an LPN, that's why I had informed my charge nurse to begin with that we may need to do something about the blood because of the abnormal result. She however, stated because it was only the potassium level that was off, the blood probably did not hemalyze, otherwise other portions of the chem panel would have been off as well, and so she thought the tube should just be mixed again and re-ran.

Here is a link that you may want to share with her. It explains why you should have re-drawn a new blood sample if the sample is hemolyzed and suddenly the potassium is higher then previous. Simply shaking the tube & running the test on the original blood is incorrect. Anytime you get lab results that do not make sense, it is best to draw a new sample and run that.

Medscape: Medscape Access

[KRVRN, BSN, RN]

I understand the story as indicating the charge nurse believed the sample was NOT hemolyzed given that the only level off was the K. As in, if it was hemolyzed everything else would be off too.

[AZQuik]

I understand the story as indicating the charge nurse believed the sample was NOT hemolyzed given that the only level off was the K. As in, if it was hemolyzed everything else would be off too.

Which is why you redraw. Maybe everything else was off but looked normal due to the hemolized sample. If things are clotted or hemolized, we redraw.

[KRVRN, BSN, RN]

If it's not hemolyzed, do you redraw?

[James W.]

If it's not hemolyzed, do you redraw?

AFAIK, given you have clinical reason not to, you put it to the

authority who is ordering the ( seemingly needless) repeat..

If you can show your clinical judgement is being disregarded, then

comply with the directive, but state you'll take it to 'supervision'..

[BeenThere2012, ASN, RN]

Let me make sure I understand. The second test you used the same tube of blood that was hemolyzed? The one that gave the potassium level of 5.1? If that is what you said you did because the charge nurse told you to) that makes no sense. Hemolyzed blood means the RBC has ruptured and the potassium has leaked out of the cell into the plasma and you will get false high level. Typically, when double checking "funny lab results" it is customary to re-draw the blood sample to re-test.

As to changing form paper to computer charting, some hospitals I have seen that they transition gradually by either doing "hybrid" charting to test the system & allow staff to get used to computer charting by doing both paper chart & computer chart on say 1 patient for each nurse. This helps to get the glitches, evaluate before going "live" completely.

Not all places do hybrid charting. We had to go cold turkey. Also, it doesn't make sense that the doctors did not have to use the system. That is the whole point of computerized charting...that all work can be reviewed by all. Doesn't make sense, especially in light of what happened to you. This policy in particular can cause problems...just as it already has for you. Thank God your charge stood by you. This could have been a real mess.

[BeenThere2012, ASN, RN]

If it's not hemolyzed, do you redraw?

I would want to, but only if you have permission from the patient and they are not a " hard draw". Otherwise, hemolyzed is hemolyzed and the same sample should not have been used.

[kerrhi]

How did this conversation go from pointing out how no matter what, Dr's can do no wrong, to a full blown blood draw/lab review? This is another example of how it's always the nurses fault.

[brownbook]

Like Kerri mentioned, the whole point is the doctors taking no responsibility for their mistakes, taking no responsibility to learn about the new system, so therefore it was the nurses fault!

This was NOT an academic discussion about why would K levels change!

this discussion is as goofy as the doctor not acknowledgeing, understanding, the new system!