I had a patient that choked after taking her pills the other night. Happened around 2200. I was there standing in front of her while she was taking her pills. I left the room after she drank her water. A minute after that, a heard a moan in the room and went back. Saw patient holding her throat. Asked her if she was choking, she nodded yes. I did the Heimlich and she started coughing. I rejoiced after doing the Heimlich as I never had done it after I had my BLS certification. Little did I know, it is a severe case that is reportable to nurse supervisor, admin on-call, MD, and the state.
My mistake: Didn't told my nurse supervisor about it right after the incident happened. Though she overheard it when I was giving report to the incoming shift. She told me to make an IDT about it and make an IR. Admin on-call wasn't informed since nobody in my shift nor the incoming shift knew that she needs to be notified about it. Family wasn't made aware because of the time though I forgot to pass it on to the incoming shift. MD was made aware thru fax but forgot to document it on my nurse's notes.
Now, I feel like I'll be totally grilled today when I come in to work. My clinical directors would be there. And only God knows what's gonna happen. I did my very best to give care to my patients, but right now, I just don't know what to think about myself. I am new to LTC and had 6 weeks of orientation. I am on my last month of my introductory period. Should I ask them for more training? I've been having lots of mistakes in the past few days because of improper documentation, unfinished admission papers and little things. Can I get fired from being written up?
Please share me your thoughts. I'm feeling so down right now.
At LTC facility, everything is an incident report, from skin tears, little scratches, a bruise(old fading), another patient touching the arm of another patient which are all jokes and your boss is going to make a big deal about it, stating state will be coming to investigate this and that..... LOL..... I dont know why an administrator have to be informed because of one choking episode. I'm sure she's going to hear about it during her stand up meeting. If its something like patient is missing or wandered out of building or if police came about patient or there are fire we definitely have to call the administrator. I'm sure you are going to get into a big trouble if you didnt do anything about it when patient is choking but not filling out an incident report is to me a simple mistake which you can fill it out when you go back to work and you shouldnt really be terminated. I dont think you need more orientation because everybody makes mistake. Just be more careful next time.....
Specializes in CT stepdown, hospice, psych, ortho.
This is slightly off topic but sort of related to aspiration/choking
I once got my you know what reamed for continuing the practice of giving pills with applesauce for a patient on thickened liquids. I was a new nurse and continuing what every other nurse ahead of me had been doing.It didn't dawn on me to question it because everyone else was doing it and nothing bad had happened. Surely if nurses with so much more experience than me were giving it with applesauce, I could too.
It was actually a good thing to happen because it taught me we all make mistakes and tend to base practice on what has worked in the past instead of best practices that are supported by evidence.
Now I am the experienced nurse and still have to remember not to play the follow the leader game when something unfamiliar comes up because its so easy to ask someone else instead of looking up the policy when you're busy (and when are we not?)
I did check and asked her if she was having any pain upon inhaling or exhaling. No complaints at all. Since it was that late of night and being on a weekend, I only made the MD aware thru fax. I am just so nervous about how my day at work its gonna be like because of everything that happened over the weekend. Didn't had enough sleep last night, spent an hour crying over the mistake I've done and the outcome that may come out of it.
As nurses we feel everything is our fault. Especially newer nurses. I cannot see where you did anything wrong at all. You gave the resident her pills. She swallowed them. You went back into the room when you heard her in distress. You actually did a great thing and saved her life. Now the resident will probably get a swallow eval and there may be a change in how she needs to take her meds. All of the policies and procedures will take time to learn and I do not believe anyone knows them all. I am still learning after being at my place for 15 months.
I agree with everyone- you did your part clinically and the patient told you it was no biggie. The patient is the only one that matters. This is a learning experience, you know what to do now, and there will only be improvements from here! As new nurses, we learn each day and try to be better our next shift. You are doing great!!
This is slightly off topic but sort of related to aspiration/choking
I once got my you know what reamed for continuing the practice of giving pills with applesauce for a patient on thickened liquids. I was a new nurse and continuing what every other nurse ahead of me had been doing.It didn't dawn on me to question it because everyone else was doing it and nothing bad had happened. Surely if nurses with so much more experience than me were giving it with applesauce, I could too.
It was actually a good thing to happen because it taught me we all make mistakes and tend to base practice on what has worked in the past instead of best practices that are supported by evidence.
Now I am the experienced nurse and still have to remember not to play the follow the leader game when something unfamiliar comes up because its so easy to ask someone else instead of looking up the policy when you're busy (and when are we not?)
i dont understand the issue here. If the patient is on thickened liquids but not puree or ground diet what is the problem?
i dont understand the issue here. If the patient is on thickened liquids but not puree or ground diet what is the problem?
Same here. I don't know how the heck I'd get ground-up pills into someone without it. And they need to be ground up because otherwise they get spit at me!
Same here. I don't know how the heck I'd get ground-up pills into someone without it. And they need to be ground up because otherwise they get spit at me!
i was taking it differently, i thought they were giving them whole in AS to facilitate swallowing....but if they are ground up, it makes even less sense that it would be a problem, how the blazes you s'psed to get them in?
That threw me off the path for sure.. Why would someone get in trouble for giving meds in applesauce for someone on mech. soft or puree. I mean it's applesauce, not chuncky applesauce but looks the same as puree to me.
I actually started to put in pudding as the residents don't mind the taste as much. So now everyday before I start my pass I get two cups of SF pudding. they love it and don't cringe when they see me :):)
Specializes in OB, Peds, Med Surg and Geriatric Nsg.
This is slightly off topic but sort of related to aspiration/choking
I once got my you know what reamed for continuing the practice of giving pills with applesauce for a patient on thickened liquids. I was a new nurse and continuing what every other nurse ahead of me had been doing.It didn't dawn on me to question it because everyone else was doing it and nothing bad had happened. Surely if nurses with so much more experience than me were giving it with applesauce, I could too.
It was actually a good thing to happen because it taught me we all make mistakes and tend to base practice on what has worked in the past instead of best practices that are supported by evidence.
Now I am the experienced nurse and still have to remember not to play the follow the leader game when something unfamiliar comes up because its so easy to ask someone else instead of looking up the policy when you're busy (and when are we not?)
So you give pills whole in pudding or applesauce? I'm kinda confused. In my facility, there are residents that take their pills crushed, whole in pudding or whole plain. I usually ask them how they take their pills or check if there's a FYI in the MAR that Patient A is on aspiration precautions and needs thickened liquids. I always follow what's written on the MAR, which consumes half the time of my med pass.
Specializes in OB, Peds, Med Surg and Geriatric Nsg.
UPDATE: Surprisingly, my work today was better than how my weekend was. I already practiced my statement on how that choking episode happened during my 15 minute walk to work. I have a tendency to stutter since English is my 2nd language. I just have so much respect to people of authority which makes me more nervous. When I reached the nurse's station, none of the clinical directors pulled me aside and started lecturing on me. So, could it be a NO-BIGGIE? Though I am thankful that no written nor verbal warning was done. Thank God I still have this job. I think I should stop being a worry freak. If stress was a fat burner, I would've been a size 0 in 1 day! LOL
To everybody who had comforted me with their kind words and encouragement, thank you so much! You have no idea how much strength you gave me to hold my head up high knowing I saved a patient's life despite the little mistakes that I made. God bless all of you!
You might wanna make a quick cheat sheet with patients name, room number and how they take their pills (way they transfer, full code, etc) I put a C if crushed, W if whole, and + A applesauce or whatever their particular situation is. It makes my life soo much easier. Even after a few weeks I forget what one patient's normal routine is and check my sheet, It's quick and convenient. Just leave cheat sheet in your mailbox, don't take it home.
Ms.RN
917 Posts
At LTC facility, everything is an incident report, from skin tears, little scratches, a bruise(old fading), another patient touching the arm of another patient which are all jokes and your boss is going to make a big deal about it, stating state will be coming to investigate this and that..... LOL..... I dont know why an administrator have to be informed because of one choking episode. I'm sure she's going to hear about it during her stand up meeting. If its something like patient is missing or wandered out of building or if police came about patient or there are fire we definitely have to call the administrator. I'm sure you are going to get into a big trouble if you didnt do anything about it when patient is choking but not filling out an incident report is to me a simple mistake which you can fill it out when you go back to work and you shouldnt really be terminated. I dont think you need more orientation because everybody makes mistake. Just be more careful next time.....