on probation because i made a mistake

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Just need to talk and tell my side of the story.

My patient couldn't have any narcotics for her pain. I took it upon myself to give 25mg instead of 12.5mg. THe order was written as follows. Phenergan 12.5mg q 4-6hoursprn. The reason I gave the second dose is because she was hurting and nauseated and needed something for relief and couldn't have anything due to the hyda-scan she was scheduled to have.

I'm rather amazed that a nurse would take it upon herself to double an ordered dose of medication. That is so clearly practicing medicine without a license. Phenergan is not a pain med, and you not only gave it once but twice! And then reported it to another shift, so you obviously felt O.K. with your decision.

Why didin't you call the doctor? There are other meds that could have been tried if the Phenergan wasn't working. And excusing it by saying it was really busy is a cop-out.

Sorry, I realize this sounds really harsh, and I'm trying hard to be understanding and sympathetic to the fact that you wanted to help your patient be comfortable, but it is no wonder you are on probation. What did you expect to have happen?

I'm sure you learned a good lesson. You need to stay within the scope of your license.

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Specializes in Education, FP, LNC, Forensics, ED, OB.
I cannot understand why you are being treated like someone addicted to drugs. This whole situation doesnt make sense to me. Why do you have to go to counseling? We all make errors in judgement at time.

Because of the nature of the infraction.

Giving double doseages twice like this could be inferred the dose was not given to the patient and instead, taken by the nurse.

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Because of the nature of the infraction.

Giving double doseages twice like this could be inferred the dose was not given to the patient and instead, taken by the nurse.

Thanks Siri, was wondering why myself.

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Sorry, I realize this sounds really harsh, and I'm trying hard to be understanding and sympathetic to the fact that you wanted to help your patient be comfortable, but it is no wonder you are on probation. What did you expect to have happen?

I'm sure you learned a good lesson. You need to stay within the scope of your license.

*whew* I'm glad someone else agreed with me, I was starting to get a little nervous!

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Specializes in LDRP.

Yikes! Purposefully doubling a dosage of a potentially harmful med?

How old was this pt? I've had some pt's that just 12.5mg of phenergan snowed them for the whole day, but 25mg, then 4 hours later, another 25mg?

Even if you HAD an order to give 25mg, I certainly wouldn't have. That's too much Phenergan, too close together for a pt who's NOT EVEN NAUSEATED!

Of course, if a pt wants pain meds but can't have them, maybe snowing them w/ the Phenergan will make them forget their pain?

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I understand the reason for the probation, and agree with it. It's scary that you decided to double the meds without an order, and probation seems warranted. Like others, I am confused as to the drug testing continuing, I would think that after the initial negative you would not be subjected to having to call daily to see if you are to be tested. Is there more to this story?

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I am confused as to the drug testing continuing, I would think that after the initial negative you would not be subjected to having to call daily to see if you are to be tested. Is there more to this story?

If her state is like CA, all nurses who are reported for med-related infractions are tested. Probation programs are not taylored to individual nurses but rather to infractions. Even though she has not been proven to be chemically dependent, she will still have to undergo testing because of the infraction.

Don't know if other states are like this, but in CA if you have had a DUI/DWI within three years of applying for a license, you will be granted the license but placed on probation for three years, will have to attend AA meetings, and will have to be drug tested. This is to protect the public.

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If her state is like CA, all nurses who are reported for med-related infractions are tested. Probation programs are not taylored to individual nurses but rather to infractions. Even though she has not been proven to be chemically dependent, she will still have to undergo testing because of the infraction.

Don't know if other states are like this, but in CA if you have had a DUI/DWI within three years of applying for a license, you will be granted the license but placed on probation for three years, will have to attend AA meetings, and will have to be drug tested. This is to protect the public.

Ohhhhhh, okay. Thanks for clearing that up!

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I can understand the drug testing if you make a mistake. That seems like a fair enough intervention but from what I am reading she is now subject to take a drug screen whenever her number comes up and is also recieving counseling for drug abuse. I may be taking this wrong but it doesnt make sense to me.

Her error was one in judgement. We dont know the whole story but based on what she is telling us, I feel this is one of those cases where they could care less about fixing the problem but only want something to look good on paper. Why not explain to her, the rationale behind her mistake, the appropriate actions that she should have taken, etc? I dont see how mandatory drug testing and counseling will remedy this situation as it seems that illegal drug abuse wasnt the problem.

It also seems that she admitted to her mistake and didnt try to hide anything. Again my personal opinion is that this should have been handled internally but with a definate warning that if it happened again there would be serious consequences such as termination and reporting to the board.

We are missing so much information. In my old unit this would not be an issue as our standing orders allowed us to give 12.5-25 mg Phenergan heck my job right now allows me to give 25mg Phenergan PO. Maybe that is why she didnt think more of it. Phenergan is not controlled and is often given for nausea and vomiting but few people give it the caution it needs.

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Ok, I'm not a nurse but let me get this...

You doubled the dose

Pt was feeling sick and hurting

Gvae double dose again

PT had a reaction

You called the Dr.

Reported it to the next shift

I agree that what you did was wrong but I'm interested to hear what the Dr told you when you called and told him/her what you had done. Also why did the next shif not question you on why you had doubled the dose and if youhad instructions to do so from a Dr.

Like I said not a nurse just wanted to know a few things. Sorry you have to go through all of this I'm sure hind sight is 20/20.

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I think it's been established that she shouldn't have given that much phenergan. The dead horse has been sufficiently beaten.

Any helpful advice for her from here on out (besides not doing it again...har har)? Good luck to you OP, I think you've gotten some good advice in this thread from others who have dealt with the BON.

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Phenergan is not controlled and is often given for nausea and vomiting but few people give it the caution it needs.

Phenergan can also be used as a sedative and as an adjunct to pain medication. I have had a lot of requests for phenergan d/t "nausea" from patients with Hx of substance abuse. I will also agree that it should be used with caution.

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