AllyRN

Hello everyone! I just wanted to let you guys know that I absolutely did not sleep last night LOL. But I did go in to speak to my manager about it and he said that he did not have an answer for me and there was no policy. He even sat there with me and called the pharmacy and the pharmacy said “technically they could taken it at 9,10,13 if it is PRN TID”. So they did verify that PRN TID does not mean every 8 hours and that there is no policy. But manager said I did the right thing by calling the MD and that writing the incident report was correct. He also gave me more resources in case I question myself. Thank you everyone for being honest and giving me advice!

Thanks for the input! I appreciate! To be completely honest, I’ve been through these forums all night and I found one that states that TID prn is not the same as every 8 hours and it blows my mind because I could not find a definite answer. I will be talking to my manager today to review what happened and asked for the policy. Thank you again!

Good point... I’m just too nice of a person and in the moment it was just me and the CNA, no one else saw it. And I thought the right thing to do was help. And the MAR didn’t have a time. It only said TID....

I’m a new nurse and literally today was the WORST day ever. 1.) I decided to go into work while barely getting over a cold (I took meds, wore a mask, hand hygiene, etc.). I’m just overall felt fatigued. 2.) There was a patient running down the hallway and into the stairwell and it wasn’t even my patient but a CNA and I ran after her and tried to stop her (we’re on the 7th floor) so it took forever because she did not stop until she got to the door and security finally arrived and then I had to take time to call back up to see who was the nurse that had her and see what was going on to give answers to the security. 3.) I had a discharge right at the beginning of my shift that I had to get everything ready for and that meant that I would also get an admission (which I did). None of these are excuses. I just know I was not in the right head space and now I’m confused about this med error. My patient had a medication order written: TID metaloxone for muscle spasms. Long story short, I basically gave it only 4 hours apart. And I did question it. So I asked someone who I thought was a nurse because she had a stethoscope on, a WOW, and she had been on the unit since change of shift. She said it was fine. BUT BIG SURPRISE, she’s a respiratory therapist and I didn’t discover that until after giving it(not saying that there’s anything wrong with RT’s, but I was looking for a RN). I am also a new float nurse, so I literally know no one. I ended up thinking about it again and I asked our resource nurse about it and she was shocked. She said that she wouldn’t give it less than 8 hours apart and to notify the MD. I called the MD and they said to continue to monitor the patient. I ended up writing an incident report because I believed I was wrong after I heard what my resource nurse said. I emailed by manager asking to meet with him and to let him know about my mistake and to discuss what happened. But my main question is, are TID PRN medications every 8 hours? Do they mean the same thing? I’m confused because I felt like because it’s TID, it means to not exceed a certain dose in a day but we can give it when needed with nursing judgment . I’m not saying I would given medications 10 minutes a part or anything crazy like that. Was this a true medication error?

So, I was discussing with this nurse about one of her patients. Her patient is a VERY hard stick. So difficult to the point where are IV team has put that patient on a “no more sticks” list because they have poked him about 11 times in 3 days, way past the hospital policy. Anyways, she said her patients IV site has no s/s of infiltration/phlebitis. But the patient said it was a slightly sore when she palpated it to check for and bubbling/infiltration. The IV flush perfectly, no signs or infiltration. We had the IV nurse come in to assess. She said because of the discomfort, it probably shouldn’t be used. We talked to other nurses who knew this patient better and they told her because there’s no s/s of infiltration/phlebitis, we should get a KVO (keep vein open) so we can at least have access just in case of an emergency due to the fact that it flushes well and with no s/s. Since it was night shift, the night float doctor agreed and said he would discuss with the NP in the morning for possibly a more permanent IV access. So the order was in place for 10 ml/hr to keep the vein open until they figured out what to do. The patient did not complain of any pain with IV fluid or flushing. Is this appropriate? Or should the IV been taken out immediately?

Hi everyone! This is my first time writing here and I’m here looking for advice or to see if someone had a familiar situation and what their input is on it. I will try my best to describe this event without getting too much into. My patient has a history of a fib, currently sinus bradycardia on the tele monitor. 7-3 nurse tells me that they d/c his metoprolol q 12 hours and decided to start him on a long acting metoprolol schedule for the next day to help control his BP. The 7-3 nurse gave him his first dose and then it was d/c’d. She told me that she text paged the resident and did a chat line to her multiple times to her about creating a one time order for metoprolol at night so he can at least get his last dose. The receipt said that the resident saw it. No order was placed for a one time order. So I stupidly forgot about it. Around 2030 my patient flips into a fib with a controlled rate between 70-100. I paged the night float doctor. The BP was elevated SBP 156, I have given him lisinopril about halfway through my shift ( just a side note). The patient was asymptomatic and baseline confused. The doctor comes down to evaluate and I told him as soon as I remembered about how he didn’t get metoprolol at night because it was no longer an order. He asked me who the resident was and I told him and he said “oh, she’s incompetent”. I felt horrible. He was very annoyed. He ordered a one time dose if metoprolol and I gave it, rechecked his BP (147 SBP) but still in a fib. Told to continue to monitor. I feel like I dropped the ball on this one. I should’ve really made a note to remember and pushed for that dose of metoprolol... I read through his notes and he’s flipped to a fib once before during his stay and he has a history of a fib. Has anyone gone through this before? Could I get written up for it? I really have no excuses, I just feel like a bad nurse and lack so much experience. Thank you all for listening to my rant. I’m praying the patient will be ok..