I am really sorry that happened to you... truly. (((Hugs)))
Not reporting however, will guarantee that nothing will be done, and will continue to send the message that this is acceptable behavior— not the crime it is.
I wonder too if anyone’s AG would be more responsive than hospital admin? Like if the victim contacted the AG himself if police did nothing?
We have patients admitted to the hospital every day that forget they have already taken their BP meds, take another dose, and bottom out. So yes, the duration of action and drug class absolutely matters because you have a combined effect.
I'm not completely disagreeing with you that the patient the OP described may have needed a second dose...but you don't double up for a single administration just because the same drug or drug class is ordered for two different indications.
You can give beta-blockers for anxiety as well as blood pressure. So if someone's blood pressure was 100/70, was feeling anxious, and it was time for their BP meds, you would just double the dose if it was ordered? Not unless you want to code your patient.
In terms of what I define as stacking, depends on the indication. In our hospital, unless someone is immediate post-op, we prefer the nurse give the ibuprofen, wait an hour, then give the opiate unless the pain level is really high, then we prefer the opiate be given and then give ibuprofen on an alternating schedule.
Can you copy and paste where I said LTC is EQUAL to "crappy nursing".
Oh that's right...gosh, I never said that did I? Seems like you have a literacy issue if you didn't catch that I was SPECIFICALLY referencing a particular practice that I am sorry...still amounts to crappy nursing.
Do you have any acute care experience? I'm getting the vibe you don't or your experience is very limited. You seem to think that acute care isn't regulated at all. This isn't true.
Guess what? Some drugs <shock> do two things at once. If someone was opiate naive and you gave them a Percocet at night ordered PRN for pain. would you also give them a Valium at the same time that had also been ordered PRN for sleep? Or would you put your critical thinking cap on and figure the Percocet is going to most likely knock them out anyway and you don't need to combine the two?
A prudent nurse would give only the Percocet before you ended up with a non-responsive patient. If you think you should give both meds because "one was ordered for sleep" and the "other was ordered for pain", then I would highly suggest a pharmacology refresher. Sorry of that offends you--but this is a huge issue in nursing right now.
That kind of ranks up there with your acute renal failure being prescribed vancomycin. Would you just give it because, "Well, it was ordered" or question it?
Of course two meds that both impact BP are given at the same time or in the same duration of action, the number of different orders that are being utilized aren't what determines if a med isn't going to safely tolerated by a patient, a since med from a single order may be excessive, and 5 different meds given from 5 different orders may be insufficient.
I'm curious about how you define 'stacking'? Why wouldn't you give ibuprofen and an opiate "at the same time"?
It doesn't seem particularly confusing, leaving aside the issue of whether this is an appropriate way to prescribe and use benzos (it's not), the only thing that matters is how the prescriber intended for the order to be interpreted, which in this case sounds like is was a continuation of a home med.
The most likely way it was meant to be interpreted would appear to be that the patient takes Xanax 0.5mg throughout the day, then takes an additional 0.5mg at hs, which would mean you interpreted the order correctly.
Would it make more sense to people if it was written "0.5mg q hrs, MRx1 at HS" or "0.5-1mg q 8hrs". I think people are getting into the weeds with the semantics of the orders and missing the intent of the order(s).
Yes I would and I do give multiple meds that impact BP concurrently. If that's the med cocktail that has proven to work for that resident you bet I give them. Stacking meds is not always inappropriate, sometimes that is what works for that individual.
Our residents are certainly not over-medicated for staff convenience. We perform monthly order audits on every resident by pharmacy in conjunction with the primary provider and the RN to ensure all orders remain appropriate. We are required to attempt med reductions of psychotropics, benzo's and opiates on a regular schedule. LTC is one of the highest if not the highest regulated field of medicine there is. I doubt the average acute care patient gets the kind of scrutiny of their orders that our residents do.
I am greatly offended that you assume LTC is equal to "crappy nursing." RN's certainly shouldn't need a babysitter, but they also certainly don't need your condescending attitude and insults toward an entire specialty.
I do all of these things, at times. My doctor also gave opiates and ibuprofen together every six hours after both of my deliveries. I don't think it's "crappy nursing" at all and I've never worked in long term care.
Would you have given two meds that impacted blood pressure? No, you would not because you don't want your patient to bottom out.
It may be "common" in long term care, but it's called crappy nursing and why so many seniors are over-medicated for staff convenience.
I write for scheduled pain meds and PRN meds all the time after deliveries. I count on the nurse's critical thinking skills not to stack meds inappropriately. RNs should not need a baby sitter. I don't mind stacking ibuprofen with an opiate for better pain control, , but you don't give them at the same time and you don't stack opiates with other sedating drugs such as Ativan, etc.
I had my administration tell me never to reveal to a patient what my workload was (consciousness of guilt). I got called into the office for doing precisely that. I told them I wasn't the one who brought the subject up: the patient had and then he asked me directly how many patients did I have that day. So I told him.
My manager reminded me we weren't supposed to talk about that with patients or family members. I told her that "he asked me a direct question. What was I supposed to do? Ignore the question? Or lie to them? Pick one!"
I heard no more about it. If they had told me to never answer the question again, I would have told the patient: "my manager told me to never answer those questions." Why should I be the defender of the policy? I didn't make it nor was I the reason why there even was such a policy.
They knew they were screwing the patients. They just didn't want to admit it.
Perhaps it would be wise for the healthcare giants in the US, to study the healthcare models of countries who have better outcomes, higher patient and employee satisfaction scores, and adjust accordingly.
Otherwise, I see the problem remaining the same, for the forseeable future.
Besides telling nurses to pursue another career, I also tell friends and family to do all they can to stay OUT of a hospital.
And if they must be hospitalized, I encourage them to bring along someone who will act as their advocate.
I also tell them to be nice to the nurses because more than likely he or she is doing the best they can, with an unmanageable patient load.
"I have every reason to believe it's gone downhill."
As supporting evidence: The nurse "gave me her number and left."
I'd like to approach this from the other side - unrealistic patient expectations. Staffing is an issue, but there's absolutely nothing to use in his statement. He's demonizing a way to get in touch with the nurse? How often was he checked on? Was it a ratio issue or was any time alone an issue? Side rails? Bed alarms? Cardiac monitors? He could've been near the nurses station with passing eyes on his every five minutes. We simply don't know and to say otherwise is speculation.
Blanket critical statements like American healthcare has gone downhill represent the worst kind of uninformed opinion stated as fact.
I realize this comes across pretty strong and I'd love a chance to talk with him to get more detail. As it stands, this complaint comes across more like the guy I had that got mad at me because he got a normal spoon and not a soup spoon for his soup.
Part of suing a person or institution is showing damages. Since nothing happened to the prisoner he can't really show any damages. So he could clearly win the lawsuit, but how much money is awarded for no damages?
The prisoner should sue, if only to bring more shame and scrutiny to this prison. What kind of a care provider gives somebody a pill that was fished out of a bloody bio-hazard container? What kind of actual physician tells a nurse to do it?
If anyone ever asked me to retrieve something from the sharps container I would be on the phone with OSHA in a hot second. Workplace safety.
Was the pharmacist disciplined? How about the supervisor?
I am so sick of stories where multiple people screw up and the nurses take all the blame.
Yes, totally poor judgment, but you know what gets my goat? Prisoners get expensive treatments for free, hard working, law abiding citizens can't afford treatments and medicines. Hard working mothers and fathers go into debt paying for astronomical copays and out of pocket expenses while the indolent segment of the population gets a free ride.
The OP's "double dosing" is just a symptom of a bad system and stems from multiple issues. Here's what comes to mind for me:
Benzodiazepines are not the best treatment for insomnia and if used regularly they can cause rebound insomnia and make the patient dependent on the medication in order to fall asleep. Now granted sleeping in a hospital is way different than sleeping at home so some extra help might be needed, but many of the folks in the hospital that need benzos for sleep were already taking them for sleep when they got there.
Technically, the patient saying the doctor prescribed 1mg of Xanax is true and there's a good chance the OP isn't the first (or last) person who did this.
The doctor wrote the duplicative orders for Xanax which were then reviewed by a pharmacist before being profiled on the patient's MAR. Ideally this should have been caught by the doctor or pharmacist and one of the orders should have been canceled.
The hospital should have a policy regarding duplicative orders and educate nurses on how to address them. It's not clear if that's the case here, but orders like the ones referenced by the OP and orders where there are multiple meds prescribed with the same or similar indications get a lot of well meaning nurses in trouble. For example, there's an order for 2mg of morphine for PAIN and 4mg of morphine for CHEST PAIN greater than 5/10. The nurse decides to give the 4mg of morphine because while the chest pain is only 2/10 the patient's leg pain is 10/10. It seems okay on the surface, but it could get a nurse in big trouble. Or maybe a patient has orders for both Tylenol and Motrin for pain and fever q4 hours. How should you give them? How do you know which you should you try first? Do you give both at the same time or rotate between them every 4 hours? What if Tylenol is for both pain and fever but Motrin is only for pain? If I give Tylenol for fever and shorlty after taking it, the patient wants something for pain, can I give Motrin or do I have to wait since the Tylenol has pain as an indication too? Having a clear policy about these types of orders can prevent this confusion and nurses who are aware of the issue are less likely to second guess themselves when deciding whether or not to give a med and/or get clarification from the provider.
When the OP scanned the medications, the EHR should have warned her that it was too soon to give the additional Xanax (it may or may not have done this). Unfortunately, technology bias can lead to an overreliance on the computer to catch mistakes and some nurses (and doctors and pharmacists) assume all is well if the EHR "lets" them do something.
Reporting this as a med error or near miss is appropriate, but I sincerely hope the OP isn't being punished for her actions. That helps no one and negatively impacts safety.
My last workplace (ambulatory care) had a different brand machine. It wasn't anal; it was downright passive aggressive. It would pretend it never saw your fingerprint before. The process to actually get one of its precious meds out of it was quite elaborate. If the multiple steps weren't completed just so, you had to start over.
Sometimes it would decide it needed to reboot itself, but only if the clinic was especially busy that day. We learned never to keep epi or other emergency meds in it.
That machine would not have lasted a week on a med-surg floor. Someone would have taken a baseball bat to it. Probably me.