BigMar

believe it or not, when i am not in your room putting your kleenex box at a precisley 43 degree angle from the corner of your overbed table which you are perfectly able to do for yourself, i am not sitting at the nurses' desk reading the paper, waiting for you to beckon me. (unless I pick up a noc shift )

Thanks for the advice. there were a few responses to my question that were a bit reactionary, but yours was actually constructive. I am NOT a tattle tale and I was concerned about if I should and how to approach the other nurse, that is why I posted. And, btw, the injection site where the bruise and hard, painful lump was was exactly one inch below the acromion process on the front part of the upper arm, right where you you put an IM, not the back of the upper arm which is the site for SQ injection in the arm. The pt is also really skinny, no extra fat in the arm (can hardly pinch enough to get it in the belly), so there would be no reason to inject a SQ med there. And one more thing in my defense. I would never report an incident based on assumptions. I just inferred from what the pt said and the location of the lump what had happened and thought that this may need to be addressed somehow. It would be irresponsible of me to completely disregard the notion entirely. Hence the post. At the facility where I work, all med arrors have to be reported into a database that tracks them. The purpose of filling out the incident report is not to get the other nurse in trouble. Please. Cut me some slack.

yeah, i guess asking her what happened would be the next step. i just don't want to seem like a know it all and i don't want to step on her toes. she has many, many years more experience that i.

Today at work, i was assessing a pt's skin and noticed an approx 3-4cm bruise with raised, palpable hematoma at her deltoid. I asked, "what happened here?" and she said, "the other nurse gave me that really painful shot for my diarrhea right there." This pt is on SQ, SUBQ!!! sandostatitin for a high-output fistula q8h. From what I inferred, the "other nurse" had given this med IM. It is very clearly, and has always been, ordered as a subq medication (and is never given IM, as far as I know). If I assume correctly, and I recognize that assuming is a bad thing, this is a med error--WRONG ROUTE. My dilemma is this: Should I address this with my fellow RN directly, or write up a med error report that will involve the DON and powers-that-be and become part of the pt's medical record? I am sure this caused minimal harm to the pt and hopefully the hematoma will resolve without complication. The pt also, technically, received this medication, although the absorption may be different... arghhh. The nurse is very sweet and I don't doubt her safety, in general. I also don't want to bring it up to other nurses on the floor for fear of being gossippy or undermining... Any suggestions would be appreciated.

The facility I work at uses "Y" blood tubing that allows for a saline bag to be hung with the unit of blood to be transfused. Our practice is to prime the tubing with the saline first, to eliminate those pesky air bubbles. Then, just prior to administration, and before putting tubing into the pump, priming with it blood so that it has only blood in it when it is strung through the machine and then connected to the pt's IV access (after 2-person checks, of course). This is beneficial for 3 reasons: 1) There is no waste of precious blood product while trying to rid (prime) the tubing of bubbles 2) You can pinpoint the moment that the bood actually started infusing into the pt which leads to 3) then you will know exactly when the blood product began to transfuse and can monitor for reactions within the "important ten minutes". This saves you time and guess work. You have to stay by the pt's side and monitor (on my unit anyways, we don't have remote monitoring...) for the first 10 minutes (the amount of time research says that most blood reactions will take place in). It's a good idea to know exactly when that 10 minutes starts, so you can recognize a reaction as quickly as possible, which may not happen if you are infusing a mixture of blood and saline at the start.