Nlink

*know before

It was morphine. Unfourtunately we only have one RN working at a time so you get what you get as far as assitance goes. But yes, it is good to know who before who is competant, at least you have an idea what you might be getting into when you need help lol.

Flushes with regular meds, pre and post feeds and "water feeds"...but no there is no protocol as to how much h20 to use to flush each client after a prn. I just take some water out of the next flush. For example if giving prn at 1300 and next meds due with 100cc h20 at 1400, I would use 50cc to flush the prn and 50cc to flush the 1400 meds. As far as I was aware until this incident that was what was always done.

Yes Buccal is not swallowing however client is non-verbal functions developmentally at a 2 month level and cannot follow directions. Also has spastic quad and is never not flailing around therefore putting anything in the clients mouth would be a risk.

Thank you aldragonRN. Client is not paliative so I can't see a Dr. changing the order to buccal/subling with the potential for aspiration. Perhaps order should be changed to include an H20 flush though.

Like I said high risk for aspiration. Which could cause grave harm...

Have you never disagreed with a decision a coworker has made? If you see someone doing something "wrong" you just turn a blind eye and say "not my problem"?! She was directly involved with his care. If you see someone doing something that could potentially harm a client I would hope you would take the time to advocate on your clients behalf.

I wanted to be better informed if I am put in the same postition as the other RPN. I did not know if RNs had the authority to change routes of administration. I want to be able able to advocate for my clients appropriately. I never indicated that this was something that I would personally be disciplined for. I simply asked whether or not this was an error.

Client has a long-term G-tube and all of the orders state via G-tube none PO. Almost all of our clients are tube fed, when we have an order that says PO we get it changed right away so that our NPO clients are not given it orally in error. We rarely have an PO by accident since almost all of our clients are g-tube and NPO and have the same physician. Her rationale for administering buccally instead of G-tube was that the dose was less than 1ml and would sit in the tube. She said she did not want to flush with water because there was no flush scheduled for that time. Personally I have never not flushed a tube after administering a prn med regardless if there is no flush at the time. Since the med would obviously sit there making it ineffective and the medication could damage the tube. I just deduct the amount from the next flush and give less at that time.

Recently a nurse (RN) where I work chose to admin a prn bucally instead of via g-tube. The order stated via g-tube. This client has a high risk of aspiration. I did not find out about this until after it had already happened and was working in a different building at the time. Can an RN change the route of medication without an order? Would this not be considered a medication error? Is this something I should encourage the other nurse who called me upset about the situation to persue in regards to reporting a med error/talking to management? She did chart that she opposed this decision, she is an RPN, and the the RN chose to do regardless of her objection. It is possible that this resulted in harm to the client, he was sent to hospital later on that day however I have not worked since and do not know why he was transferred.