PicklesRN

I remember paraldehyde and you are correct, it does smell bad. I also recall one New Year's Eve giving a patient an alcohol IV for drinking auto radiator coolant. That was the cure at the time. Never had such a patient since then so I don't know what the treatment is now.

At the hospital I worked at being going to the company I'm with now, med errors meant that you had to complete an incident report but nurses could not be reprimanded for them. If it was a problem they could be asked to have more CEs or some educational process could be implimented but no write ups or any other such procedure. The thinking was if a nurse would be in trouble for making a med error, she would be less likely to report it. If it was a chronic problem and education wasn't working it was reported to the BON and the nurse was let go. But a write up for a med error... it didn't happen.

This is interesting. I graduated in 84 and I am totally unaware (or I just don't remember) morphine or dig coming in tablet form for injection. Was this JUST for injection or was this an oral tablet that was used for injection? Was it the same stuff we use today? Were those drugs not available in injection form at that time? Please don't misunderstand my questions to be doubting you, I am not. I just find it interesting. I didn't know this still happened in the 70's. I really thought the practice went out somewhere in the 40's. Was this a sterile tablet or was it what we give today for oral use?

I do understand what you are saying, but if you will look at the post in question, there is a smiley face after the comment. I am a person with a very dry sense of humor and I often times have to use smiley's, etc. to show I am not being serious. I think the poster in question was doing the same however they are free to correct me if I am wrong about the smiley after the comment in question.

Hmmm.. I'm pretty sure the poster you quoted wasn't posting literally. They were just joking a bit and making a point. I seriously doubt the person in question would actually strike a patient. :chuckle

That is an interesting point. Gotta wonder what upper mgmt would say to that. :chuckle

Nobody has their claws out, nobody is attacking you, and nobody is accusing you of anything. The OP asked for suggestions on taking care of the baby and you started talking about being judgemental. I'm not good at reading between the lines, I take people's posts at face value and if I am unsure of the point of a post, I ask. No claws here. I think all of this is important and especially for a student. Your first crack baby is no piece of cake. It stirs all kinds of emotions and assorted thoughts. I think there is value in pointing out previous experiences because this young nurse is going to be facing the same issues we have in the past. It's a huge topic with lots of issues. Pointing out a judgemental attitude that isn't there, just isn't fair.

I honestly don't think I would do your job well. Really, I would be concerned that I would lose my temper with these parents. They just don't have the right to harm these little babies or older children. I don't think I would do the kids any good since I do worry that I would lose my temper. Good for you that you can do the job~

I don't know what happened to the RPh. She is gone but I don't know if that was on her own or if she was fired. Due to the huge number of mistakes I can only assume she was fired but I am speculating. As for a med error vs. a communication error... I can't see how it was anything but a med error. The label on the baggie was quite clear it was a 'vial' of Levothyroxine. Inside was a tablet. That was a med error on the part of the pharmacy since it was filled incorrectly. The fact that a nurse with a great deal of experience took an unsterile tablet, crushed it up, heated it, drew it up in a syringe and injected it knowing the drug comes in a vial...that was sheer stupidity. In no way is that a communication error IMNSHO. We have come a long way in administering meds since the 40's when this was likely common practice. We have also come a long way since the 70's as well. While this was certainly a mistake on both departments of the hospital, I can't see how anyone could consider such stupidity a communication error. Out of curiosity, what oral tablets did you give in the 70's by crushing, heating, and drawing up to give IV without a filter?

While what you say is true I'm not so sure it is "wrong" to be a bit judgmental. When I say that I don't mean that it is up to the nurse to go and tell Mom what a dirtball she is, I don't mean that at all. But I'm not so sure any compassionate human can avoid thinking creepy thoughts about Mom and/or Dad. You are looking at, working with, caring for, and holding a tiny little human that is suffering in a way that no baby should have to suffer. It's mighty difficult not to become angry with the people/person that did this to the poor, innocent little baby. It isn't a matter of who should or should not play god, it is a matter of being human and feeling anger for what people do to their children. Would you feel the same about someone who molests children? What's the difference here, they are both doing severe and sometimes permanent harm to an innocent child and there is NO excuse or justification for doing that to another human being. If someone is preggers and they make the choice to keep that baby they have a huge responsibility to that child. The responsibility doesn't start after the child is born, the responsibility starts before she becomes preggers. I'd be a big fat liar if I claimed not to be judgmental in a situation such as this. That doesn't mean it affects my nursing in any way, that doesn't mean I would express my opinions to Mom. But to pretend I am neutral would be dishonest. And just for the record I am not claiming my way is the right way, it isn't. It simply is. I'm not so sure it is a bad thing to feel anger for what is going on. As nurses we can only take so much before we can't take anymore. I think it is okay to feel the emotion albeit good or bad, work through it, and move on. It is quite easy to suggest someone in this position shouldn't be judgmental however that doesn't really address the problem. The problem is what the nurse is feeling and what her coping skills are made up of.

The obvious is that the laws need to be changed. In many states (all???) you must obtain permission from the patient, or in this case the patient's parents/guardians. If nobody attempted to obtain consent from the guardian, the bitee should be pushing to attempt this. It's the same as when my sis was raped. This was when we didn't have a lot of info about HIV, clearly she wanted him tested for all the usual dx's but ... he refused. He had the right. The upside is that the judge did was pubic hair samples, as well as other samples. My sis was dating a police officer at the time. It was his buddies that helped to obtain the samples. Sometimes what we put out in this world comes back to bite us... in the pubic hair region.

Very true. Also I think sometimes people are so intelligent they missed the boat when it comes to common sense. Some people have great IQs but very little common sense yet others have common sense but not much in the way of book smarts.

I had decided not to write of a similar story because I didn't think it would be believable but after your Morphine story I have to tell this one. I certainly didn't believe it when I was told, I had to see the paperwork for myself. An older hospital RN had an order for 100mcg of Levothyroxine IV qd. Pharmacy printed the sig on the label correctly however the person filling the baggie put a 100mcg Levoxyl tablet in the baggie. For whatever reason this error was not caught in the pharmacy and the drug was sent to the floor. The nurse took the tablet, crushed it, mixed it with NaCl, heated it, drew it up in a syringe and injected it IV. She thought it was okay because she used a filter needle. The nurse should have probably retired a long time previous to this incident but she didn't. So the hospital gave her a choice, either retire voluntarily or be terminated. She retired. I suspect she probably lost her license but I don't know that for sure. I don't understand errors such as this or the one you posted about the Morphine. I can see errors where you give the incorrect dose or incorrect drug, but how could someone crush a tablet, a common tablet and think this is okay? Or how could someone draw up a dose in a syringe from a non sterile bottle? Seriously, what would you do... pour a bit into the cap of the amber bottle and draw it up? Isn't that about the same thinking as drawing up the drug from a suppository? How can a nurse not know better? An RPh I know thought that if you used a small enough micron filter that it would filter out all of the bacteria. How can someone get through 4-8 years of college and not realize this? The RPh defended the nurse with the Levothyroxine tablet because if she used the correct filter she thought it would be sterile. The morphine, the tablet given IV... that isn't human error, that is something much different, I just don't understand how anyone could make that kind of error. Again, wrong dose, wrong drug, wrong frequency... I understand. But the others I just don't get it. The spooky part of any med error for me are those that might have happened and I never realized it. You know, the big 'what if' questions. Most med errors can typically be reversed but only if we are aware we did it. Something I started doing a long time ago was after my checks and rechecks when I give a med I usually tell the patient what each drug is and what it is for as I am giving it. Something about saying it outloud makes a difference and often times the patient knows what they are supposed to be getting so that is yet another check.

I have one of those. It was about 15 years ago and to this day I feel horrible about it and it still haunts me. I knew my patient was not doing well on her meds, I knew she was pretty darn stable and doing well and suddenly some bright doc decided she needed mega treatment for mild asthma. She was Paranoid Schiz so she was already on a slew of psych meds and the doc ordered a huge amount of meds for mild asthma. If you looked at her MAR you can't really say the drugs were not okay to be given together but how many studies have been done with those specific 21 different drugs? Polypharmacy at its best. Within 24 hours something was very wrong. I called the doc and he said she was fine. I told him she wasn't, he reminded me he was the doc. The next morning she was dead. Just as I came into work she was coding. Her face was the size of a small watermelon. I *knew* something was wrong but I didn't push hard enough. Her symptoms were not really specific the previous day, it was one of those things that I knew her well enough to know something was very wrong. Vitals were fine, she had no complaints... but she was having a reaction to one or more of the new drugs. I still think of her often. I regret that I didn't push until someone listened to me. I could have easily pushed the issue but I didn't. For me the lesson was to listen to that little voice in the back of my head, it rarely leads me in the wrong direction.

I was working ICU one night and the resident ordered Augmentin for a patient. It came up in liquid form and the resident was going to give it IV! Yes, IV! I heard the nurse all but yelling not to give it and he was the type with the attitude he was the doc, the nurse was but a lowly 'gofer' ... you know, go for this and go for that. She kept begging him not to give it, she said it was PO only. He insisted it wasn't, it was IV. Finally the nurse ran out to get the clinical RPh and they ran back to the room just as the resident had finished giving Augmentin IV. The RPh asked what the h*ll he was doing? The RPh went on to ask when he has ever known Augmentin to be made for IV use and the nurse chimed in to add ... and since when do IV drugs come in Bubble Gum flavor! Finally, the resident caught on and realized what he had done. Amazingly, the patient was fine and suffered no problems becuase of it. I fully understand human error will happen. We are all human and we will ALL make mistakes. But it is nothing but stupidity and ego when someone is begging and demanding you stop and think about what you are doing and you ignore the huge issue the nurse was making out of this. When someone is that adamant there is a problem, you don't just ignore her, you stop and think.