gertiemae

I work night shift in a skilled care center. Our pharmacy supplies us with emergency boxes filled with abx, lasix, assorted IV meds, etc.Sometimes the MD orders a dose that is not supplied. Our Vanco does not come premixed, but several other antibiotics do. I would not hesitate to use 1/2 bag of the premixed antibiotics. HOWEVER I would make sure that the bag is well mixed, and draw out 1/2 of the solution, and mark the dosage and amount of fluid plainly on the IV bag. Vanco is not something to fool around with, and I have known IV pumps to be inaccurate. I would feel MUCH safer having removed the extra amount myself. In your case, I would also notify the pharmacy the next morning, so there would not be any question about what the patient had received.

I usually use the latest 'extra-stength' hand cream from the sample bin at Wal-Mart. I've found several good ones, including some of the Jergens for extra dry hands. My current favorite is the Palmer's Olive butter lotion. It absorbs quickly, and leaves no greasy residue... Also, for those nasty, painful papercuts, etc. I use super-glue! It Burns for just a second, but seals up those little boogers like a dream, puts down a water-proof seal, and protects from germs...and by the time the glue has worn off, the cut is healed. Got that tip from my doctor. After all, it IS the forerunner for the surgical adhesive that everyone's using these days!

In our center, each hall has it's own report sheet, with room number, patient, doctor, and room for notes on each. Report is usually taped, and the amount of detail varies, depending on how long the oncoming nurse has been away from the hall. The charge nurse in turn gives report to the CNTs, who have worksheets of their own, with I&O, bath schedule, meal % and information important to their care. Team coordinators report off to each other (and also receive report from the charge nurses), either taped or verbal depending on circumstances. these reports are more detailed as they include scheduling, coordinating the patients' care with all departments, and interacting with patients, family members, and doctors.

If the narcotics were scheduled meds and not PRN, that constitutes a med error for each dose omitted. This is a serious situation, especially if this is not a new nurse, not new to that center, and familiar to the med carts. Not to excuse a new nurse making the same mistakes... the patients involved did not get the medications that they needed... The others raise a good question... if she was hired just one week ago and only works weekends, why is she not still receiving orientation?? It sounds to me like more than one person has dropped the ball, here, and once again the patients pay the price. I am also disappointed to hear that you learned of this by overhearing others talking about this. This should have been addressed quietly by the DON with the nurse involved, and not discussed at all by the other managers, ESPECIALLY where they can be overheard!!This could have a tremendous negative impact on this nurse and her ability to be effective in her position as both a nurse and as a supervisor.(assuming, of course that the errors are addressed and do not reoccur).