So the story goes like this. I am a new nurse for about 8 mths now. The patient was having febrile neutropenia with 2-3 episodes of a spike of temp at night for the past 2 weeks, no sign of infection, have cancer, and was getting chemo. The nurse last shift told me not to give the meropenem if the blood culture was negative in the shift change report. I re-read the MD note and I thought the MD note also said that and I took the note as an order (Apparently I read the old note, the MD added a note saying to continue the abx after, which I did not read). The blood culture was negative, and I did not give 2 doses of the meropenem as a result. In the day shift, my buddy nurse texted me and told me the family was upset that the pt missed the 2 doses of abx. The family was very upset and the pt was crying over missing the 2 doses of abx and that I did not give the 2 doses of abx without an order. The day nurse received 6 phone calls from the family. The MD and the day shift nurse had to apologize. I think the pt received the final dose of abx today from the day shift nurse in the end.
I feel like I got no one to talk to that could empathize so I am writing here. I feel sorry for the pt, the family, the MD, and the day shift nurse. I feel like I let them down and it was dumb of me. I know that I can't blame anyone because I am the one making the final decision. Though I feel sorry, I am also scared about what will happen to me and if the pt will be okay. What do you guys think? I just want the honest truth and not just comforting words. ?
However, sometimes things don't go as they should and it often comes back on us nurses when things didn't come together.
I hear what you're saying with your post and agree it is inappropriate. You have provided a great example of this problem. I actually might consider filling out an incident report over something like this. Someone has to take responsibility.
Only minor point of contention to your post is that I would not have something like this coming back on me (as far as both my personal emotions if a doctor says something to me and as far as whomever else wants to act like I should've been able to make other people take responsibility). About the time that a med like this just falls off the MAR because no service will take responsibility it's time for an incident report and whatever real-time escalation is necessary. I understand that we don't have time for endless escalations and waiting for return phone calls that never come but at some point it is just other people who have done wrong, not me. I would feel kind of nothing if a doctor had some disgruntled attitude with me about this situation: "I personally called your service about this and my call was not returned."
Was this a paper or electronic note? Either way, notes should be banned. They just create this kind of confusion. Doctors should stick to orders and putting them in themselves.
Ban consult/progress notes? That is how services are billed. ?
JKL33
7,038 Posts
I hear what you're saying with your post and agree it is inappropriate. You have provided a great example of this problem. I actually might consider filling out an incident report over something like this. Someone has to take responsibility.
Only minor point of contention to your post is that I would not have something like this coming back on me (as far as both my personal emotions if a doctor says something to me and as far as whomever else wants to act like I should've been able to make other people take responsibility). About the time that a med like this just falls off the MAR because no service will take responsibility it's time for an incident report and whatever real-time escalation is necessary. I understand that we don't have time for endless escalations and waiting for return phone calls that never come but at some point it is just other people who have done wrong, not me. I would feel kind of nothing if a doctor had some disgruntled attitude with me about this situation: "I personally called your service about this and my call was not returned."
That's it. ??♀️