I HATE contingency orders

The patient wasn't harmed, presumedly. Hopefully your coworkers and boss will look at it as a learning experience. For high risk "things" like heparin drips, it's often useful to have a nurse buddy look things over and make sure all is well ...especially when you're busy and flustered.

Most facilities require a witness when adjusting Heparin. You misread the order. Most heparin standing orders are.. hold the drip for an hour.. and go from there. Do you know the half -life of Heparin?

Most likely there was no patient harm.. but you made a big med error. Now you know to triple check anything to do with a Heparin drip.

Honestly, for something as potentially harmful as heparin, I would not want contingency orders either. Is that best practice? Maybe its something your nursing practice council can look at. I doubt you re the first person to make a mistake on that. If your unit is non punitive, report yourself. Maybe they'll do a RCA and change the orders.

Mistakes are how we learn, what you'll learn from this is that due to the short half-life of IV heparin, it would be unusual to have a 3 hour pause to adjust the ptt, now you know.

I don't think there is a viable alternative however to these types of orders, how should it work instead?

That's a very good question. I wonder if we could have a certain allotted time in the am to examine all the contingency orders and get the straight, rather than being expected to pick them up on the fly. That is, I don't regularly have enough time during my shift to examine all the orders because as soon as I clock in, I have to RUN to keep up with the antibiotics and assists to the commode and pain med requests and bad IVs and CT consents, etc. Also, we have to hunt for contingency orders, which could be on the active orders page, or written in small print on the PRN mar, or else written in on the scheduled medication MAR. Hunting for parameters can be rough when you're dealing with an unfamiliar medication, or with an MD with their own preferences (some say transfuse for hemoglobin

I think the problem is that there isn't enough time to review the orders at the beginning of your shift, as you acknowledge. That doesn't sound like an ideal situation. Typically, at the start of your shift, you should be reviewing all of the orders during/after getting report from the off-going RN (at my hospital we do a 12 hour check), since it is now your responsibility to fulfill them (or question them if they are not indicated). If your assignment is already made prior to the start of your shift, it may be helpful to review the orders prior to getting report if possible. Also, as someone mentioned, with high alert medications, you should definitely review any changes in the treatment with another RN, whether or not it's hospital policy.

Hope that helps!

This makes me so grateful for the process used at my place of work.

Pharmacy manages heparin drips entirely. They get the lab results, interpret them, then call us to say – "Hey, stop the heparin for an hour and restart at (insert rate) at (insert time). They change it in the MAR... I go into the room and shut it off... an hour later – when it becomes due – start up requires a double check with another RN... and VIOLA, all done! Minimum risk of misreading the order!

I am surprised that your protocols don't call for a more involved process when it comes to something as important as a heparin drip...

Either way, I'm sorry this happened to you. Your place of employment should take steps to minimize catastrophes such as this. Not every scenario allows for the appropriate amount of time to read and interpret orders... and while we are technically responsible for this type of mistake... there are also many ways in which we are set up to make them...