Situation about PRN lorazepam

[nminodob]

While orienting on nights, a traveller shouted to me as I was entering the med room, "Get me 2 mg Ativan quick!" I was startled, but asked, "Who's the patient?" She told me, and I went in and got it for her. I had expected to see a pt climbing the walls, but strangely, when I found her in the pt room the lights were down and it was very quiet. I handed her the vial and she said, "Thanks, hon." That was it. Later I found out she did the same thing with 2 other nurses, demanding PRN Ativan and behaving as if she wasn't able to leave the pt room (there was a sitter in there, but I am assuming on break at the time). Questions popped into my head, like, Why all these PRNs were needed when she was relieving the sitter and couldn't get them herself, and Maybe as a newbie I was taken advantage of??? I didn't see anything else out of the ordinary to lead me to assume diversion was taking place, but the sitter seemed very stressed and overwhelmed. Was I right to "step and fetch" Ativan for this traveller? Should I have administerd the dose myself?

Any thoughts on this?

[caliotter3]

Sounds very fishy to me and as if you assisted in acts of diversion. From now on, let them get their own meds, or administer the med yourself. You don't want to be the one accused of diversion. Whose signature is on the record for removing the med? Your signature. No. Don't do this again.

[tothepointeLVN, LVN]

I have no idea but I would love to hear the answer....

[netglow, ASN, RN]

So now what should she do? self report? to cover her tail? Wondering if you pull meds for anybody at all.

[Vito Andolini]

I think she should talk to the traveler - share her impressions and concerns and get some answers from her. Depending on what the response is, she can go from there.

Did the traveler give the med to the patient? Does the traveler have narc access? Where was the sitter? Just get everything answered. Leave no questions oppen in your jind. Or even open in your mind, LOL. Sorry, feeling goofy today.

[truern]

You signed it out of the Pyxis?? Did you make sure she signed off on it on the MAR?

I wouldn't do it, but that's me. It's hard to judge the situation from here. For sure I'd mention it to *somebody*.

[MoopleRN]

I would never pull a med I'm not going to give. I would've gone into the room first to let her go pull her own med while I stayed with the patient and if I'd seen the patient quiet, I'd wonder out loud why she wanted the ativan. If there was a sitter in there, she didn't need you to sign out the ativan, she can go get it herself. If the sitter is on break, the sitter needs to be out of the room on a real break. Sounds like a good learning experience for you.

[onetiredmomma]

In a true emergency we should be able to trust each other when asked to get a med "quick". Since you found out she did it to two other nurses I would suggest chatting with your manager. Tell her/him exactly what you told us and ask her what she would advise you to do in the future. The other thing you could do is offer to stay with the pt like was previously suggested.

[PICNICRN, BSN, RN]

I work in an area where we pull out prn sedation and pain meds for eachother's patients all the time. HOWEVER.... usually, it IS because the patient is doing the "aligator roll" in the bed and the my co worker is laying on them to keep them intubated. Maybe this nurse could not leave the room because the sitter was on break? I assume you pulled the 2mg vial so there was nothing to go back in and waste it with her later. Did you check to see if she signed it off? Who knows, maybe she is just that lazy! I guess in the future you should just make sure it is signed off on the MAR and you watch the person actually give the med or you could give it yourself if it would make you feel better. As long as the MAR matches up with the Pyxis you should be covered.

[BradleyRN]

Diverting. She has probably been exposed for giving so many PRN doses in the past and now realizes she needs to keep as many as possible out of her name.:)

[RheatherN, ASN, RN, EMT-P]

I would have stated that i wasnt comfortable doing that, esp with the 'weird' situ, and told her i would stay with her pt so that she was able to get the med under her name and admin. if she stated that she doesnt have access, i would get the cn and ask them to help, because your not comfortable. esp if its not emergency!! ya know? like it sounded. if she's mad, shes mad, oh well, its your license.

-H-RN

[SweetLemon]

I have to agree with the above reposes.... sounds very fishy indeed. If it happened once I might be able to see it but 3 times in one night. Also is this nurse giving this as an injection and if so He/She had better have a good reason to do so. If you are walking in the room and finding the patient is in no way a danger to themselves or others I would start to wonder if possibly this nurse is not only taking advantage of you but his or her patient as well.

Just to play the devils advocate in regards to patients and PRN ativan though, I know of a few patients on my unit who when they first come in and have not been on regular meds for a while have very explosive personalities. They go from 0-10 in just a few minutes and do not require much stimuli to really get them going. If you did not know the patient the signs are subtle but rather them letting them to get to a place where they have lost all control I offer a PRN (PO) and if they decline I let it go. I would never give an emergency IM unless absolutely necessary.

If you are the one getting the drug out of the cart and signing your name to it, you should also be the one administering it. This keeps everyone safe in the end. If the other nurse is the one administering it they too should be doing a followup, but what if they don't... sounds like this nurse uses the narcs fairly liberally with their patients and could possibly over sedate them... now who going to get in trouble.... your name is signed to the narc :uhoh21:. Sorry you are getting taken advantage of I hope it gets better soon.