Published Apr 14, 2014
Hello all. I am a brand new nurse, graduate May 2013. I got a job in a Pediatric ER about two months after passing the NCLEX and have now been there for about 6 months. I'm pretty stressed. I don't Feel like my job gave me a proper orientation and I've pretty much been learning everything as I go. I'm always so afraid of doing something that will one day have my license taken away, especially since the state of limitations for children in my state is 21 years.
The other night at work something very scary happened. I had a pt come in who was febrile and the MD told me to put a line in. At this time, I had a break so my reliever told me she would do the line. Before I left for break there was no order for a bolus. But when I came back my reliever had put the line in and my reliever told me she had a bolus and was receiving maintenance fluids. I had other pts so I didn't bother checking the order or anything, I thanked her and I let the fluids continue running. About 10 minutes back from my break, my charge nurse starts questioning us both about the fluids. Long story short, the doctor had ordered two NS bolus. My reliever had given my pt one NS bolus and was now giving her D5. As expected, her sugar shot up.
after getting a second NS bolus, her sugar went back down. My pt ended up being fine (besides her persistent fever which she had to be transferred for). My charge nurse helped us "clean up" the situation documentation wise and I don't think she is going to tell anyone it happened. But she warned us that if it was anyone else in charge that night we would have both been written up.
I understand I was responsible for not checking my coworkers work but I didn't give this medication, is this really my medication error?? If they had written me up, what would be the penalty for something like this? Is this something I could lose my license over?
any words of advice on this or how to protect myself in General would be really appreciated.
I think there are some details missing here. D5W at a maintenance rate would not cause a child's "sugar to shoot up". But if the other nurse had continued running D5W at the bolus rate, that's a different story. You also don't say how long your break was. I can't imagine that it was more than an hour. So if the other nurse put in an IV, gave a saline bolus and switched the IV fluid to D5W before you came back, and you checked on the patient and the orders "10 minutes" after you came back, there should have been no harm done. I also don't see why you would be accountable for someone else's practice. You have to have at least a little bit of confidence in the person who covers your patients while you take your legally mandated breaks, or when you've got a critical patient. As TheCommuter pointed out on another thread, there's far too much hysteria about "losing one's license". Of course people lose their licenses but when they do it's for things like assaulting a patient, stealing narcotics or coming to work under the influence. They don't lose their license for something someone else did. And they don't lose their license for hanging the wrong IV fluid. It that was the case, NOBODY would have a license. Instead of panicking and worrying about your license, apply some critical thinking to the situation. What would a reasonable and prudent nurse do? That's how the courts and regulatory bodies look at things.
Thank you for your reply. My break was for an hour. And I do believe she was running the D5 at a bolus rate. The pts blood sugar went up to 200. But then came back down after we gave her the second NS bolus. I didn't see how I was accountable either. And when I was told I would have been written up to I didn't understand. I would have only ever signed anything saying that I didn't check my coworkers work. If they were gonna write me up for a med error I would have called my union rep and not signed.
Esme12, ASN, BSN, RN
The person who started the D5 bolus would be culpable. You should be able to trust your co-workers...however this one proved she/he needs to be watched. What you did "wrong" in a very general sense of the word was not check your orders.
Over time you will learn to check and double check. My pet peeve is the MD who goes back and adds to the order and doesn't tell you....Grrrrr. You will learn to be very specific when co-worker says they will help you by saying things like...thanks for starting the line for me she needs a Saline bolus as well. When you return..how did the line go is the SALINE bolus infused? Check and double check your orders. When you come back from break check ALL your patients orders and see them all quickly. Even if it is just a glance and a how are you doing and give an update like...your labs are still pending. How are you feeling? Did that "whatever" help? What can I do for you? you are killing many birds with one stone.
You are a new grad. It takes TIME to adjust let alone in an ED environment.
There was time I hated Peds cases...the made me nervous. It is the ED nurses job to be a master of all trades. Take this as a learning experience....remember that you are going to remember the babies discomfort much longer than they ever will. It is your scope of practice and non academic ED's all over the US see all ages all the time.
Get the ENPC course book and read it. Pediatrics is a specialty all it's own. their airways are different....smaller and structurally....they can eat and breathe. Remember that 1mm of swelling on an adult airway that is 5mm wide is completely different than 1mm of swelling on a 1mm airway. Vital signs are not a predictor of how sick a kid is for they can compensate forever and by the time they reflect it in their vitals....they are in critical trouble. The cap refill/urine output is a great indicator on the younger pedi population as an indicator of distress and end organ perfusion.
So when did they last pee and how many wet diapers in x amt of time is huge!!!! Using accessory muscle is a huge sign of distress.
They need fluid, o2, and keep them warm. a crying and screaming kid is a stable kid....it's the quiet ones that will/should scare you. if the child has a congenital/chronic illness listen to the parent.....they have done this before and can help you.
Rhythms for kids....slow, fast, and absent. Familiarize yourself with the normal vital signs for the age group!
Infants....was the baby full term, what was birth weight, weigh all babies regardless of what the parents say...emphasize how important it is as that is how the medicines are given. small mistakes have huge consequences for the pedi population. If they are small so should the dose be as all doses are weight based.
The ENPC (emergency nursing peds course) has a terrific peds triage standard that should be used by all eds.
ciiamppedds: c is chief complaint, i is immunizations, i is isolation (has the child been exposed to any communicable diseases), a is allergies, m is medications,p is past medical history, p is parents impression of the child's condition, e is the event surrounding the illness or injury, d is diet, d is diapers (voids) and s is signs and symptoms
great power point triage assessment
[TD=align: left]age group[/TD]
[TD=width: 24%, bgcolor: #ffffff, align: left]heart rate[/TD]
[TD=width: 26%, bgcolor: #ffffff, align: left]systolic blood pressure[/TD]
[TD=width: 27%, bgcolor: #ffffff, align: left]newborn[/TD]
[TD=width: 23%, bgcolor: #ffffff, align: left]30-50[/TD]
[TD=width: 24%, bgcolor: #ffffff, align: left]120-160[/TD]
[TD=width: 26%, bgcolor: #ffffff, align: left]50-70[/TD]
[TD=width: 27%, bgcolor: #ffffff, align: left]infant (1-12 mo)[/TD]
[TD=width: 23%, bgcolor: #ffffff, align: left]20-30[/TD]
[TD=width: 24%, bgcolor: #ffffff, align: left]80-140[/TD]
[TD=width: 26%, bgcolor: #ffffff, align: left]70-100[/TD]
[TD=width: 27%, bgcolor: #ffffff, align: left]toddler (1-3 y)[/TD]
[TD=width: 24%, bgcolor: #ffffff, align: left]80-130[/TD]
[TD=width: 26%, bgcolor: #ffffff, align: left]80-110[/TD]
[TD=width: 27%, bgcolor: #ffffff, align: left]preschooler (3-5 y)[/TD]
[TD=width: 24%, bgcolor: #ffffff, align: left]80-120[/TD]
[TD=width: 27%, bgcolor: #ffffff, align: left]school age (6-12y)[/TD]
[TD=width: 23%, bgcolor: #ffffff, align: left]18-25[/TD]
[TD=width: 24%, bgcolor: #ffffff, align: left]70-110[/TD]
[TD=width: 26%, bgcolor: #ffffff, align: left]85-120[/TD]
[TD=width: 27%, bgcolor: #ffffff, align: left]adolescent (13y +)[/TD]
[TD=width: 23%, bgcolor: #ffffff, align: left]12-20[/TD]
[TD=width: 24%, bgcolor: #ffffff, align: left]55-110[/TD]
[TD=width: 26%, bgcolor: #ffffff, align: left]100-120[/TD]
[TD=width: 27%, bgcolor: #ffffff, align: left]adult[/TD]
[TD=width: 23%, bgcolor: #ffffff, align: left]16-20[/TD]
[TD=width: 24%, bgcolor: #ffffff, align: left] 70-100[/TD]
[TD=width: 26%, bgcolor: #ffffff, align: left]
triage course - nursing continuing education (ce) - nurse ce - ceufast.com
pews.....the pediatric early warning (pew) score system can help nurses assess pediatric patients objectively using vital signs in the pediatric intensive care unit. the scoring system takes into account the child's behavior, as well as cardiovascular and respiratory symptoms. http://academics.ochsner.org/uploade...0PEWS%20v2.pdf
ahrq innovations exchange | pediatric early warning (pew) score system
this is another great assessment tool for assessment short and sweet but informative.
Parents welcome....sitting in a in a chair, without wheels, only. Parents like Gomers will go to ground.
(I couldn't resist "The House of GOD" reference)
If they have tears have no fears.....If the pacifier's wet they're all set.
Learn nursery rhymes and learn the popular kids shows.... NOW!
They are going to cry from the moment you begin to hold them...forage on! YOu and the parents will remember it much longer than they will.
Beads will find places where no bead has gone before......
The art of calming a parent that although their child is bleeding and it's important to everyone.....the child will survive the injury.:hug:
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