TPN Bag Wrong in Practicum

[Tracy0924]

Hi all! Long time reader, first time sign up and post myself.

Today I did my Block III practicum. I'm hoping someone can help me out here. The TPN bag on my acute biliary pancreatitis Sim-man did not match the order written by the physician. The physician order had famotidine checked but the bag did not have famotidine.

I had no idea what to do so I just paused the TPN and said I would call the pharmacy after, but I never got the chance to call the pharmacy because I was so busy with everything else in the short 30 minutes that they give you.

Was I right to pause it? A classmate told me it is dangerous to pause the TPN because of the glucose/insulin content. But, another classmate said I was right to pause it. (Side Note: It was also running at the wrong rate, but I verbalized that I would have changed the rate if the content in the bag was correct, so I should be good for that safety point.)

Anyone have any comments on this? Appreciate any and all insight.

Thanks! Tracy

[NICU Guy, BSN, RN]

Were you starting the TPN or taking over for another nurse that had the TPN already running? When hanging a new bag, the contents must be checked by another nurse. In our MAR, TPN is a double sign-off with another nurse.

If the bag is already running when you start your shift, then someone screwed up not checking it before starting the TPN. I would first call the doctor and see if they want you to get a new bag of TPN or call pharmacy to get the Pepcid to add to the bag. Because it wasn't something that would cause harm to the patient such as having too much Potassium, then I wouldn't stop the TPN. It could take 30min-1 hour for you to get a new bag from pharmacy and get it started. In the mean time, your patient is not getting their nutrition.

[Tracy0924]

Thank you so much for this response. In the scenario, I was taking over for another nurse.

I will definitely take this knowledge with me. Very much appreciated!

[IVRUS, BSN, RN]

As GUY, so appropriately said, the problem is that whomever hung the bag, did NOT verify its contents, nor properly checked it with another medical professional before hanging. Now, I don't believe that the solution should have been stopped just for the missing medication, if this was the only thing pharmacy forgot to add and everything else was correct, but I would have alerted the MD and perhaps the DON or nursing supervisor can have an educational program centered around the issue.

[Tracy0924]

Thank you very much as well. At least I only did this in my practicum and not in reality. I'm glad I asked about this here!