Vanco: give or wait for vanco trough?

[rn.5245]

Hi! I am trying to figure out if I took the right action with an order for vanco and trough levels. My patient was on vanco q 24 hours. The doctor wrote the following order:

"vanco iv pharmacy to dose."

"draw vanco trough at 1600."

When i arrived for my 7pm shift, the trough for 1600 had still not been drawn, as the lab was backed up. The daily vanco was scheduled for midnight. The renal labs were wnl. I checked the trough from 2 days prior, and it was low, 4.6, so i called pharmacy about the order and they sent me the scheduled dose, which i gave at midnight. Then at 1:30 am lab calls with a vanco level of 27. Apparently they drew it late, on my shift.

This patient had past orders for vanco troughs and specific hold/wait parameters for the dose, and as i understood it, since this order didnt instruct to wait for the trough and didnt give parameters to hold vanco if the trough is a certain level, I was supposed to give it based on pharmacy and the schedule for the dose, and the trough was not to determine my midnight dose.

My question is, did make an error bc i didnt wait for the trough, or did i follow the order correctly as written?

Any feedback would be so helpful. Thanks!

[Ladypink-37]

I'm just wondering why was the vanc trough scheduled to be drawn at 1600, if the vanc abt wasn't due to be given until midnight, then the trough should had been drawn within 30min before that dose was given (if it hat was the 4th dose) another thing, u don't know when the lab arrived to draw the trough, it's all poor communication too, these are patients (human beings you go to the hospital to get well) and rely on the nursing team to provide good care). This is really important as it monitors the toxicity levels.

[Ladypink-37]

If the previous nurse changed the administration time from 1700 to midnight, then she could have at least notified the lab that the dose time was changed to midnight and they needed to draw tough now between 1130pm-12am...she could had at least done that for you since she was responsible to give the dose on her shift.

I definitely see where I fell short in this scenario, being the last line of defense I know I should have followed up.

for

I'm not sure if this changes anything, but upon review all my papers and the mar, I realized that the vanco was actually scheduled for 1700, with the trough at 1600.

When lab never came, the day nurse passed it to me by calling pharm and changing the time to midnight. But this was not really clear, as I did not realize the full situation....

So I am frustrated with myself in that I mishandled the situation, and just bummed that I did not realize/clarify with each team member that was involved, because I was on the receiving end of each of their actions, while they got to pass it down the line...

I hope this doesn't turn into a write up, although I would understand if it does happen...i will think of it every time i have a trough in the future, as i add it to my collection of mishaps i will hopefully never repeat this mistake!