Was I wrong?

[waggykeeper]

The other day I was covering IVs for LVN, the doc ordered IVF c K+, before hanging it I checked the K+ levels and it was 5.6, the LVN called the doc about it but doc said "just give what I ordered" and hang up the phone.

So I refused to administer the IVF c K+. I am a relatively new nurse, but that was a rational thing for me to do. Before making the decision I asked my charge nurse and she just said to document it but did not advise me for or against it.

Am I going to get in trouble for this?

[beewink]

It's hard to say if you'll get in trouble - each workplace is different when it comes to good & bad management (a bad manager would blame you) - but you definitely did the right thing. It is so frustrating dealing with doctors sometimes!

[GilaRRT]

Depends on the patient. I would have no problem giving a DKA patient potassium even if their potassium was a bit elevated. However, a renal failure patient with an elevated potassium may be a different story. An elevated serum potassium does not always mean the patients total potassium is elevated.

[canesdukegirl, BSN, RN]

Are there parameters at your hospital to hold a med like K? I would have held it, and would have accepted a write up if the doc wanted to write me up. It is a patient safety issue. The K was elevated, and I think you did the right thing.

[guinans]

We all know as nurses we cannot simply "follow doctor's orders" if we know harm will or may come to a patient if we follow the order. Because you hold a license and are responsible for your own actions, I think you have a right to have it explained to you the rationale for administering IV potassium to a patient with a high potassium level. I think you were right. If your charge nurse was not able to investigate the situation, and the physician was unwilling to explain, maybe your nurse manager, a nurse educator, or a supervisor could investigate prior to administering the med. I don't see how anyone could fault you if you took steps to clarify an order that made you uncomfortable.

[brownbook]

You probably did the right thing medically unless there is something we don't know about this patient?

I know the LVN told the doctor, but the last thing he said was "just give what I order." You (it would have been nice if your charge nurse was more proactive) or the charge nurse needed to call the doctor back and repeat, reinforce, whatever, what the K was not going to be given. Document document document. Quote what you said, quote what he said. Even have a co-worker, or charge nurse, listen on the other phone line for "back up."

If it was still an issue you need to find your institutions "chain of command" a list of people you can call, to go over peoples heads, to keep calling and notifying, if you feel a patient isn't getting proper care.

[beewink]

You probably did the right thing medically unless there is something we don't know about this patient?

I know the LVN told the doctor, but the last thing he said was "just give what I order." You (it would have been nice if your charge nurse was more proactive) or the charge nurse needed to call the doctor back and repeat, reinforce, whatever, what the K was not going to be given. Document document document. Quote what you said, quote what he said. Even have a co-worker, or charge nurse, listen on the other phone line for "back up."

If it was still an issue you need to find your institutions "chain of command" a list of people you can call, to go over peoples heads, to keep calling and notifying, if you feel a patient isn't getting proper care.

Great advice. I did what you recommend regarding the documenting once while I worked in an ICU - similar situation. My problem came when the Nurse Manager found out and emailed me asking me to rescind my charting because the doctor 'may get in trouble'. What a joke and I refused.

[Soulwindow42]

Certainly u did the right thing and its simple. Why give more if the pt has more than enough. It would be safe and protective for you and the doctor if you have called him again, or call your charge nurse for help to talk with the doctor. He may get irritated but he will realized he should be grateful you prevented the patient from possible cardiac arrest:)

[jrock17]

Good Job!!

If I could only add...perhaps suggest a follow-up BMP in like 2 or 4 hours to confirm/deny the need for this extra K+?

Then, you will both find out if there is a true need for this pt to have supplemental K+.

Way to stick to your guns

[blondy2061h, MSN, RN]

How much potassium was in it? If it was 20meq in 1000 ml at 42 ml/hr or something like that, I wouldn't be concerned. I'd also consider if I were giving other potassium sparing or wasting drugs, the patient's creatinine, patient's potassium history (were they 2.8 that morning and up to 5.6 after getting 80 meq or something?). It's too hard to judge without knowing the whole story.

[systoly]

I'd have called the doc myself. Did the LVN write up a TO order? Did you hear her talk to the doc? A lot of times, the response you get from the doc depends on how the situation is presented.