What did I do wrong?

[mzsuccess]

OK. So I'm a Cna while in nursing school. I work at a retirement center. And I was assigned to sit with this gentlement who had a stroke. One evening while sitting with him he gets really agitated and starts yelling, screaming at his wife. Kept getting up saying things were out the window that wasn't there, asking was he going to doe and couldn't sit still. I thought he was honestly going to hit his wife..I never seen him so upset. Now I'm not suppose to give meds we give them to his wife and she gives them to him. Every other day, the mangers are changing the "what to do" forums and who to call and his son also. He's on hospice. I called the triage nurse because it was late. I explained to her what was going on and I told her he had ativan and she told me to give it to him. ThT was two days ago and now. I get to work and I hear I'm in big trouble and the son is so upset yelling. Saying it was the wrong medicine, but it had his name on it and he's now messed up. Anyway I'm suppose to have a meeting tomorrow and don't know what to expect. I feel bad and everyone is looking at me crazy like its my fault and I don't know what to tell my boss. I feel embarrassed and it makes me not want to be a nurse anymore. Plus the wife is fabricating the story and she isn't all the way in her right mind. How can I handle this or should've handle this? I charted everything, like I was suppose to and other girls gave it to him and didn't chart anything.

[Nibbles1]

I think at worst, just my own professional nursing opinion, you will get wrote up and a good talking to. You know now to never ever put yourself in this situation. And after you become a nurse, you know to never put another cna in this situation.

[mzsuccess]

That's guys. Yeah apparently he wasn't suppose to have the ativan anymore and it was in his med lockbox. It was a note, that said if he becomes agitated call nurse and wife gives ativan. He's continuing to act out but he was that way before he even had the med. It does seem like the hospice nurse didn't take it out because she ran here to taken it out out earlier. So now it falls on me. Funny thing is I was asked to pick up another case and my boss answered but didn't say anything about it. It was really a poor choice.

[mzsuccess]

I meant thanks guys my phone is always changing my words. Bit the wife is changing her words around..so I'm in hot trouble.

[mzsuccess]

Kryptonite no I didn't hand her the wrong med. We have a key that we keep away from her as responsibility and he was yelling and acting abnormal. I called the triage nurse and she saidto give the atvian to the wife to give to him at 0.50 ml and that's what I did. And charted every single thing. This happened on Saturday and I come back to work today and this is what I'm hearing. The med was apparently dced and was still in his box. But their were notes about giving him ativan but we as Cnas wasn't aware it was stopped.

[mzsuccess]

OK the med that was given was called

Cp HALOPERIDOL it said to be given for agitation. But people call it ativan and I don't think its the same. That's the name I charted for the med.

[vanilla bean]

Well, the good news is... you didn't give Ativan, which the son was concerned about. The bad news is... you practiced outside of your scope and then posted details about it on a very popular public forum!

[Red Kryptonite]

Haloperidol, trade name Haldol, is a completely different drug than lorazepam, trade name Ativan.

I'm starting to see why there is a problem.

[mzsuccess]

Well he wasn't suppose to have the other med I listed which had for agitation written on it. So I guess I'll be possibly getting fired.

[mzsuccess]

I really don't want to be a nurse anymore

[blondy2061h, MSN, RN]

I'm so confused

[jadelpn, LPN, EMT-B]

The triage nurse made an error--apparently she did not know the Ativan was d/c'd either. Ativan and Haldol are 2 different things. I would think that a licensed nurse who is directing you incorrectly would be on the nurse. When you called and explained the situation, it would be up to the nurse to then decide to come and assist and medicate. Instead, she chose to have you assist the wife in medicating the patient. Which was Haldol, the only medication in the box for agitation. (I am assuming...)

In any event, the son can cool his jets as the patient never received Ativan. The triage nurse should be the one explaining as she delegated you as opposed to going to the home herself to assess. And you did as you were delegated to do--which in assisted living or some home care hospice, it is well within the realm of a medication aide to assist the client or the family member in obtaining a med from a lock box to administer in that setting. And it is up to the primary nurse to educate the patient/family on safe administration of their own (or family member's) meds--IN THAT SETTING--it is not acute care, it is not a LTC licensed facility, this is hospice, which can be most compared to assisted living.

With all that being said, OP, you do need to familiarize yourself with the medications as well. So that you are clear on which med the wife needs to be looking for in the box. And not to use the wrong medication name when communicating with the family. The triage nurse could also update the son, and not leave that to you to take on.

Because this is hospice, this patient will get progressively worse. Which could manifest itself in acute behavioral changes. To justify this as a family member who is not on the same page as this, and going through the "letting go" process, family can and do "blame" just about anything. ("They gave him ATIVAN, that is why my usual mild mannered father is now a raving lunatic!!") This is inaccurate information.

Which brings me to--the only thing that you could say is that you called the triage nurse per protocol with an acute mental status change. You were delegated to have the wife give "Ativan". You pointed to the "agitation drug" and the wife poured and administered. You later realized that it was not Ativan, but Haldol. You were just helping the wife look for the "PRN agitation" drug.

There was no Ativan, the patient never got Ativan, and you did not administer anything the wife did, as per protocol.

Should you continue in this line of work, I would be very clear on when you need to have a nurse come and assess the patient, and to begin interventions. I would be very clear on what medications are in the lock box and what they are used for as to direct a family member accordingly, and be equally as clear of your need to have the nurse call and discuss the plan of care with a family member (like the son).

The bottom line in all of this is that as the licensed nurse on call who is triaging issues, the responsibility lies on the licensed person on what is delegated to UAP's.

[mzsuccess]

Why? Because I was so dumb?