What to do

[eternalbride]

I had a patient who is suppose to get an antibiotic IV around the clock. Now the problem is that she has missed 3 doses due to the fact that she has no. IV access. Now the plan is for her get a midline the next day. Should I reshedule antibiotics or just chart not done? This antibiotic does not come in p.o. form.

[ED Nurse, RN]

I need more info- why can't you start an IV? Are you in the hospital? Someone can get an IV in I'm sure. You have to chart not given, you can't just reschedule them. Have you spoken to the MD? Just bc a medication does not have a PO form does not mean they can't give a similar med in the same class, or a IM form.

[TheCommuter, BSN, RN]

I need more info- why can't you start an IV? Are you in the hospital? Someone can get an IV in I'm sure.

Based on posting history, OP most likely works in a nursing home/LTC facility. This means no IV team, no in-house pharmacy, and nursing staff who might not be the most proficient at starting IV lines.

Anyhow, the MD probably knows about the situation because he/she had to have ordered the midline placement. This happens all the time in LTC. I wouldn't worry about it if the MD is aware.

[roser13, ASN, RN]

This is most definitely NOT a question to ask on the internet. Patient care should be given according to facility policy, procedure and MD order. No one on the internet can give you an appropriate answer.

[eternalbride]

In retrospect I should have spoken to the doctor. at the time i told my charge nurse about the situation. She advise that I attempt to start one. It slipped my mind after the failed attempt. Others have tried before me and failed. The next shift nurse was made aware about situation. The PICC line team is suppose to be coming sometime during their shift. Should I have written a nurse's note staying reason behind not giving antibiotics?

[eternalbride]

Thanks for your replys. Yes it does make sense that the doctor is already aware since the order was put in place.

[ED Nurse, RN]

In retrospect I should have spoken to the doctor. at the time i told my charge nurse about the situation. She advise that I attempt to start one. It slipped my mind after the failed attempt. Others have tried before me and failed. The next shift nurse was made aware about situation. The PICC line team is suppose to be coming sometime during their shift. Should I have written a nurse's note staying reason behind not giving antibiotics?

So this pt needs abx, has missed 3+ doses, and your didn't think it was a necessary task to inform the MD? You are the nurse, you are responsible for communicating issues! What if this pt becomes septic? If I had a pt come in to the ED septic bc YOU did not properly treat this pt- I would be reporting you to the state. This is negligence! How do you think this is ok? People are just put on abx, especially IV, just because! You better hope this pt doesn't become further ill and suffer adverse consequences from your lack of care.

[NuGuyNurse2b]

I'm sorry, I had to like the above post. As harsh as it came off as, OP, you sound negligent. I mean you and your whole facility withheld a medication because of your ineptitude; nothing to do with the patient. If there's a silver lining out of this, you'll be wiser next time.

[TriciaJ, RN]

In retrospect I should have spoken to the doctor. at the time i told my charge nurse about the situation. She advise that I attempt to start one. It slipped my mind after the failed attempt. Others have tried before me and failed. The next shift nurse was made aware about situation. The PICC line team is suppose to be coming sometime during their shift. Should I have written a nurse's note staying reason behind not giving antibiotics?

3 missed doses? Doctor not informed? At this point I think you need to write an incident report.

[amoLucia]

Based on posting history, OP most likely works in a nursing home/LTC facility. This means no IV team, no in-house pharmacy, and nursing staff who might not be the most proficient at starting IV lines.

Anyhow, the MD probably knows about the situation because he/she had to have ordered the midline placement. This happens all the time in LTC. I wouldn't worry about it if the MD is aware.

I find it verrrry interesting that those respondents who are the most critical of this situation do not seem to be employed in LTC/NH field.

TheCommuter and I have been there & done that. We know that often things do not move quickly when something like this comes up.

NHs only have just so many few nurses who are certified (and proficient) to try starting IVs and this pt sounds like a tuffy one to start. TICK TICK TICK

Another fly in the oint is that consent for PICC/midline insertion requires consent (guessing that pt can't sign). Oh, pt's son/dtr is working when 7-3 left a phone call message (maybe lucky if there's cell/text capability). But the family delays getting back to NH. TICK TICK TICK

Let's hope that the pharmacy can provide IV ABT without having to call the insurance for IV drug and/or procedure authorization/approval. That's an adventure unto itself. TICK TICK TICK

The contracted Pharmacy IV team has to be called & THEY schedule the insertion as they are able to provide advanced IV insertion-certified nurses. TICK TICK TICK

Something like this situation requires unbelievable finesse to achieve. It is all dependent on getting all the celestial stars in perfect alignment. I say this with no meany-ness but you guys in ER/ICU/acute care have little to NO understanding how many hoops we have to jump thru to satisfactorily and effectively orchestrate this task.

With the exception concerning appropriate and TIMELY physician notification, I'm NOT surprised about the time delay in this snafu. (My take is that the MD was most likely notified approp.)

And just remember that this was the holiday season!

To address OP's concerns - it is hoped that all the details in this situation have been approp documented. The orig MAR would be circled as NOT GIVEN and the IV ABT would be started just as soon as the new PICC IV site tape was taped down! A new MAR would be started & timed just as soon as the med was being started.

I have only one possible questionable concern - could that pt NOT be sent out to a local hosp where Interventional Radiology coordinates new PICC IV insertions? That might have been an option but some facilities HAVE to go thru their own IV Pharmacy first. Just a thought.

[TheCommuter, BSN, RN]

I find it verrrry interesting that those respondents who are the most critical of this situation do not seem to be employed in LTC/NH field.

I think you hit the nail on the head. Nurses who work in acute care will never, ever understand the uphill battles faced by LTC nurses unless they've actually walked one mile in the shoes of the LTC nurse. Residents' needs cannot simply appear in thin air...after all, this is not the hospital.

I see some armchair quarterbacking at its finest.

[Libby1987]

Regardless of the lack of resources, OP seemed to not have notified the MD at the first missed dose and failed access attempt, "it slipped her mind.."

If she had notified the MD immediately when it was known that the antibiotic would not be resumed until access obtained, MD would then make decision whether the patient needed to be transferred or whatever other options were appropriate/available or to put antibiotic on hold. This post would then be a moot point.

And I say this as a HH nurse with even less resources than LTC (though this sounds like rehab).