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.

[SmilingBluEyes]

I have worked LTC. If one of my residents missed that many abx, there definitely would be a call to the doctor and charted as to what he/she said to do. I would cover my butt and that of the facility.

Otherwise, I would be in a world of ----

[Here.I.Stand, BSN, RN]

TheCommuter and AmoLucia -- I completely get how this could happen, given 1) pt is a difficult stick, 2) relatively low need for IV starts in LTC, and the fact that IV starting is not like riding a bike, and 3) no ultrasound to assist in IV starts.

Where the OP went wrong was not addressing the issue. The prescriber should have been notified about the lack of IV access. S/he could have opted to change to a PO antibiotic to which the infection is sensitive, transfer to a hospital for PICC placement, etc. The problem needed a solution; forgetting about it or ignoring it is not a solution.

[ED Nurse, RN]

I can't even count how many septic pts I have received from LTC bc they were not treated appropriately or the signs of infection were not identified quickly enough. So "armchair quarterback" I think not- just bc I work in acute care doesn't mean I don't know what I'm speaking about with LTC. A standard of care is a standard of care- in LTC and acute care, and is this situation the standard of care is not being met, plain and simple. The cavalier attitude that, "oh well, I forgot," or "oh well, this is just how it is in LTC" are not acceptable. Maybe the complacency of just accepting "it is what it is" in LTC needs to stop and like in acute care, need to fight to get what pts need, or send them to acute care where they can get the acute care they need instead of waiting days for IV abx bc they don't have an IV. I'm very bothered by the complacency in this situation and even further bothered that some people think it is ok that the pt has missed multiple doses of abx.

Bottom line, I see negligence in this situation- on the nurse and the MD if aware. However, I do not think OP even realizes the severity of this situation, which is even further disturbing.

[TheCommuter, BSN, RN]

I would cover my butt and that of the facility.

Otherwise, I would be in a world of ----

I concur. Regardless of which setting, all nurses must be vigilant and practice in a prudent manner that meets or exceeds certain standards of care.

[4boysmama]

I'm sorry, but those of you claiming armchair quarterbacking and that everyone who is being harsh with this nurse must be (only) acute care nurses...I'm here to tell you that I am a LTC (and also home hospice, with even less resources out in the field at pt's homes!) nurse, and this would never, ever fly in the facilities I've been in. 3 missed IV antibiotic doses?! And for an abx that doesn't have a PO version (I'm going to take a wild guess that we're talking about Zosyn here?) How much time are we talking about for the "3+ missed doses"? Is that 3 shifts? So....24 hours? I can tell you with utmost certainly that if this had been where I work, if a pt of ours on an iv abx went longer than 1 shift without tx, and we were unable to insert a peripheral line ourselves (which would be unlikely) and the outside PICC team we contract with was unable to come out stat and could only do until the next day....that any of our docs would be ordering that we send that pt back to the hospital for line placement and initiation of the abx. AND if we hadn't notified the doc? OMG...pretty sure there would be serious (serious!) disciplinary action on the nurse(s) who failed to call. That's a delay in treatment, big trouble with state survey!!

OP - you simply can't let things like iv abx "slip your mind" we're not talking about skin lotion or multivitamins. imo, Highest priority (besides emergent issues and pts crashing, of course) in LTC is iv management, blood sugars/insulin management, and wound care.

[NuGuyNurse2b]

seems like you and all the others accusing members of armchair quarterbacking are taking this too personal. No one has expressed any negative thoughts about LTC nursing per se. At least not in this thread; maybe you're carrying some of those feelings from that other thread on LTC. The issue is the OP's handling of the situation, or rather, her mishandling of the situation. are you honestly telling us that what went down was acceptable? Let's be objective about this before you start hurling accusations.

[NursesStickTogether]

She probably did. It helps to have some support & get other opinions especially if it's not something you deal with every day. Pretty sure that's the basis of this site...