What's your best catch?

[beekee]

I was reading another post called what was your worst mistake? I find reading about mistakes very informative and educational, but we never get kudos for all the good stuff we do. We just get lambasted (sometimes by others, often by ourselves). So, I want hear about your best "I rock" stories!

I don't have any great stories, but I'll share one recent encounter. I had a CHF patient who became fluid overloaded and went into respiratory distress. Doctor ordered P.O. lasix instead of IV. I took the time to double check that the doctor had indeed wanted PO (he didn't). I was a little hesitant to bother the doctor again, but he had a reputation of belittling staff. But, I did it anyway and he thanked me for calling (and changed the order).

[dianah, ASN]

When I worked in Radiology I happened to be passing one of the X-ray rooms (the one we usually did barium enemas in, but other X-rays and fluoroscopic exams were done in there too), and something told me to stop and look in the room.

As I opened the door, there was one of our student radiologic technologists, standing next to an in-patient. The student was just preparing to disconnect the IV.

"What are you doing," I asked.

"Preparing the patient for this exam," the student replied.

Meanwhile I eyeballed the IV: it was heparin infusing.

The student was planning to disconnect the infusion for the 30-45min exam.

I instructed the student to leave it attached, that the patient needed this medication.

Just took a few seconds to educate the student to always call one of the nurses before disconnecting an IV. :)

[Coffee Nurse, BSN, RN]

As a newish grad, I had a very sick kiddo on multiple inotropes one night. Changed all his lines per usual at the beginning of the shift, then watched as his BP drifted down and down over the next little while. After obsessively checking every line, connection, pump setting, etc., I finally figured out that pharmacy had sent up a premade syringe of dopamine -- with no dopamine in it (i.e. just the diluent, D5W or whatever it was) Ordered a replacement stat, hung it, and boom, BP back WNL.

[canoehead, BSN, RN]

My first good catch was a kid with vitals going up BP and HR while he pooped blood all night. He was well out of his normal range, and had an alarming amount of blood loss. The pulse went up, as expected, but so did the BP, I think the last reading was 160/90. I discussedit with my coworkers, the night supervisor and the resident on call multiple times. The resident finally gave me an order for 20mg Lasix (patient had NO renal issues) and my charge nurse flipped and called the attending. I think that was the only time an attending was called by nursing at night that I remember on that job. Anyway, he came in, and said that the patient was close to coding. Apparently the increasing BP was part of the great pediatric compensation we hear so much about, and we caught the child just before he crashed. My documentation of multiple calls to the resident, and consulting my colleagues saved me and that boy.

The best catch I ever did was a lady on a MS unit, sorry I can't remember the details or even her primary diagnosis. I was night supervisor and a travel nurse called me into the room because something "just isn't right." We did every assessment we could think of, and got just borderline sick results, but the patient thought she was dying (bad sign) and while I was watching she had about ten seconds of precode gray pallor. It was dramatic enough and clear enough that I spoke to the physician myself. He was less dismissive of me, but still said there was nothing wrong. I stood my ground, and pushed, saying she was extremely sick, so he ordered more labs...and got a pH of 7.2. We flew to the ICU. Equal credit goes to the travel nurse who knew something wasn't right, but couldn't nail down why she felt that way. Nursing (and parental) spidey senses are should not be ignored.

I want to add one more. I was working OB, had a woman in labor that wasn't making any progress because a previous biopsy of her cervix had healed it shut, she couldn't dilate. The physician decided he was going to put a scalpel in her lady parts, and make a little cut, and then it would open right up. He brought his gear in the room while I questioned him in the "are you sure that's safe?" and "have you ever seen/done this before?" line, because I could see her dilating herself into a perforated uterus, or hemorrhage. He was wise enough to go call his wife (also an MD) and see what she thought. She thought he was crazy, and came in to section the patient. Thank goodness.

[AceOfHearts<3]

I have a few good ones.

One time I kept hearing the alarm of an IV pump that would start and then stop. I go and investigate and found a resident just hitting silence without even looking at what was running. Turns out it was levophed and the patient's BP was in the toilet.

Another time I received report on my patient and when I went in to assess them I was very alarmed when they had no movement on one side of their body. I had him assessed quickly and received an order for a stat head CT. Another provider saw the order and came to see the patient, who by that time had regained some movement but was significantly weaker. Second provider didn't think the patient was bad enough for a stroke. They were eating their words a short time later when the CT scan was positive.

I had a patient with a chest tube who had tolerated a procedure with it very well the day before. The procedure was completed a second time the next day and I immediately knew something was wrong. I had people come and look at him, we sent him for X-rays and he seemed ok by the providers standpoint. He came back from X-ray and immediately started coughing up large blood clots. A rapid was called and he went to ICU to be intubated, bronched, and the bleed cauterized.

Some smaller catches, but still important have been with meds. I once had pharmacy profile an antibiotic to be given just a couple hours after it had already been given. The antibiotic was one given only every 24 hours and had been given in the ER. They were so thankful I called and clarify. Another time the doctor and pharmacist both missed that they ordered/verified the wrong route for a med. Another time I had a patient who was close to being overdosed on Coumadin. We always gave it to everyone at dinner time and I had an alert pop up that it was too soon to give. I did some investigating and provider A had ordered an appropriate dinner time dose, however provider B had ordered a morning dose that was given by a student nurse and CI. I called provider A who cut her ordered dose in half and was very relieved I called her.

[K+MgSO4, BSN]

I was caring for a young guy who was shot in the abdomen with buckshot. It had damaged his bowel so he had a stoma and his urethra so he had an SPC. His abdominal drain kept pouring out straw yellow fluid. I was adamant that it was urine and the trauma surgeon was adamant that it was not. I was doing a late/early shift. Went home after my late and couldn't get this pt out of my mind. Spent half the night researching duplex renal systems. Went back in the morning and dragged the surgeon into the pan room with me to dipstick both urine and drain output.....told him if I was wrong I would bake for him. I was right.

Pt down for a CTIVP after the poor surgeon regained the ability to speak and could convince radiology to do it. Confirmed duplex system retrograde to his "normal" system of a huge horseshoe kidney. Back for a quicky nephrectomy after investigations to whick of his kidneys functioned.

Bottle of wine and cheesecake from the surgeon í ½í¸€

Same guy a week later, was recovering well had a shower with the AM nurse apparently scalding hot. Started complaining of abdo pain, AM nurse medicated. I took over for a PM. He was still complaining of pain, pulled up the sheets to assess properly and saw that his comfeel dressing had been shrivelled by the heat of the shower. Warned him that he needed to put his hands under his bum, yanked off the dressing which was all hard and shrunken-pain resolved.

[brownbook]

We "almost" always use Lactated Ringer for our surgery patients. We had an IDDM in PACU whose glucose was high, the nurse had given him a few doses of IV insulin. His sugars wouldn't not budge. I took over the patient for her lunch break and kind of automatically, when I heard her problem, checked his IV bag. He had D5 LR running. She hadn't hung the IV bag, he had come from OR with it.

I wish all patient problems were this easily solved.

[meanmaryjean, DNP, RN]

Have a PICU/ NICU background but was working as house supervisor of a small/ borderline critical access hospital. Had a baby delivered who was not looking right. I suspected an undiagnosed cyanotic heart defect, and the peds was absolutely terrified and looking to do something while the transport team was en route. She decided to put in an umbilical line. I was in and out of the nursery coordinating the transport when I stuck my head in the nursery just in time to stop her from putting in an umbilical catheter straight out of the package- had not been flushed or placed on a stopcock.

In the deep dark past, I WAS the NICU transport team and went to get a kid from an outlying hospital with something non-life threatening like an imperforate orifice. Arrive, and hear the unmistakable sound of a kid in severe distress grunting away in one of those old box-type incubators. The nursery nurse says "Doesn't he cry weird?". Ended up leaving the first kid for later and racing the kid with the undiagnosed hypoplastic left heart in for some emergency PGE1 (which we just so happened to be doing clinical trials on since it was not on the market yet)

[CelticGoddess, BSN, RN]

I had a patient who had had a smallish cyst removed who was complaining of being light headed. The orders for her dressing were "surgeon to change first dressing, reinforce if needed". Day shift had reinforced it (with an ABD pad) and never told me. This is about 1am. Her BP was slightly low but pt has history of low bp. Pulse was wnl for her (96, but she'd been sitting at 92-94 all day). I peeked under ABD pad and that puppy is saturated with blood. Call the MD, (a 3rd year resident) who was reluctant to come down to see her because "it was a small cyst, she's fine". I think I called him 3 or 4 times before calling the rapid.

My pts Hgb had dropped (don't remember exact numbers but she was above 10 before the procedure, to below 6, and was symptomatic). The surgical resident had nicked a small artery and the the blood started leaking through the sutures. Because it wasn't that much at the beginning, it was missed. It wasn't until she got up and moved funny that the sutures opened and blood started pouring out. The surgical resident was so pissed at me because he had to leave a trauma to come deal with this little mess that the nurse couldn't handle (yes, he told me that). I gave her 2 units of blood that AM and she got 2 more units of blood during the day. The resident had to resew the wound to repair the nicked artery.

I am very happy to report that the surgical resident got a huge dose of Karma. walking into the room for this "tiny little problem that the nurse couldn't handle", the resident slipped on the blood on the floor and fell on his but. I didn't laugh, then! But boy did we all (His attending, the RR team, my charge, me, most of the nurses on the floor) when he was gone. Even the patient laughed!

[KatieMI, BSN, MSN, RN]

Too many of them to list.

Retroperitoneal hematomas, spinal ischemia on paralyzed patient, incarcerated wall scrotal hernia (I had to auscultate scrotum for that and the patient asked, in astonishment "but what did you listen for down THERE? ), innumerable DVTs. Right now eagerly waiting for neurologist to come and evaluate the patient for another zebra.

I just love zebras. And I love doing physical exams with no gloves. And, no, I do not have CT scan implanted into my fingertips.

[TigraRN]

Patient developed a different rhythm (that actually looked like V-fib on monitor), no symptoms with it, I did an EKG and it was a STEMI.

Had to convince a doctor once to get an order for US of the foot (no pulse, cold, mottled), the doctor got frustrated a did a doppler to look for pulses ("Nurses don't do that!"), sure enough - thrombi and IR.

[meanmaryjean, DNP, RN]

Too many of them to list.

Retroperitoneal hematomas, spinal ischemia on paralyzed patient, incarcerated wall scrotal hernia (I had to auscultate scrotum for that and the patient asked, in astonishment "but what did you listen for down THERE? ), innumerable DVTs. Right now eagerly waiting for neurologist to come and evaluate the patient for another zebra.

I just love zebras. And I love doing physical exams with no gloves. And, no, I do not have CT scan implanted into my fingertips.

You win the internet today!

Also, a gold medal, a raise, and perhaps an extra week's vacation.