Whose error?
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I'm a new grad (May '05) and work at nights in Telemetry. I've been out of orientation for a month now and last night I ANOTHER shift from hell and 2 incident reports. These were both from the same pt who was receiving blood thru a mediport.
First Report: I was called to the room during the admin of a 2nd unit of blood. (About 50 minutes post start of infusion). The 83 yr old, against my specific instructions, had gone to the bathroom without assistance. She said she couldn't wait and wanted me to see what was in the toilet. The bowl water seemed filled with blood. Her dx was rectal bleed but the blood seemed pretty excessive to me ). I called in the Charge who noted the stool and left.
The patient then began to complain about her mediport stinging her. When I examined it, I noted that there was fresh blood on the gauze , and a hematoma forming and so I stopped the blood at the "Y" tubing and opened the saline. I then called the Charge again who sent the assit. charge. She instructed me to stop the transfusion. I turned off the pump. She tried and failed to get a peripheral line and called in the Charge who decided to replace the mediport needle. The Charge was letting me do the replacement since I needed to be checked out on this skill. While trying to access the port and with the pt. complaining of pain and getting very anxious, the assist. charge recommended that we not do this since she said that the hematoma seemed to be getting larger. At this point, I asked whether I should go and call the MD to apprise him of the total situation. The Charge instructed me to do so.
While on the phone with the MD, I told him of the bloody stool, the mediport prob, the prob with getting a peripheral line, the anxiety and pain of the pt. He gave orders: give the existing Xanax order a bit early, a Lortab, and told me he had called for a consult with GI already. He told me he did not know what to do about the mediport but asked if we could continue to try to get a peripheral line. As he was saying this the Charge walked up and said she had gotten an IV in the patients forearm and had restarted the blood. The physician seemed satisfied and all was well.
BUT I had to write up an incident report on the situation.
After the phone conversation I gave the patient her meds. She was exhausted and I knew she needed sleep. Over the next two hours I looked in on her thru the door 2 times and had the aide take her BP. When the time came for the blood to be done, I walked in the instead of the line being red, it was pink. At the Y tubing, THE SALINE HAD NEVER BEEN SWITCHED OVER TO THE BLOOD LINE. I had missed it because the line was still dark red when I walked in to give the meds (from the initial infusion) and in the dark when I checked her, I did not notice it was getting lighter.
The Charge had not switch the lines but had simply restarted the pump.
When I told her about it she said it was my fault and that I should not have turned off the blood and turned on the saline when the first problems started happening with the port. And that she never did that but just stopped the pump. (Actually, I did not recall doing this at the time but know that when there is a problem, and not a reaction problem, that I was taught to switch over to the saline first). I accepted the accusation saying I obviously switched over to the saline and stopped the blood but that she had told me that she restarted it. Regardless, she said she would have to write another incident report and for me to order another unit of PRBC.
Ok . . . Who takes this responsibility? ME? HER? Both?
I know this is long but at this point I'm exhausted and depressed. This was the night from hell with NO pharmacy (on Sat. nights), a very busy Charge Nurse, a new patient (the same one) who could not tell me what meds she had received before admit, and not enough experience and support to do my job correctly. YES, no one was harmed but I feel helpless and hopeless about nursing. This type of problem is ongoing. I'm constantly stressed about pt conditions and not sufficient support. (This night I had other patients who had other problems and was only able to keep them safe, not able to be a good nurse to them). I'm close to resigning . . . and don't know where to turn. HELP me.....God Bless every nurse.