Withheld meds

[demo24]

Hi all,

I was just curious about the legality of a particular situation. One morning I come into work and the night shift nurse leaves a note stating that the pts peg tube was clogged and to call for a GI consult which I did. The problem being is that i was unable to pass meds that were to be administered via peg due to the clogging of the peg tube. I called the GI dr twice to come and hopefully look at it in hopes of fixing it, but no response all day. I at some point had to state that meds and feeding were held due to no access pretty much all day. The pt still remained stable and i was able to give iv meds, but in the mar i had no choice but to put med not given via peg due to no access. I also wrote in my notes that the dr was notified twice, and no response. Is this a red flag and considered a med error and will and can there be legality issues because of this? I guess what im asking is did i chart properly? Thank you

[SLPLSSinSCRUBS]

Demo24,

I think so far you have taken the necessary steps needed to solve the issue at hand. That being said, did you try to unclog it? As others have stated, if you did everything in your power (which it so far seems you definitely did), then you will be just fine. You notified the physician twice which was awesome, and you were able to administer via IV. You documented properly, too. Nice job! I would have definitely taken this issue to the charge nurse as soon as I got no response the first time I notified the physician. In my eyes, there is not much more you can physically do for the patient.

Best!

[morte, LPN, LVN]

you need an order, because it will land on you if you don't get one. the PCP could have ordered the person out to replace, otherwise he/she needs to take the responsibility of no meds being given.

[MunoRN, RN]

you need an order, because it will land on you if you don't get one. the PCP could have ordered the person out to replace, otherwise he/she needs to take the responsibility of no meds being given.

If a Physician writes an order that I can't follow then I don't need an order that says I don't have to follow it, I not only have the ability as a nurse but it's required as a nurse that I not follow orders that can't or should not be followed.

[wanderlust99]

I would document that you can't give due to no access. MD needs to be notified to prescribe med to unclog tube (I can't remember the name of it). Or whatever your policy is on unclogging tubes, maybe you don't need a prescription.

If that doesn't work, MD needs to convert whatever is per peg tube to IV form if appropriate/needed, i.e. metoprolol etc. until tube is fixed. So you go through the meds w/MD and he/she will decide if a one time IV dose is necessary.

[morte, LPN, LVN]

If a Physician writes an order that I can't follow then I don't need an order that says I don't have to follow it, I not only have the ability as a nurse but it's required as a nurse that I not follow orders that can't or should not be followed.

the problem is there was no order!

[MunoRN, RN]

the problem is there was no order!

No order for what? If the PEG is clogged the nurse should discuss with the MD if they want to use an alternate route or tube, but no order is needed to allow the nurse to not put medications down a clogged feeding tube.

[blondy2061h, MSN, RN]

Why didn't you just drop an NG for the meds and feeds until the peg got sorted out?

*sarcasm*

[CoffeeRTC, BSN, RN]

So, I know you don't get to see your patients for that long like we do in rehab or LTC, but my next question would be, "why did it clog?"

Often times, pills are not crushed well and disolved. Solution...warm water, let them sit then give them, make sure you flush well before and after giving meds (check for any fluid restrictions) and/ or see if you can get liquid meds ordered.

The tube feeding solution...some are just thinker than others and some just curdle in the feeding tube. Again, flush well. Flush at least q shift.

Another issue I see is that many nurses will flush or admister the free water via graity or on the pump. There isn't enough pressure to really clear the tube. I recommed flushing with the piston syringe at when you give the water flushes.

[Swellz]

I don't see why you'd need an order to withhold the meds. You couldn't give them. The only thing I didn't see you mention that I would have done is contacted the primary physician again to let them know that you paged GI twice and they never called back, and that you can't give any meds that aren't IV. Then chart all your communications and interventions, like you said you did.