I'm in orientation on a med/surg floor. My pt. was 30 years old and 25 weeks pregnant admitted for nausea and vomiting possibly relating to a chole done the month prior.
The order was 4 mg Zofran and 25 mg Phenergan now. I remember being told by one nurse that she doesn't like giving 25 of Phenergan because it knocks the patient out; she prefers to give 12.5. Since my pt. had morphine shortly before I got this order, I took it to my preceptor. She said give the Zofran and hold the Phen for an hour and then give it. That's what I did.
About 15 minutes later the resident comes back and sees the pt. is still nauseous. He asks if I gave it. I explained what I did and he said something to the effect of, "I realize you are in orientation still but I gave you an order." I was very embarassed since this was yelled at me in the middle of the nurses station! Nobody came to my defense either. Everyone who originally thought I should hold it quickly said to just give it!
Anyone have any insights on this? Should I have just given them both in the first place?
and yes, usually you can mix phenergan with other IV meds due to the fact that its a vesicant. it really irritates the vessels, and lawsuits have risen over damage to vessels. since i work on a surgery floor, its common to dilute phenergan with the NS in an IV flush, or if you mix it with other IV meds (that are compatible, of course) that will work too.
Promethazine being a vesicant has nothing to do with mixing meds. What matters is compatibility.
and yes, usually you can mix phenergan with other IV meds due to the fact that its a vesicant. it really irritates the vessels, and lawsuits have risen over damage to vessels. since i work on a surgery floor, its common to dilute phenergan with the NS in an IV flush, or if you mix it with other IV meds (that are compatible, of course) that will work too.
Promethazine being a vesicant has nothing to do with mixing meds. What matters is compatibility.
To the OP, Next time I saw this physician, I would bring up the incident to him and let him know that his actions were unacceptable and will not be tolerated again. Yes, physicians, PAs, and NPs are able to write orders but that does not give them the right to verbally abuse you for not doing what they wrote. You never have to sit there and take verbal abuse from your colleagues. If you sit there and take it, it makes a statement saying that it's okay for you to be spoken to in that manner. Next time it occurs, you can simply inform the individual that you will not be talked to in that manner and then turn around and walk away. I've had physicians yell at me for paging them in the middle of the night when my pt had a serum K of 9.1 and was having ventricular ectopy. It's the nature of the business but it shouldn't be tolerated.
As far as giving the Zofran and Phenergan, I would have given both and not thought twice. Phenergan and Zofran work on different receptors. Narcotics and antihistamines are often given together because of their synergistic effect.
I am sorry you weren't backed up. I find that in a lot of situations, people will claim to have your back until they are called into question too. Then they go running scared. Sucks, but it happens more often than not.
I would have probably given the Phenergan if she was alert, vitals were stable, and she was actively vomiting. Actually if she wasn't just zonked out and her vitals unstable, I would have given it. I find that Phenergan seems to help better if the patient is currently vomiting and extremely nauseous. I usually give Zofran if they are just feeling sick to their stomach. Now I have nothing to base that on except for experience, and that is just what I have found in my experience thus far.
Also, I worked in Oncology for nearly a year, so I realize my treatment of nausea/vomiting might be a bit different. It was nothing for us to give Anzemet and Dexamethasone scheduled. Then Phenergan and Zofran as PRN all in a short span of time. I'd also usually give some Ativan scheduled or PRN to my chemo patients as well. And unfortunately, lots of times all of that combined didn't touch the problem. So I am saying what I said before with the knowledge that my judgement might be a tad different. Same goes for pain control.
Anyway, I am very sorry that happened to you. It is better to be yelled out while being an advocate for your patient than do something because you are afraid to stand up for what you think is right. ALWAYS go with your gut. You get that feeling for a reason. :)
meandragonbrett
2,438 Posts
Promethazine being a vesicant has nothing to do with mixing meds. What matters is compatibility.