Wow. Just wow

Nurses General Nursing

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I'm really at a lost for words. A nurse deliberately made a med error. When she was notified by the nurse that caught the error that an incident report will be made, she had a resident write the order to cover her. Now a patient is retrieving a medication that is not indicated or needed. No harm done to patient, but it is just sad that some nurses are able to get away with this type of behavior.

prnq....

You ALL know you need an order BEFORE giving any medication.

It's ILLEGAL to do otherwise.

Let's stop with the warm fuzzies and excuses about patient comfort and care...to break the law

Get the order!

It's outside the scope of your license and considered criminal activity...for a nurse to give medication without an order

No MD will EVER, EVER back you up should a patient have an adverse reaction to a med. that you

gave, without an order..no matter how 'friendly'! He'll throw you under the bus for exceeding your scope of practice. Count on it!

If you catch a med. error, just write an incident report without discussion or elaboration, to protect your own license....and the patient!

"Noted on Med. sheet: Motrin given by previous shift at 6am 2/2/15. No MD order found on MD orders at 9am 2/2/15"

That's your job to report an error! Let administration sort it out/ cover it up/correct it/ etc etc etc...that's their job!

Let them discuss with the MD and nurse the proper protocol! Not your job!

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Specializes in Mental Health Nursing.

1) It really depends on the situation. As a poster said, sometimes a nurse will give ibuprofen and then the MD will simply write an order later. It isn't that big of a deal.

2) Now there's the case of a nurse accidently giving the wrong dose of a medication because the dose was either decreased or increased without the nurse actively checking the order. Some of the nurses where I work are buddy-buddy with the MDs and once they realize they've made such an error, they'll notify the MD and the MD will write an order for the dose the nurse gave. I don't agree with this at all because it indicates a flawed system and quality improvement can't be done if med errors are covered.

3) Now, let's say a nurse purposely gave an extra mg of a medication because s/he felt the prescribed dose was not enough. Then s/he lets the MD know and the MD writes an order. Now you have deliberate criminal activity IMO.

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And that's why we have so many medication errors!

If she had a verbal order it should have been documented!

Protocol states that you get a written order...or a verbal order which you document

on the order sheet BEFORE you give the medication.

Acute care, or any facility, is not immune from following protocol and being "neat and tidy"!

Too many nurses overstepping the parameters/scope of their license creates

medication errors and adverse reaction to the patient!

If ALL nurses insisted that everyone..(no exceptions, including your favorite MD who doesn't want to be 'bothered, whines' and intimidates after hours'...you all know who you are!), follows medication protocol, conscientious staff would benefit as well as your patients.

It's a team effort after all..not withstanding, making 'arrogant, illegal' decisions that are outside the scope of your license.

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3) Now, let's say a nurse purposely gave an extra mg of a medication because s/he felt the prescribed dose was not enough. Then s/he lets the MD know and the MD writes an order. Now you have deliberate criminal activity IMO.

This what I'm picturing has happened.

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prnq....

You ALL know you need an order BEFORE giving any medication.

It's ILLEGAL to do otherwise.

Let's stop with the warm fuzzies and excuses about patient comfort and care...to break the law

Get the order!

It's outside the scope of your license and considered criminal activity...for a nurse to give medication without an order

No MD will EVER, EVER back you up should a patient have an adverse reaction to a med. that you

gave, without an order..no matter how 'friendly'! He'll throw you under the bus for exceeding your scope of practice. Count on it!

If you catch a med. error, just write an incident report without discussion or elaboration, to protect your own license....and the patient!

"Noted on Med. sheet: Motrin given by previous shift at 6am 2/2/15. No MD order found on MD orders at 9am 2/2/15"

That's your job to report an error! Let administration sort it out/ cover it up/correct it/ etc etc etc...that's their job!

Let them discuss with the MD and nurse the proper protocol! Not your job!

Are you seriously advising charting another nurse's med error in the patient's chart?

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What about this scenario..

You're on call in home health. You have a knee patient, that you admitted and know that they're a high functioning healthy middle aged adult with bad knees from sports. They're 3 days post op and the spouse calls at 3 am reporting patient up for the last hr with pain 9/10, they've iced, repositioned, no s/s of complications and have taken the max dose of Percocet 5/325 2 tabs every 6 hrs and their next dose isn't due for another hr. The rx bottle is of course in their possession. What actions would you take?

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What about this scenario..

You're on call in home health. You have a knee patient, that you admitted and know that they're a high functioning healthy middle aged adult with bad knees from sports. They're 3 days post op and the spouse calls at 3 am reporting patient up for the last hr with pain 9/10, they've iced, repositioned, no s/s of complications and have taken the max dose of Percocet 5/325 2 tabs every 6 hrs and their next dose isn't due for another hr. The rx bottle is of course in their possession. What actions would you take?

Im not sure I understand. If the patient is experiencing 9/10 post-op pain that isn't controlled by his ordered narcotics I would advise him to go to the ER to be checked out.

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Im not sure I understand. If the patient is experiencing 9/10 post-op pain that isn't controlled by his ordered narcotics I would advise him to go to the ER to be checked out.

Are you familiar with the range of pain mgmt for knees? (That's not meant to sound snarky, I'm trying to understand your rationale)

You would send a healthy knee patient to the ER? By car 3 days post op with 9/10 pain or by ambulance?

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There is a huge difference between giving a med in an emergency and getting the order later to save a life and deliberately practicing outside your scope in a non emergent situation.

If you can't give details, why the dramatic post? We can't give intelligent feedback with what you gave. Sometimes medications are given without an order and then covered with an order after the fact. This is not uncommon in hospital settings - emergency or not. It depends on the situation.

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Are you familiar with the range of pain mgmt for knees? (That's not meant to sound snarky, I'm trying to understand your rationale)

You would send a healthy knee patient to the ER? By car 3 days post op with 9/10 pain or by ambulance?

Well, I was a little confused why the wife would call a nurse over knee pain in the first place, unless it was some sort of ongoing issue where the pain could not be brought under control. I would be concerned they're not healthy if they had ongoing, extreme pain that narcotics were not touching. I assumed in the scenario you mentioned that adjusting the dose had already been tried. I consider 9/10 pain that cannot be brought under control with narcotics to be an emergent situation possibly indicating an infection or something else had gone seriously wrong with the knee post-op.

If it's just "routine" post op pain, that's another story. If the wife is simply calling to see if she could give the pill an hour early, I don't see what's wrong with telling her to go ahead and give it, and then call the doctor and get an order to adjust the dosage. It would be cruel to make them wait.

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What about this scenario..

You're on call in home health. You have a knee patient, that you admitted and know that they're a high functioning healthy middle aged adult with bad knees from sports. They're 3 days post op and the spouse calls at 3 am reporting patient up for the last hr with pain 9/10, they've iced, repositioned, no s/s of complications and have taken the max dose of Percocet 5/325 2 tabs every 6 hrs and their next dose isn't due for another hr. The rx bottle is of course in their possession. What actions would you take?

Is the spouse qualified to decide if there are any complications present? I wouldn't be comfortable with taking her word for it and would urge them to seek medical attention.

It's obvious that if the patient has a 9/10 pain four hours after taking the prescribed dose and the expectation is by the prescribing physician is that it provide pain relief for six hours, the prescribed dose isn't doing the trick.

If you're wondering if I would say that it's okay to take the next dose one hour early, under some circumstances I would. Percocet isn't available in my country but after looking it up, I concluded that it's oxycodone and paracetamol/acetaminophen and the maximum allowed dose of paracetamol hasn't been reached. As a nurse it's in my scope to administer a drug that's supposed to be administered every six hours, one hour early, providing it was safe. But again, different country, perhaps different rules.

Anyway, my main concern is why the patient is experiencing severe pain and that would be the reason for me to contact the patient's provider. Complications need to be ruled out and the prescription needs to be changed in order to provide adequate pain relief.

Are you familiar with the range of pain mgmt for knees? (That's not meant to sound snarky, I'm trying to understand your rationale)

You would send a healthy knee patient to the ER? By car 3 days post op with 9/10 pain or by ambulance?

I'm not at all familiar with the pain management of knees several days after surgery since I'm not a home health nurse or work in rehab. I always have the benefit of having "eyes on" my patients. My experience is limited to pain management during surgery itself and the immediate post-operative period/ a few hours (and I might add, not ortho) and a measly 5 mg of oxycodone won't be of much use in that scenario ;)

Considering the topic of this thread, I though that this was a question pertaining to scope as far as medication administration, not a quiz on the correct pain management of post-op knees. Are you saying that 9/10 is expected/normal despite an adequate dose of analgesia?

Would a spouse who's comfortable ruling out complications on her/his own really call and ask for help, instead of just giving the pain med herself? I guess I too am a bit confused by this entire scenario.

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Hi Brandon, no offense but I found your post a bit rude. I should have never posted this thread because I cannot give details. I'm also not over reacting , as this nurse was grossly practicing outside if her scope . Words from the nurse manager not me. Thank you everyone who did respond. I'm letting this go , it is now I n the hands of my employer .

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