Wow. Just wow

Libby1987 · Mar 4, 2015

9/10 pain on a new knee just home is common, instructing teachable caregivers re s/s of complications is a common and expected occurrence in home health. Nothing in that scenario is unusual.

Percocet 5/325 2 every 6 hrs for a new knee is a starting dose and most commonly prescribed to patients who underestimate TKR pain and tell their dr they don't need a strong dose.

Many patients come home on OxyContin q 12 and Percocet 1-2 q 4-6 for breakthrough, which they usually have initially except for the rare bird with super high pain tolerance.

roser13, ASN, RN · Mar 4, 2015

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

My thought exactly. It would never occur to me to string a co-worker up like that. Report a med error through proper channels? Of course. But take it upon myself to include the error in a legal chart..... Wow is right.

BrandonLPN, LPN · Mar 4, 2015

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 .

I didn't mean it personally. I would have to assume it's possible any poster was overreacting if they can't share what happened.

macawake, MSN · Mar 4, 2015

9/10 pain on a new knee just home is common, instructing teachable caregivers re s/s of complications is a common and expected occurrence in home health. Nothing in that scenario is unusual.
Percocet 5/325 2 every 6 hrs for a new knee is a starting dose and most commonly prescribed to patients who underestimate TKR pain and tell their dr they don't need a strong dose.
Many patients come home on OxyContin q 12 and Percocet 1-2 q 4-6 for breakthrough, which they usually have initially except for the rare bird with super high pain tolerance.

I'll take your word for that kill me now-type of pain is to be expected after knee surgery. I still don't understand what kind of feedback you expected when posting your scenario in a thread about med errors and practising outside of scope? And if this teachable caregiver knew that this was expected why call you at 3am? I'm still confused :sour:

As you wrote, 1-2 Percocet in that particular strength can be prescribed every 4-6 hours, paracetamol deciding the upper limit. I would have no problem with the patient taking it one hour early (nor would my prescribing physician). Not that this would seem to solve the patient's problem other than momentarily.

~PedsRN~, BSN, RN · Mar 4, 2015

My thought exactly. It would never occur to me to string a co-worker up like that. Report a med error through proper channels? Of course. But take it upon myself to include the error in a legal chart..... Wow is right.

Exactly. IMO, going into a patient's chart *THAT IS NOT IN YOUR CARE* to chart a med error that YOU THINK YOU SAW/KNOW, made by a nurse that IS NOT YOU - is grossly going outside your boundaries!!!! Wowsers.

I find that unethical and maybe even illegal. :eek:

BrandonLPN, LPN · Mar 4, 2015

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.

Yes, that's what confused me, too. I don't really understand why the wife is calling the nurse at 2am, unless something rather urgent is going on.

Is she really calling just to see if it's okay to give a Percocet an hour early? To her husband, at home? Out in the real world people take their pain meds a little early all the time. The directions on the prescription bottle aren't set in stone.

The very fact that she's calling a nurse at two am would lead me to believe she feels this is something more than normal, expected pain.

Or maybe I'm being dense and not grasping the point of the question?

BrandonLPN, LPN · Mar 4, 2015

Exactly. IMO, going into a patient's chart *THAT IS NOT IN YOUR CARE* to chart a med error that YOU THINK YOU SAW/KNOW, made by a nurse that IS NOT YOU - is grossly going outside your boundaries!!!! Wowsers.
I find that unethical and maybe even illegal.

Yes, the nurses I work with would assemble to murder me in some sort of secret, ancient nursing ritual if I ever did something like that to one of them.

Angeljho, MSN, NP · Mar 4, 2015

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!

I don't think she was saying to document the med error in the patient's chart. I think she was saying to document it in an incident report.

BrandonLPN, LPN · Mar 4, 2015

I don't think she was saying to document the med error in the patient's chart. I think she was saying to document it in an incident report.

Well, its certainly worded like a nurse's note.

And writing an incident report about another nurse forgetting to write an MD order for OTC Motrin is still pretty darn catty.

Angeljho, MSN, NP · Mar 4, 2015

Well, its certainly worded like a nurse's note.
And writing an incident report about another nurse forgetting to write an MD order for OTC Motrin is still pretty darn catty.

Agreed. These so called private investigator nurses are very hard to work with.

OP, don't worry. Perhaps you can discuss the incident with your nurse manager if you feel patients are at risk by this nurse. Based on how worried you are, I'm guessing this is something serious.

Libby1987 · Mar 4, 2015

So my home health example doesn't make sense to non home health nurses, it was a somewhat common scenario that happens in home care, just home from the hospital following the orders to a Tee and wanting an okay from the nurse to give the med early. I was trying to get at whether you would find it acceptable to go outside the MD orders and notify the DR in the morning that their current order isn't holding the patient's pain (we don't have the 1 hr window that LTC has afaik), or would you call the MD middle of the night?

As the poster above made a big deal about ITS AGAINST THE LAW but this is the scenario we often get in home care (sorry, can't give hospital scenarios :-), do we wake up the dr for a common non urgent post op symptom, tell the patient he has to wait an hour or tell him it's okay this once and we'll discuss with the dr in the am (hence do what the nurse did in the OP).

psu_213, BSN, RN · Mar 4, 2015

Protocol states that you get a written order...or a verbal order which you document on the order sheet BEFORE you give the medication.

That sounds very nice, but not always practical. At my previous job I received a pt from the PACU. After just a few minutes on the unit she was having severe vomiting. The resident was in the middle of a procedure and he said to me "give her 4 mg Zofran IV." I read it back to him, went to the Pyxis, got the Zofran, gave it to the pt., and the put the VO in. If I went 100% according to what you have above I would: 1. take the VO, 2. write the VO, 3. fax the VO to the pharmacy, 4. wait for pharmacy to "verify" the med and put it in the patient's eMAR. That could take a half hour or more. If I have a post op pt. vomiting (or in severe pain, or having a hypertensive crisis, etc.), I am not going to go through all those steps before administering the med.

I don't know what happened in the OP's scenario and I understand why she can't give all the details. However, I can understand how someone would not follow the protocol to the letter of the law.