Aug 28, 2006

Med Error....Or not

I'm very sorry I haven't been frequent with my entries lately. I've just had little interesting to say.

My latest development is that I sorta kinda made a med error yesterday.

I worked yesterday and today and had the same patients both days. Today I was confronted by a not-so-friendly resident about an order he wrote on Saturday. (I was off Saturday) He had increased the patient's dose of Insulin (Lantus) from 10 units a day to 20 units a day. Well on Sat. that order was signed off by the nurse and sent to Pharmacy. When I had the patient yesterday, the med order on the computer said 10 units. Pharmacy screwed up and hadn't changed it.

I gave the patient 10 units because that's what the MAR (med record) said. This morning....I was looking in the past doctor's orders (Those are still written and not on computer yet)...I was looking to clarify another matter and came across Saturday's increase order.
I caught it...called the pharmacy to inform them to fix it and gave the patient 20 units. After that...Cocky not-so-friendly resident gets huffy with me about the 10 units yesterday. I told him I caught it after the fact and that it was corrected this morning.

He actually WROTE an order to file an incident report. That's like basically the doc saying "Nanny Nanny boo boo....I'm telling on you"

Well I was happy to file the report. I explained to my charge the situation, he showed me how, and I described in depth...what happened.

Now yes...I could have checked the PREVIOUS DAY"S orders but no nurse with 5 or 6 patients has time to do that. If I had dug into the comments of the MAR on the computer I could've found the increase but that was not where it was supposed to have been. It was not listed correctly on the MAR by the pharmacy. The nurse on Saturday should have caught that when she or he should have given the patient an additional 10 units that day as well.

The whole damn hospital shuts down and nobody wants to work on the weekends. The Lab, the pharmacy, the doctors, even the damn nursing staff get lazy and use the fact that "It's a Sunday" as an excuse.

I really hate working weekends.

Listening to: "Save me" by Aimee Mann

Aug 14, 2006

Et Tu Brute?

Still going well at the major screw ups yet. ;)

I had one of those days today.
Ya know...the ones where everything goes down at once?

I will preface this with reminding you that I worked as an Nurse Aide aka Clinical Asst. aka Patient Care Technician for 2 years. I worked as a Unit Clerk for 1. I liked being an aide. I took pride in my job....enjoyed helping the nurses.

Most meds at our hospital are given at 0900 or sometimes 0800 if needed before a meal.
I started the day with only 4 patients which means I get the first admit of the day. The first admit from the ER came up to the floor at 0830. We have a one hour window to give meds on time or they are flagged (In the computer) as overdue. Which means my 0900 meds are due by 1000 or they turn bright red in on our MAR (Medicine assignment record).

At that same time, I had a Cardiac enzyme blood draw on a 98 yr old women at exactly 0800. and another set due by 1000 on another patient.

I also had one of my cardiac monitored patients (I had 3) go into SVT while the other 2 went on the fritz and needed new batteries, leads, etc.

I also had insulin coverage to give before breakfast at 0830.

All I needed from my aide (one I've worked with the whole 3 years I've worked there) was to weigh my new admit, get a set of vital signs, and orient him to the call light, TV, etc.

She was" too busy". Et tu, Brute?

My Lazy LVN "partner" decided to not do anything today so I was also getting flagged down by her patients as I passed their rooms for pain meds.

The charge....whom I love and was indeed helpful to me when my 98 yr old lady's IV blew for the 5th time...he started a new one on her....which she pulled out later. He was busy also helping Lazy LVN with her patients.

Is it too late to consider clinic work?

Listening to: "Ohh La La" by the Ditty Bops

Aug 10, 2006

Feeling snuffy and the 5th vital sign

Sorry, I've been MIA lately. These past two weeks have found either me or my daughter with coughing, aching, stuffy head, fever so we could NOT rest and needed medicine. (Little Nyquil commercial joke)

Ari has just today become fever free so I think things are back to normal. I really hope I don't catch any flack for missing 4 days of work though. (2 last week for me, 2 this week for Ari)
It sucks really, I need to be working to get that extra dough for my NY trip which is in just 5 weeks.

Work has been good though. Since going off orientation last week, I think I have been handling things ok. I haven't gotten more then 5 patients yet (we can get up to 7 on my unit). I'm hoping they'll hold off on assigning me more then 5 until I'm a little less green.

The last shift I worked I had an unusual patient. He was in for a recently diagnosed stomach age....middle class.....had a job....and a supportive family at the bedside. Really weird. He was my most pleasant patient for the day and pain control was the only issue at hand.

I'm big about that....Pain meds. It's always high on my priorities to get patients pain meds when needed and asap. The older nurses I work with don't see it that way. From what I understand..RN schools have only recently begun teaching the importance of "Believing the patient subjective complaints about pain" over "seeing objective proof of pain". It IS the 5th Vital sign....not only taught in my RN school but also incorporated MULTIPLE times in our assessment charting.

For me, I think a hospital stay and a doctor's order for pain meds is enough proof. It's not my place to get all judgmental over whether someone could be in pain or not.

HOWEVER...I did have another patient on another shift almost put herself in a coma because she was asking for and getting pain meds from us ON TOP of taking from a stash of vicodin she kept hidden in an Motrin bottle in her room. One of our nurses discovered that and promptly tagged it and sent it to our pharmacy to be held for her until discharge. This particular patient didn't really have any diagnosis supporting her pain either....other then COPD...which might cause some breathing discomfort. It's patients like this that disillusion nurses like me, I think....over time.

It's still not up to me though...I would have a chat with the patient and the MD if I thought the pain was not being addressed or being OVERLY addressed.
By the way, check out my new banner to the right.... a link to Change of Shift. This week's edition is out and worth checking out.

Listening to: "It don't mean a thing if it ain't got that swing" By Duke Ellington, Swing Kids Soundtrack

Aug 4, 2006

Hey Bloggers

Hey Bloggers,
I found this through Kim at Emergiblog.
Join in the tribute.
I'm number 1284.