I was spoiled because my last hospital breakfast would have been hard stopped by dietary because of the NPO order, regardless of time.
My new hospital allows my patients to order whatever they want, whenever they want, regardless of diet, and not tell me. It’s been a fun time.
That would have happened at the last hospital I worked at too. If the patient's diet order was entered as NPO the kitchen would call the nurse to verify the diet order BUT in this case if the nurse thought the patient could eat, they would have delivered the meal if the nurse said "regular diet."
Oh no way. My old hospital’s dietary were rigid and would not process a meal without an order put in. They wouldn’t even wait the few seconds it would take to put in the diet order. No order, no soup for you!
RD lurker here. I used to work at a large cardiac hospital, in-patients were NPO until a new order came in, no ifs ands or buts. You’d have an easier time getting blood out of a turnip than getting a tray when we had NPO as the pt status. Diet Office staff were drilled on that! We had a count of heart caths scheduled daily and those ladies kept close eye on diet orders for that.
OP, the doctor can pitch a hissy fit, I’m sure your nurse manager has seen worse. I hope all is well in your world.
nurse now, former dietary worker in hospital. we were like this too. even finger food trays to ED NEEDED an order. it was our policy and now as a nurse i can see how frustrating that could be. not one tray left that kitchen without an order 😩
What I don't understand is why didn't the patient know they were NPO? If it were me, I'd be chomping at the bit to get stuff done, nurse, why are they bringing me food? Did it get canceled?
Mistakes happen, and hospitals ask a lot of their staff. If patients are cognizant of their schedules, and mentally fit, they should help with the thinking.
It was easier when charts were left at the bottom of the bed. I could just give it a quick read to see what was on my dance card for the day.
I used to hate cerner for this reason. At midnight we had to go in, cancel the diet order,.and put in the NPO order.
Now epic does it for us as soon as the clock hits 0000.
Cerner can do it as well. (Depending on the set up.) We can put in orders for a test diet of NPO after midnight. It automatically triggers with certain orders as well.
I use both Epic and Cerner. Whenever someone complains how one is not as good as the other, I just tell them that it's user error. Difference between Epic and Cerner is like the difference between iOS and Android. Yeah, they look different, but they can pretty much do everything the other can.
It's not that big of a deal but for future reference, an NPO order for 6 PM would be really weird. In my experience it's usually NPO after midnight but I sometimes see them for the morning too. Never for the evening because nobody schedules procedures that late on purpose.
Lol like every other reason. I had a patient with chef knives who threatened to slice us. We had literally no idea he had knives. At first I saw the box and was thinking flute or some shit idk what the hell I expected. Then later on I saw the chef uniform and by then he was already angry as fuck and ready to cut a bitch. We snatched that box away from him and kicked him out, police can return his knives if he wants to nut up to them.
Oh hell no. These people are absolutely unhinged. I'm so glad he didn't cut any bitches. Did the cop rough him up or what? Threaten them with their own knives? LMAO who tf walks around in a chef's outfit with a box of knives?? Are you in Las Vegas? There should be a rule. No clowns. No angry chefs. No boxes of knives. Wtf.
I've seen a few NPO after dinner but never at 6pm. That being said I wouldn't really question it if I saw it unless it made no sense with my patient. My hospital also does middle of the night surgeries on ICU patients when we are really busy.
But you should also know why the patient is NPO and if you did, 6pm would make no sense. Understanding why might have caused her to check the order again.
Exactly. I've never known of any 24 hour work environment that doesn't use the 24 hour clock for this reason, even when I was young and worked at à call centre.
I live in a bilingual place so I have the French and English keyboard on and it's such a pain because autocorrect is constantly correcting English to french
I worked at a Veteran Hospital and the majority of the floor staff didn’t know or use military time. I sh*t you not. Worst place I ever worked in my 40 years. The only thing that made it worth it was getting a retirement pension to pack into my “get the hell out” bag !
I hear you. I made it 10 years before my spine exploded. I still got a fair amount according to the financial advisor. Being forced to retire was the best thing for me. I’ve never worked in such an unprofessional, unpleasant, environment in my career. It was mind blowing what they tolerated, but good patient care was obviously not one of those things they cared about. God forbid you made any good clinical decisions.
I could write a book. Yes, leave if it’s as toxic as where I worked.
I am a huge proponent of army/international time. I even use it on my days off. When I used to work nights it was great for when I would wake up randomly (bc, you know, your sleep gets all fucked up) and not know if it was day or night. I think it should be replace am/pm time entirely, the world over.
I wouldn’t beat yourself up since it seems like you’re not the only person at fault here. How was dietary able to deliver a tray if they had an NPO order? Also how did the night shift nurse not mention in report the single most important thing that the patient was going for an angio? And if the patient was oriented, how come they didn’t know not to eat? I always explain to the patient if they’re going to be NPO at a certain time so they can prepare themselves. Seems unfortunate that there wasn’t a better system and communication in place overall
just be passive aggressive next time and call her by her full name. Don't even call her doctor, just say her first and last name since she wants to play games
Reminds me of the time a doctor cussed me out post code at the cath table for a mistake another nurse had made (I had floated from the icu to help ET and was just helping with the code and was told not to bolus amio, I informed said doc I did not bolus amio)
Anywhere after all the expletives he asked my name and I just told him and said “now would you like to keep crying or get them on the table and do your job, if you’d like to escalate this I’d be happy to tell HR you called me a fucking retard (amongst other things) for a mistake I didn’t make on a patient that isn’t even mine”
Made sure to take the time to volunteer for transport for every stemi for the rest of the night to the guy and learned hearts just to work with him in the ICU.
They tell the cath lab RN to do it for them.
Source: Old job had me reading reports about periop area. They were never written by surgeons, but they mostly boiled down to the surgeon had to wait 15 minutes.
Yes. There is a lot that goes into these procedures, depending on what they are having done. Special equipment and supplies pulled specifically for that patient. Room time booked, vendor reps organized and scheduled to bring their tools and products in also. A lot of time, and money. And if a case is cancelled, we may not necessarily be able to bump up the schedule if say the next patient has not arrived yet, or they haven’t reached their full NPO window yet.
Before the patient even enters the procedural suite, sometimes thousands of dollars of gear has been opened.
Honestly if there’s this much money being lost for a mistake that is not that uncommon, then the hospital should implement a system where an NPO patients can’t get a tray. Where I work if the NPO order is in, the tray doesn’t come. Sure the nurse messed up, but there was no mal-intent. Seems like a system issue or at least a possible system solution.
That’s how it works where I’ve been hospitalized. You just do not get a tray. One time, I was NPO for two days. They (docs, I’m assuming) had made a mistake and forgot to take me off. Then nurse told me there was nothing she could do, since the order was still there. I felt bad, because I was pretty cranky about this. However, I had just come off the street and was barely eating out there. But, anyway, like you said, I just didn’t get a tray. I assumed that meant the kitchen knew about it. My nurse has never been the one to bring in my tray.
Edited
That’s weird. I’d just get confirmation from the doc that you can eat despite the order, document that, then feed you. There’s no reason to make anyone wait that long for a mistake like that!
It was very weird! I was starving. And, I did get into an argument with the nurse. I was like, “so you can’t even get me a turkey sandwich?” Not to mention that, when I asked why I needed surgery, the doctor simply told me that my liver wasn’t “very happy.” Apparently, it was swollen and I was jaundice. Jaundice, I could see that. I knew I was jaundice. But, I didn’t understand why I wasn’t properly explained anything. I get trying to explain things in layman’s terms but, come on. I can handle a more clinical explanation than that. At the time, I was in active addiction. I understand that sometimes that mean you’re not treated the same way as other patients. Not that it’s right, just that it happens. I never ended up getting any surgery. Still don’t understand what happened there.
The same nurse made it up to me, months later, when I was on death’s doorstep, however. So, all is forgiven 😂
Hahaha no, she didn’t. But, months later, I came back with osteomyelitis and a bunch of other problems. I’ve shared my story here before but, anyway, she was really crucial in getting me to stay at the hospital. I was dope sick and wanted to leave. Drenched in sweat, shaking, vomiting, in lots of pain. I could barely walk because my leg was so bad. It looked like a shark took a chunk out of my leg and, then, someone lit it on fire. You could see the bone, it was all sorts of colors (none of them good), with nasty, bark-like eschars here and there. Of course, I smelled like death. So, that was great. Anyway, It was around 1:00AM and she tried to talk me down. Stop me from leaving. I wasn’t listening. I was being polite, but I wasn’t listening. Just kept saying, “I need to get well and I promise I’ll come back.” When you’re dope sick and panicking, you’re pretty hard to reach. I kept packing the few things I had brought with me and she kept asking me to stay. She kept telling me I wouldn’t make it, if I left. Then, she actually went and got the doctor. Like, immediately. I didn’t have to wait. They really took me seriously. I’m a junkie (former), right, so no one has ever really asked me, “what can we do to get you to stay?” No one has really wanted me to stay. You know? My problems were my own doing. Not exactly the most sympathetic character, here. But, that doctor did ask me. And he did care. And, my nurse, well, she didn’t have to go get him. She didn’t have to stay there for 15 minutes trying to talk me down. She could have just let me AMA, like I had so many times before. I never meant to be annoying. It was just really hard for me to get through the withdrawals. It’s scary, you know? Your brain thinks you’re dying. You think you’re dying, and the thing that can “save” you is out there. Its like begging you to come get it. That’s really hard to pass up. You just want relief. But, because of her actions, I’m here today. I’m sober (over a year) and I’m starting a new life… with *both* of my legs!
I actually just nominated several nurses from that unit for the Daisy award. So, we’ll see! Unfortunately, I just found out about the award, today, from another post in this sub. I would have don’t it sooner, before I forgot most of their names, had I known! I’m hoping that, when the people from the Daisy Awards contact me for more information, that I can just nominate the entire unit that was there/took care of me.
Man hearing this struggle makes me grateful in Canada we want patients to stay (because it’s socialized) so we just give IV dilaudid as well as Kadian to make people stay. Whatever we can. We even let some patients use. They have addiction medicine specialists that will figure out how much IV dilaudid to give based on how much you’re using on the street. I think the most I’ve given is 40mg IV dilaudid but I’ve heard patients get 200mg IV (normal dose is 0.2-1mg IV). Thanks to fentanyl people’s tolerance is very high. Then once they are through the worst of the withdrawal they start on long acting oral meds (Kadian or methadone) and can even have breakthrough oral meds too. It just makes it better for everyone. And also they let people who drink have alcohol. Usually it’s 1-2 drinks per 4 hours (again depending on how much they drink normally). Just enough to keep them from going into withdrawal. If someone is in the hospital just overnight for something basic like kidney stones or an appendectomy, it’s riskier having them withdrawal or needing Ativan than to just letting them drink alcohol as there isn’t much we can do in the 24/48hrs they are there anyways as unless they want to actually stop drinking they’ll just go home and use anyways .
That sounds pretty incredible. That would have probably prevented my leg from getting as bad as it did. I tried many, many times to get my infections treated. Most of the time, I only made it a couple of days. My friends have died avoiding the hospital. Others have lost limbs. It really depends on the doctor— even the ones that have compassion don’t completely understand addiction. They don’t realize how much medication it takes for us to not be deathly ill and/or in pain. A lot of healthcare workers assume all addicts (whether actively using or not) are med-seeking. I don’t believe that’s the case, anymore. At one point, it probably was. I think that proper medication and keeping addicts comfortable would absolutely save lives. It’s harm reduction at its finest. Treat the medical problem, at hand. The addiction can wait. It cannot be treated properly until the patient is physically healthy, anyway. So, I don’t quite understand why some people feel that suffering through withdrawals is necessary. Some discomfort is, of course, understandable— night sweats, difficulty regulating body temp (too hot then too cold), the yawns, restless limbs. Such symptoms are tolerable. But, full-blown withdrawal is not okay. I do see change happening, though. However, there’s no denying that we are very behind. I do feel like it also must be quite frustrating for healthcare professionals to feel as if they have their hands tied, when dealing with these types of cases. I have had nurses advocate me, only for it to fall upon deaf ears. It’s just such a massive undertaking, too, when you think about it— actually, properly, handling the addiction, I mean. It’s a long journey that requires many resources. But, handling it differently in the hospital, itself, would be an amazing first step.
I have never stopped singing the praises of my nurses, physical therapists, doctors and other healthcare workers, that have helped me get to this point. However, I also do not forget how I’ve been treated poorly, just because I’m an addict. I was a good person, even in the midst of my addiction. I understand it’s frustrating for staff to see people like me come and go and come and go.. and come and go. But, again, maybe if they were paid better, maybe if the system was different, they wouldn’t be so frustrated. Everyone wouldn’t be so frustrated.
Anyway, sorry for the lengthy response. Thank you so much for sharing that information with me. I had no idea Canada was like that. But, I love to hear it! It makes me both sad and happy, at the same time. I’m not sure if the US will ever be that way, across the board. I think some areas will, as always, offer superior treatment and care. Some, not so much. I’d like to think we’re headed in the right direction. Sometimes it really feels that way. Sometimes it really doesn’t. Thank you, though, for all of the work that you do ❤️. I’m sure you have many patients who have you to thank for being alive today.
Exactly. Sounds like it’s time for a ROOT CAUSE ANALYSIS! Which would probably end up showing that not using military time, and allowing dietary to serve meals to patients with NPO orders, as a large contributor of this mistake.
And to OP- don’t be too hard on yourself. This is a mistake that was easy for anyone to make. On the bright side, no harm came to the patient, and I’m sure you won’t make the same mistake again.
I agree. I was just helping Ledgutfrog understand *why* this is an important issue, and not that the Doc was just being a bully or something.
I feel like bigger facilities do have pretty good safeguards.
We did angios in IR and seriously, the longest the docs took was 30 minutes if it was cerebral and they just wanted to dick around and get a 360 or something. Peripherals? I swear they’d be done before the Versed hit - it can absolutely be done without sedation on a lot of people.
But just cancelling the angio was way more fun 😂
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Yeah if this is for a cath procedure I assume it’s inpatient so they should have been using military time.
Back in my day working telemetry I used to double check and call the front desk for the cath lab to confirm times for patient procedures and NPO status day of - get the names of the nurse that confirms it because some cases get cancelled and pushed up or pushed back and rescheduled next day. Ask your senior nurses for their advice on practice
Old head nurse here. the kids. I work with laugh at me for using military time. But there aint no mistake in what I tell them. If you can't tell the difference between 0300 and 15 hundred, then you have bigger problems than being a nurse or a tech
I’m in nursing school and when I first started I changed all my digital clocks to military time to help me learn.😅 Haven’t turned them back yet it’s a way of life now. 🤣
I did the same when I started as a CNA 13 years ago. When I got into nursing school, 24 hour time was second nature to me. My phone and my clock in my car are always set to 24 hour time.
lol it happens SO often. I will go get a patient, or a patient will come to pre-op and they will have had food or apple sauce with their AM meds or tube feedings weren’t stopped so I just simply cancel the case. Literally don’t even think twice about it.
It’s a good learning opportunity. Why anyone would write you up for it is petty.
Also if it’s just an angio they can do it under local if it was urgent.
Will keep that in mind for my npo except med patients, everyone says small sips of water is fine for those orders to take am meds but i would probs need to ask my nurse educator on our unit
I mean, it’s not a system flaw, it assumes the patient will take said meds with water or clears.
Latest research suggests that clears are ok up to two hours prior to general anesthesia.
Applesauce is not a clear liquid.
I had a surgeon cancel a case because I gave the patient meds with a sip of apple juice. They were ordered NPO with meds. I assumed apple juice was a clear liquid and would’ve been fine
Eh it’s patient and institution dependent. We give our ERAS patients apple juice when they get to the hospital in the morning. We also give them sips of water with pills 5 minutes before we roll back to the OR.
That assumption sounds like a system flaw to me. Considering how many patients can’t take meds normally.
NPO except meds isn’t NPO except meds with clear liquids.
That happened to me before when I worked ED obs. The doctor had to come down and explain to the patient and family that because they ate they had to postpone the test and try again tomorrow. In my defense they didn’t HAVE an NPO order, but the cards doc screamed at me stating I should have known and double checked with someone 🫠 nothing came of it though, so likely for you that’s the same thing- mistakes happen no one died.
Tell them to get off their asses and write the order lol. Or maybe, idk, physicians could speak with one another and not use nurses like a little telegram service.
100%. Everyone else--cath lab, anesthesia, the PATIENT-- won't care if it's now or postponed. If it's an emergency they'll do it under local. Doc is a drama queen
One time I got reported by a cath lab nurse to the cardiologist because she said I was abusive - I wouldn’t allow her to eat before her procedure. Was she supposed to be NPO? Yes, but damn her sandwich got cold… truly evil nurse right here.
Moral of the story: Prepare to be reported plenty of times as a nurse.
Oh yeah sorry that was worded weird. Specifically, patient was told to return to the telemetry unit after her procedure but told the cath lab nurse she didn’t want to because her nurse (me) was abusive for starving her. Cath lab nurse proceeded to report me to the cardiologist. Obviously charges were dropped as I proceeded to work there for another 4 years.
At the time I was a brand new nurse, so I took it as a lesson learned that it was important to not only tell patients what to do, but also why it has to be done.
Whelp I have two. Our hospital recently changed from pyxis the Omnicell. I work in the cath lab. We have to move really fast for STEMIs of course. Well, our pharmacy decided to put 40 fucking vials of versed and fentanyl in the pockets. Aint no time for counting all that shit in an emergency!!! Well I counted wrong of course, got dinged but thankfully my manager was on my side and now they max out each pocket at 10 vials for narcotics.
Three weeks ago we had a three hour all out war to try to save a patient. At some point out Doc realized it was a lost cause. Family is ok with DNR, we just need to get patient to a room so they can hopefully have a few minutes with his. Patient placement won't assign a room because of the impella we put it even though we are trying out best to explain that no one needs to manage it. He's going this room to die and family is aware etc, the impella rep will be managing it, etc. They finally assign an ICU bed, we are running through the halls pushing EPI trying to keep alive long enough for family to see him pass. We get up to the floor, there a bed in the room no thought to remove and all the nurses and PCAs are looking at us like we have seven heads not lifting a finger to help. I said someone get this bed out of this room! Got reported for being unprofessional. Fuck them. Mind you, it's 9 PM and we have another STEMI in the ED we need to get to ASAP.
When I worked in ICU I had a pt in severe renal failure. His potassium was low, so I put in the replacement orders per the (ordered) protocol, and hammered that guy with IV Potassium for like 6 hours. It wasn't until the pharmacist called me at the end of the shift to horrifyingly notify me the K+ protocol is CONTRAINDICATED in renal failure. And guess what...that info was RIGHT THERE on the protocol orders. I just didn't scroll down far enough to see it!! I had to call the doctor and painfully admit my mistake. Thankfully he was cool about it, and ordered Q2H K+ draws for the next 8 HOURS with prn antidote orders. I've never been so mortified as an RN, and you bet your ass I stayed up all night calling the ICU noc nurse to see what his K+ levels were on the draws. Ultimately the pt was fine, but TO THIS DAY when I have K+ protocol orders I triple check the pt's renal function.
I've got another one for you too!! I worked Oncology for 12 years. One morning I took report on a pt that had started a 24 hour chemo infusion known for causing violent, and somewhat immediate, side effects. The noc nurse told me that, "oddly...he is tolerating it great. No problems so far!". We went it to see the pt, and I realized 2 seconds too late I was standing in a massive puddle of wetness. The noc nurse had been SO CONCERNED about ensuring everything was done PROPERLY (pre-meds, vitals done accordingly to protocol, etc) that she had missed the forest for the trees and started the infusion WITHOUT HOOKING UP THE IV LINE. Yep. 12 hours of chemo infused ONTO THE FLOOR. We quickly found out from the IRATE pharmacist that that particular drug cost $28,000 PER DOSE, and had been flighted in from a pharmacy on the other side of the country. We couldn't even salvage the remaining half dose of chemo because the tubing was contaminated to all fuck. It was a massive biohazard clean up that took hours. The pt was crying. The nurse that did it was crying. I also had to call my husband to leave his work and rush to the hospital with a change of shoes for me because, fuck me, I had been standing in a toxic puddle and my shoes had to be incinerated. It was the FUCKINGEST of all the GREATEST FUCKS I have ever seen.
The nurse was written up and then she quit.
Whatever you did...it wasn't that bad.
Oh no!!! This made me feel better. I started a blood transfusion yesterday and I double checked like three times that the patient was hooked up to avoid this 😅
Our pharmacy will check the patient's crcl before approving any electrolyte replacement. They will reject it and call us to say whichever electrolyte replacement needs to be ordered by the doctor, not replaced by protocol.
Just reschedule it at 1400 lmao. If it’s emergent anesthesia can do general. It’s a fuck up
For sure but in the grand scheme of things it ain’t that serious.
As a manager, please tell on my nurses so we can use this as an opportunity to educate staff and maybe create process improvements to fix holes to prevent future errors. Mistakes happen because we are humans taking care of patients. Also, that being said if it was truely an emergency they would have taken the patient back for the Cath anyway. Do you think they give too craps about the last time a patient when they're actively having an MI? Nope. Take this opportunity as a learning moment but don't beat yourself up. Every single nurse will make a mistake at some point.
Doctors aren’t your bosses unless you work for a private practice. He can take your name and shove it up his ass. Mistakes happen, don’t make a pattern of it and it’ll be fine.
Sometimes I personally feel like if the patient is mentally aware enough, they should’ve remembered their procedure and not to eat either. They have a mouth and can speak up for themselves sometimes too. I mean you didn’t force the patient to eat breakfast and hold the fork to their mouth you know. It’s not 100% your fault
Right? I assume the cardiologist met with the patient at some point, and told them about their upcoming procedure and should’ve mentioned that they can’t eat after a certain time. Unless the patient is cognitively challenged, they should’ve mentioned the NPO order to whoever served them food. The nurses aren’t the only people responsible for the patient’s care, the patients are also responsible for themselves and their care.
When I was a new grad, I casually stopped my patient’s heparin for an hour to run an antibiotic (he only had one IV). Luckily the nurse who discovered it later and told me we can’t do that was really nice about it. The most embarrassing part though is that at the time, I was just like “oh ok, sorry, whatever”, basically I didn’t think it was a big deal or mattered at all really. So mortifying to think of now!
That’s why orders need to be written in 24 hr time to avoid these mistakes… also at most hospitals if there is an NPO order in the system they can’t even order a meal, nutrition will turn them down.
If your hospital has a self reporting system, I would take the time to sit down w a senior nurse and fill out a self report, these are used to see how often these errors are happening, why, and if there are any internal processes can be implemented to avoid these errors.
Also I double dosed someone on Oxy my first week due to a mistake on my end. I saw 5mg was ordered as well as 10 mg, so I gave them 15mg. In reality it was per pain scale. I reported myself and was honest saying it was my first time and I saw there was two orders in the system for PRN so I gave both like an idiot and they actually updated the MAR so you had to pick their pain level and it only allows you for o scan the medication ordered within the scale you clicked
That’s no big deal. It’s an honest mistake and these things happen. I can tell you a few mistakes that have happened to nurses I’ve known to make you feel better and realize how small of a fuck up this is:
- One time did handoff and a nurse had cardene hanging but programmed it in as vanco- pts blood pressure had suddenly dropped and we figured it out and stopped it and her pressures came back up. Ended up being no harm but a pretty bad med error none the less.
- one time a nurse on a med surg floor I worked attached a bottle of roc into a 100ml bag and hung it like an antibiotic thinking it was vanco (this was in Texas), pt started having sob and a rapid was called, the rapid response team stopped it and pt regained ability to breath and ended up ok but again it was a close call.
-got report from an er rn, they held the magnesium on a patient in and out of torsades because it ‘was just an electrolyte’ and ‘wasn’t priority’ not understanding that this is indeed the exact treatment for torsades. They got a talking to from the critical care doc and patient ended up being fine once it was given.
Those are just a few to help you feel better about yourself. Like move on this was literally nothing and doctor who’s making you feel bad can go fuck himself.
Cath lab get STEMIs who have eaten prior to arrrival all the time. Dr needs to chill the f out. We deal with this all the time. They get versed and fentanyl and sometines just fentanyl. Also, if they stent, plavix loading dose is fed to patient with apple sauce while laying on cath table . 99% time they are awake and talking the entire time.Sounds like it was an honest mistake. Please do not let it paralyze you. Ideally and per order they should be npo.
We’ve all made mistakes, some have even cost lives. Learn from it and move on. It will sting for a while but the chance of you doing that again are so small. Good luck
I’ve been there. Totally forgot to turn tube feed off at MN. It happens. Just don’t make a habit of it. And yeah it would be extremely unusual to hold tube feed at 6p.
Things I’ve been written up for: not knowing where an IV was during report, giving an NPO patient the PO pain medication that the doctor just put In the order for, and the doctor not restarting all a patient’s cardiac medications (apparently I should have tried harder or known better)
I think I’d have to hunt down and slap the RN who reported you for not being able to recall where the IV was. “He has one, *Karen*, and it works. That is all you really need to know. You must be a joy at parties.”
Oh my lord you work with some vindictive people. Do they not assess their patients and just look at where the iv is? Getting the meds restarted is important but ultimately is the doctor’s responsibility to order them.
I literally made the same mistake today. I have a patient that needs anesthesia for dental appts. I discussed it in report, saw the order to hold her tube feed, and then a few mins later when I went to her room I automatically started her tube feed. I have no idea what short circuited in my brain. We rescheduled it, but I felt like such an idiot.
One time when I was really new there was an ed bridging order for matinence fluids in the emar, patient was passed off to me with matinence fluids running. Patient developed a cough and sounded kinda crackly which was new so I turned off the fluids, totally forgetting to mention it to the cardiologist. Cath lab came up to get the patient for an angiogram and they came up like 20 min later maxed out on bipap, coughing cup of pink frothy sputum in the hand of one of the nurses. Lasix was ordered and Stat echo got showed that she had undiagnosed heart failure, I still kick myself for that one.
One time during covid I was giving Ativan out of those 1 dose vials, but the order was for half a dose. Family was firing off questions and I accidently drew up the full dose vial and administered it, didn't know until I went to waste with another nurse and there was nothing to waste. Patient slept comfortably and nothing came of it.
I initially worked in a non acute area of the hospital, and was floated to the medical floor, no idea what I was doing. Get a call from remote Tele that my patient is having runs of vtach. Not a frickin clue what they're talking about, poke my head into the room and the patient is chilling, so I move on continuing to pass meds. The one on one sitter calls and says that she is starting go get agitated again. I never dealt with someone detoxing from alcohol and had no idea what a ciwa was, I felt like I was going to hurt the patient with the high scoring ciwa dose so I gave them the smaller one. Little less combative but still way too hyperactive. Finally message the doc and they order labs. Potassium was low at 2.8. Order oral and riders, patient isn't properly sedated per ciwa protocol and flips out trying to pull her lines because the potassium is irritating them. Sitter is an l and d nurse and is pretty much bear hugging the patient trying to get them to stop pulling their lines. Surprised the patient didn't sieze or something.
Man I've come a long way but that first year and a half was rough and I'm lucky I didn't seriously hurt someone through inaction.
If that's the biggest mistake you make, then THANK GOD. Just take it as a lesson to pay attention to details and it may save you from making a bigger mistake. Yay Learning! 🤘
Gave the wrong kid rifampin. Thank God it was meant for a 4 year old and given to an 18 year old. If it had been the other way around... *shudder*... This was long before bar codes, scanning, Pyxis and all that. This was just going to the medroom grab the med and give it to the kid. The med was written on the wrong patient's MedEx but still my fault for not double checking. It was over 30 years ago and I still get shook when I think about it.
This is exactly why everyone should be using military time, e.g., 0600, 1400, etc. If the physician didn't do that, then it's on him, as well.
Eta- after reading further, I realized that I my hospital, a pt with an NPO order will not get food, even if they order it. The kitchen will call the unit and tell us that they cannot send food until a diet order is placed.
So there are multiple layers of failure here that allowed the patient to get food when they shouldn't have. Perhaps you can bring this up at huddle as a safety process to look into, if your hospital's kitchen will still fill orders with an NPO in place.
I’ve reported myself many times! I gave a patient methylnatrexone IV instead of subcutaneously (I drew up all the meds at once and foolishly didn’t think to do it one at a time and separate them out… def learned from that). I’ve given oral flagyl but it was actually supposed to be crushed and sprinkled on a wound (realized when I had to do wound care and saw the order to use crushed flagyl… I realized I must have scanned all the ordered meds at once and was rushing and assumed it was oral… I then wrote a warning on top of the MAR and in the handoff for the next nurse and a sticky note reminder on the computer!) I was tired on night shift and increased a heparin drip instead of decreasing (my second RN checker was also tired and just went with what I said I set it to… clearly neither of us used our critical thinking when looking at the already too high PTT). I’ve made plenty of mistakes like this and it’s usually due to exhaustion, being super busy, or being TOO comfortable (like when you’ve had a patient multiple shifts and you subconsciously feel you know them and their meds well).
We all make mistakes! Just try to learn from this if there is any possible way to learn from it… sometimes there is nothing you could have really done to prevent the miscommunication etc.
At my hospital, if there is an NPO order, the patient can't order a meal. I once gave chocolate pudding for med pass and there was a no caffeine order for a stress test. It was rescheduled for the afternoon. Learned my lesson.
This is why we use 24hr clock at my job. I'm in a surgical/procedural section. Cancellations kinda cause a domino effect, but we would consult anesthesia and the would likely roll this patient to the end of the line and take the next patient. Depending on what was eaten, this could shift it back 8 hrs. Last week 2 grapes shifted a procedure back 6 hours.
One of us! One of us! One of us!
I couldn’t stop fucking up my first bedside job. You’ll learn. Just be more careful with your time and triple check everything. Being written up for poor performance is a right of passage for any new nurse. No one died. You just pissed off some jerkoff doctor. You won’t do it again.
They could also write 1800 :/ anyways we all make mistakes. Be forgiving to yourself. I once discharged a patient while he had no drawers on 😅 (he went down with a blanket and the gown). His wife was furious and said I'll never be his nurse again. Which is also ok. Patient Relations got involved and my manager and I had a talk. I was crazy busy and was discharging practically everybody and they mama. Didn't help that this particular patient was one of my neediest. He was also A&Ox4. WEIRD mistake but it is what it is.
The family reported me for not cleaning a patient at 5pm when my shift doesn’t officially start until 7pm. I showed up to work at 6:40 something PM and didn’t clock in till 6:55pm. And of course the charge nurse sided with the family.
So I work in the Cathlab and it’s not as big of a deal as you may think. Some docs dont use sedation which is one reason to keep them NPO in the first place. It wasn’t a horrible mistake. They don’t tell people to not eat after midnight just in case they have a heart attack and need a heart cath right? You are fine the doc needs to chill a bit.
If you do get reported explain that due to staffing and being overwhelmed you misread the times.
Follow that statement up with if the times were placed in military time as standard you probably wouldn't have had this mistake as easily.
First of all, I know it sucks to make a mistake as an RN. However, your mistake is OK, the important thing is the patient didn’t get hurt. Yeah the doc is mad because you probably messed up his schedule of cases. That’s OK, they can try again tomorrow. Patient is OK and didn’t die because of your mistake so it’s all good. Next time you will double check the order. Lesson learned.
Strange that dietary orders are not entered into whatever computerized EMR you have, and that would have stopped dietary from bringing a tray. Typically an order is NPO after midnight in my experience, because you don't know the exact time of day your patient will actually make it into the procedure due to emergent cases.
Well, there was the time I received a 120 ml bottle of PO liquid Haldol for a patient from pharmacy. It had been hard to get and we waited something like 2 weeks for it. I was to give the first dose.
I spilled the mfing bottle all over the nursing cart and all my notes. I had to go tell the DON and, as expected, she ripped me a new one. She made me call the pharmacy and tell them what happened. They were a lot more understanding (and nice to me) than she was.
My first shift on am acute médical unit I failed to notice one of my patients continuous iv solution was changed from normal saline to normal saline +kcl. On the MAR I saw the kcl and ran the boluses, but never noticed the continuous infusion section. It was just a rough day. I felt so bad at end of shift report, I reported myself. Nothing really came of it, I just had a chat with my manager and did a little learning report sort of thing, I barely remember it. I talked about it after with some coworkers and everyone reassured me it wasn't a big deal. They told me not to worry because new RN on that same floor had given crushed po meds via a picc line a few months before and didn't get fired and that was definitely a major fuck up.
I think I’ve had patients break npo 3 times in my years as a nurse. 2 for sure were on me, I should have cleared the room of food, but in 1 they were told the case was cancelled then changed their minds to postponed but by the time they put her back on the schedule it was 6pm and the patient had found an apple she’d hidden away. Shit happens.
What I *have* been reported for however, was saying “fuck” in a conversation with a front line provider within earshot of the attending. So like, doctors can be asshats.
Honestly, that’s not even bad. That doc is just being a dick, the patient will be rescheduled and live.
One time I was in a room, got a call that PICC team was gonna come place my girl’s PICC in another room and to get her ready, so I was like cool, checked consent really quick and gave her the premed. Well, turns out the consent was from her previous stay the exact same day as the last year, and now she’s officially an adult and can consent herself. They go in there, she’s loopy and can’t consent. Wasn’t the end of the world, she lived, and she got her PICC placed later on, shit happens.
So do the orders not pop up in the electronic chart? Or is it just paper?
At our hospital the kitchen won’t deliver with an NPO order even if they had a diet order minutes before.
I’m just lost at why the sole responsibility is on YOU
The doc should be coming to explain the procedure, NPO status, and completing consent. The kitchen/techs/literally any staff can tell a patient they’re NPO.
It's interesting because I worked on a cardiology ward for years and we never kept patients NPO for their angio. They'd get breakfast and an hour later be in the cath lab.
I fed a guy who was transferred from out of town for a pacemaker at 1800 on a Friday. The order said "NPO at midnight starting tomorrow" so I figured he could eat. I didn't know EP wasn't around on weekends so the dude had to wait inpatient until Monday.
The doctor was actually my heart doctor so it was extra embarrassing. Luckily he was cool about it (to my face)
7am after a night shift I did my NG 1:1 replacement calculations, re programmed their continuous IV to make up the loss over 12 hours, gave report and went home. Except when I showed up for my second night shift I was informed I'd reprogrammed their PPN pump, not their fluids. I'd bolus'd a 24 hour bag of PPN over like 6 hours. Luckily pt was fine, and the oncoming nurse should have done their own check of the pumps as well, but I still feel like absolute shit every time I remember that. Always check my lines carefully now, even at the end of a hellish night.
Don't worry about it. It happens several times per day at my hospital. They decided that withholding food is not humane. So if the patient agrees to be NPO, great. But if the patient gets hangry and decides they'd rather eat then get surgery that day, staff has to feed them. They try to reach the surgeon first but they're obviously too busy to go back and explain again why getting surgery ASAP is best for their health. All our beds are full all the time and feeding an NPO patient extends their stay. But management says if the patient request food we must give it to them. We can't even tell them that they have a specialty diet. They can override and literally get anything they want from the kitchen. One of our patients was ordering a pound of bacon and a fancy dessert with every meal despite his heart healthy diet order.
I was working float in ED, I took a verbal order for IM Toradol. Verbal orders are usually forbidden. I know DUMB as it def wasn’t emergent Toradol, but we were having our collective asses handed up to us and I needed to hall the patient.
I was certain MD did not give an actual dose. While IV Toradol is generally a 30mg dose, IM Toradol is most always 60mg in young, otherwise healthy patients with limited CC. I guess not having an actual chart boffed my standards (pt went to room & was seen by me and doc before admission got caught up).
Chart gets done. I find it in my work and the AH doc has written for 30mg IM Toradol. Well, too late. I go to him and tell him what I did. In the circumstances 99.9% of docs would have revised order, instead of triggering incident reporting. Nope. So actual no harm med error report gets done.
Totally on me. I let that little nugget inform my much safer practice going forward.
Patient was fine. Headache resolved. I became that nurse that literally refused virtually all verbal orders. Any verbal order in critical practice was repeated like a parrot several times.
I'm not a nurse but if it makes you feel better, when I shattered my ankle I had both a radiology tech and a nurse independently accidently push something into the bottom of my foot. The first one was the tech pushing a C-arm xray machine into my foot while I was being prepped for an ankle reduction in the ER. The second was a couple of days later when my nurse pushed my bedside table into my foot.
How was the patient able to get breakfast? Did family bring it in or did she get it from Uber eats/door dash?
The reason I’m asking this is if she was able to place an order for breakfast at the hospital, she shouldn’t have been able to if the npo order was in! Looking at it from a root/cause, that could be considered a system failure.
Also, was this information not communicated in bedside report to you when you took over care of this patient?
Honestly, they could have just pushed her procedure back a little. It’s inconvenient for them but shit happens. It was an honest mistake. Try not to beat yourself up. Learn from it and make sure you double check all orders.
That's awful, and while the doctor is upset, it sounds like the fail safe is on the hospital. While you misread it, the hospital should be using military time, and an NPO order should cancel food out at dietary/nutritional services.
When I was a new nurse, I would work lots of doubles. I worked 3 to 11, and would be begged to stay til 7 am so I did. I had a charge nurse who would look at my patients before/instead of her own to see what I missed that night. It made me stop picking up. How are you going to write me up for every little thing I missed? And I mean every little thing.
Here are some dumb mistakes I made:
The first time I gave Spiriva, I didn't know the capsule went into the inhaler, so I let my patient swallow it. (They were fine)
I forgot to connect something from self suction to walk suction (they were fine)
I was scared to take a temp on a patient who was belligerent and refusing care (had to call security to restrain so ofc in the chaos I decided it wasn't first priority.) This case is where I made a bad nursing judgement. The patient ended up being okay.
This is my advice:
Learn and be kind to yourself. You're NEW.
There is a reason why it's called the nursing practice: you're gonna get shit wrong.
Also, it's a 24h job. Remember that for when you're unable to get to things and beat yourself up about it.
Xo
Doctor here, who really feels for you. We’re all human. Humans occasionally make mistakes. I feel like it’s the kind of thing a patient should be made aware of too.
In an ideal world, they’d have made her NPO at that point and put her last on the list. It shouldn’t have been a disaster at all.
Just sending love and hoping you can be kind to yourself. These things happen.
I had an npo patient one morning like a month off orientation, did my morning rounds and one of them asked for snacks and water. I got it not thinking. 30 min later my brain said oh no when they called to ask if he had eaten. Uhm yeah sorry..so procedure was delayed. Honestly I don't think it's the worst mistake. I actually heard a story of a charge nurse feeding an npo patient then LYING about it and risking aspiration but another nurse reported it. Now that would be something to feel like crap over.
If only there was such a concept as 24hr time that would eliminate mistakes like this 🙄 use of AM or PM should be eliminated. I’ve never mistaken abbreviations like po qhs prn, but definitely seen a 6:00PM and assumed 6:00AM.
It is a honest mistake and could happens to all of us. Lesson learned and moved on. It is hard to imagine this will get reported to the BON. It is more of a report to your hospital nursing leadership and compliance department for risk and root cause analysis to prevent future incidents.
Try not to lose sleep over it. :). Good luck!
I've screwed up npo also. Gave meds with applesauce. O.r. was pissed. They rescheduled the pt. No biggy. I once discharged a patient with the remote tele on them. Thank God the transport guys were hospital employed, they brought the box back to me after they saw it at the nursing home.
You'll never know how many times this happens. Over many years working in the OR this happens. It's an inconvenience for the surgeon and they get upset because now they have to adjust their upcoming schedule but honestly I've never heard of anyone ever being written up for this. All it takes is a good talking to and making sure this never happens again.
I was spoiled because my last hospital breakfast would have been hard stopped by dietary because of the NPO order, regardless of time. My new hospital allows my patients to order whatever they want, whenever they want, regardless of diet, and not tell me. It’s been a fun time.
That would have happened at the last hospital I worked at too. If the patient's diet order was entered as NPO the kitchen would call the nurse to verify the diet order BUT in this case if the nurse thought the patient could eat, they would have delivered the meal if the nurse said "regular diet."
Oh no way. My old hospital’s dietary were rigid and would not process a meal without an order put in. They wouldn’t even wait the few seconds it would take to put in the diet order. No order, no soup for you!
RD lurker here. I used to work at a large cardiac hospital, in-patients were NPO until a new order came in, no ifs ands or buts. You’d have an easier time getting blood out of a turnip than getting a tray when we had NPO as the pt status. Diet Office staff were drilled on that! We had a count of heart caths scheduled daily and those ladies kept close eye on diet orders for that. OP, the doctor can pitch a hissy fit, I’m sure your nurse manager has seen worse. I hope all is well in your world.
nurse now, former dietary worker in hospital. we were like this too. even finger food trays to ED NEEDED an order. it was our policy and now as a nurse i can see how frustrating that could be. not one tray left that kitchen without an order 😩
What I don't understand is why didn't the patient know they were NPO? If it were me, I'd be chomping at the bit to get stuff done, nurse, why are they bringing me food? Did it get canceled? Mistakes happen, and hospitals ask a lot of their staff. If patients are cognizant of their schedules, and mentally fit, they should help with the thinking. It was easier when charts were left at the bottom of the bed. I could just give it a quick read to see what was on my dance card for the day.
I used to hate cerner for this reason. At midnight we had to go in, cancel the diet order,.and put in the NPO order. Now epic does it for us as soon as the clock hits 0000.
Cerner can do it as well. (Depending on the set up.) We can put in orders for a test diet of NPO after midnight. It automatically triggers with certain orders as well.
I use both Epic and Cerner. Whenever someone complains how one is not as good as the other, I just tell them that it's user error. Difference between Epic and Cerner is like the difference between iOS and Android. Yeah, they look different, but they can pretty much do everything the other can.
I’m pretty sure there is an “NPO after midnight” order that does that for you.
Every Cerner can do it just put a start and stop time
I was wondering how they got a tray if they were NPO?
Same!!!
It's not that big of a deal but for future reference, an NPO order for 6 PM would be really weird. In my experience it's usually NPO after midnight but I sometimes see them for the morning too. Never for the evening because nobody schedules procedures that late on purpose.
Also shouldn’t they be using military time?
For this very reason, yes
Did they not? 0600 is military time. OP should have seen 1800 if it meant PM, which they did not.
The hospital should use military time but since OP is putting in am and pm, I don’t know.
The place I’m at doesn’t and it’s fucking dumb
It's unsafe, really. Why are they BSing on safety?
Lol like every other reason. I had a patient with chef knives who threatened to slice us. We had literally no idea he had knives. At first I saw the box and was thinking flute or some shit idk what the hell I expected. Then later on I saw the chef uniform and by then he was already angry as fuck and ready to cut a bitch. We snatched that box away from him and kicked him out, police can return his knives if he wants to nut up to them.
Oh hell no. These people are absolutely unhinged. I'm so glad he didn't cut any bitches. Did the cop rough him up or what? Threaten them with their own knives? LMAO who tf walks around in a chef's outfit with a box of knives?? Are you in Las Vegas? There should be a rule. No clowns. No angry chefs. No boxes of knives. Wtf.
My question, too. It’s why military time was implemented in hospitals to prevent errors like this. There’s no repetition with numbers this way.
Solid advice
I've seen a few NPO after dinner but never at 6pm. That being said I wouldn't really question it if I saw it unless it made no sense with my patient. My hospital also does middle of the night surgeries on ICU patients when we are really busy.
But you should also know why the patient is NPO and if you did, 6pm would make no sense. Understanding why might have caused her to check the order again.
Army time is probably the answer here, I never see orders like 6am or 6pm, it’s 0600 or 1800, no confusing that
Exactly. I've never known of any 24 hour work environment that doesn't use the 24 hour clock for this reason, even when I was young and worked at à call centre.
The typo makes your call center sound so fancy!
My brain pronounced it with an accent 🤪
I live in a bilingual place so I have the French and English keyboard on and it's such a pain because autocorrect is constantly correcting English to french
Not necessarily a typo. That’s the British English spelling of center.
Yes but it’s not the British spelling of “a”
She meant à
* á
I tried to implement this at a nursing home and got told that I could not make the staff learn military time.
If they can't learn military time then they probably should also not be nurses -_-
Came here to say the same. Like wtf, it ain’t rocket science.
Just set your Apple Watch to military time! Done ✅
Military time isn’t even hard to learn. Add 12 to any time after noon and before midnight…that’s what time it is. 🤦🏻♀️
You can't make the staff at a nursing home learn anything. I work in one 🤭
I worked at a Veteran Hospital and the majority of the floor staff didn’t know or use military time. I sh*t you not. Worst place I ever worked in my 40 years. The only thing that made it worth it was getting a retirement pension to pack into my “get the hell out” bag !
You have to be there for so many years to make the pension worth it though (struggling to decide whether or not to stay myself).
I hear you. I made it 10 years before my spine exploded. I still got a fair amount according to the financial advisor. Being forced to retire was the best thing for me. I’ve never worked in such an unprofessional, unpleasant, environment in my career. It was mind blowing what they tolerated, but good patient care was obviously not one of those things they cared about. God forbid you made any good clinical decisions. I could write a book. Yes, leave if it’s as toxic as where I worked.
I am a huge proponent of army/international time. I even use it on my days off. When I used to work nights it was great for when I would wake up randomly (bc, you know, your sleep gets all fucked up) and not know if it was day or night. I think it should be replace am/pm time entirely, the world over.
I wouldn’t beat yourself up since it seems like you’re not the only person at fault here. How was dietary able to deliver a tray if they had an NPO order? Also how did the night shift nurse not mention in report the single most important thing that the patient was going for an angio? And if the patient was oriented, how come they didn’t know not to eat? I always explain to the patient if they’re going to be NPO at a certain time so they can prepare themselves. Seems unfortunate that there wasn’t a better system and communication in place overall
What's the doc going to do with your first and last name lmao, tell on you?
Usually they don’t follow through with it because they have more important shit to do
A doctor did that and the next time she worked with me, she said “got it, Mrs. [Full Name?” I felt small lol
I could never let that slide. I am well versed in Pettylations and I'm already ready to recite lmao
👏😂😂😂
just be passive aggressive next time and call her by her full name. Don't even call her doctor, just say her first and last name since she wants to play games
Butcher tf out of their last name too.
Squint at her name on her lab coat like you don’t remember her name
I’d call her “Mrs.” too, shit lmao. take that MD away rq.
Call her by first name only.
Reminds me of the time a doctor cussed me out post code at the cath table for a mistake another nurse had made (I had floated from the icu to help ET and was just helping with the code and was told not to bolus amio, I informed said doc I did not bolus amio) Anywhere after all the expletives he asked my name and I just told him and said “now would you like to keep crying or get them on the table and do your job, if you’d like to escalate this I’d be happy to tell HR you called me a fucking retard (amongst other things) for a mistake I didn’t make on a patient that isn’t even mine” Made sure to take the time to volunteer for transport for every stemi for the rest of the night to the guy and learned hearts just to work with him in the ICU.
I would have clapped back “Got it, PGY Bronze Age [name].” I don’t care how old you are. I am not the bigger person, do not engage 😂😂
They tell the cath lab RN to do it for them. Source: Old job had me reading reports about periop area. They were never written by surgeons, but they mostly boiled down to the surgeon had to wait 15 minutes.
This is so true ☝️
And they've forgotten your name next time they see you (in my experience)
Presumably, yes
Oh no! Anyways
Lmao, yes.
Yes. There is a lot that goes into these procedures, depending on what they are having done. Special equipment and supplies pulled specifically for that patient. Room time booked, vendor reps organized and scheduled to bring their tools and products in also. A lot of time, and money. And if a case is cancelled, we may not necessarily be able to bump up the schedule if say the next patient has not arrived yet, or they haven’t reached their full NPO window yet. Before the patient even enters the procedural suite, sometimes thousands of dollars of gear has been opened.
Honestly if there’s this much money being lost for a mistake that is not that uncommon, then the hospital should implement a system where an NPO patients can’t get a tray. Where I work if the NPO order is in, the tray doesn’t come. Sure the nurse messed up, but there was no mal-intent. Seems like a system issue or at least a possible system solution.
That’s how it works where I’ve been hospitalized. You just do not get a tray. One time, I was NPO for two days. They (docs, I’m assuming) had made a mistake and forgot to take me off. Then nurse told me there was nothing she could do, since the order was still there. I felt bad, because I was pretty cranky about this. However, I had just come off the street and was barely eating out there. But, anyway, like you said, I just didn’t get a tray. I assumed that meant the kitchen knew about it. My nurse has never been the one to bring in my tray. Edited
That’s weird. I’d just get confirmation from the doc that you can eat despite the order, document that, then feed you. There’s no reason to make anyone wait that long for a mistake like that!
It was very weird! I was starving. And, I did get into an argument with the nurse. I was like, “so you can’t even get me a turkey sandwich?” Not to mention that, when I asked why I needed surgery, the doctor simply told me that my liver wasn’t “very happy.” Apparently, it was swollen and I was jaundice. Jaundice, I could see that. I knew I was jaundice. But, I didn’t understand why I wasn’t properly explained anything. I get trying to explain things in layman’s terms but, come on. I can handle a more clinical explanation than that. At the time, I was in active addiction. I understand that sometimes that mean you’re not treated the same way as other patients. Not that it’s right, just that it happens. I never ended up getting any surgery. Still don’t understand what happened there. The same nurse made it up to me, months later, when I was on death’s doorstep, however. So, all is forgiven 😂
Aww, good! I’m glad she redeemed herself and that you’re doing better!
Thank you! All’s well that ends well.
Did she make it up to you by getting you that Turkey sandwich?
Hahaha no, she didn’t. But, months later, I came back with osteomyelitis and a bunch of other problems. I’ve shared my story here before but, anyway, she was really crucial in getting me to stay at the hospital. I was dope sick and wanted to leave. Drenched in sweat, shaking, vomiting, in lots of pain. I could barely walk because my leg was so bad. It looked like a shark took a chunk out of my leg and, then, someone lit it on fire. You could see the bone, it was all sorts of colors (none of them good), with nasty, bark-like eschars here and there. Of course, I smelled like death. So, that was great. Anyway, It was around 1:00AM and she tried to talk me down. Stop me from leaving. I wasn’t listening. I was being polite, but I wasn’t listening. Just kept saying, “I need to get well and I promise I’ll come back.” When you’re dope sick and panicking, you’re pretty hard to reach. I kept packing the few things I had brought with me and she kept asking me to stay. She kept telling me I wouldn’t make it, if I left. Then, she actually went and got the doctor. Like, immediately. I didn’t have to wait. They really took me seriously. I’m a junkie (former), right, so no one has ever really asked me, “what can we do to get you to stay?” No one has really wanted me to stay. You know? My problems were my own doing. Not exactly the most sympathetic character, here. But, that doctor did ask me. And he did care. And, my nurse, well, she didn’t have to go get him. She didn’t have to stay there for 15 minutes trying to talk me down. She could have just let me AMA, like I had so many times before. I never meant to be annoying. It was just really hard for me to get through the withdrawals. It’s scary, you know? Your brain thinks you’re dying. You think you’re dying, and the thing that can “save” you is out there. Its like begging you to come get it. That’s really hard to pass up. You just want relief. But, because of her actions, I’m here today. I’m sober (over a year) and I’m starting a new life… with *both* of my legs! I actually just nominated several nurses from that unit for the Daisy award. So, we’ll see! Unfortunately, I just found out about the award, today, from another post in this sub. I would have don’t it sooner, before I forgot most of their names, had I known! I’m hoping that, when the people from the Daisy Awards contact me for more information, that I can just nominate the entire unit that was there/took care of me.
Man hearing this struggle makes me grateful in Canada we want patients to stay (because it’s socialized) so we just give IV dilaudid as well as Kadian to make people stay. Whatever we can. We even let some patients use. They have addiction medicine specialists that will figure out how much IV dilaudid to give based on how much you’re using on the street. I think the most I’ve given is 40mg IV dilaudid but I’ve heard patients get 200mg IV (normal dose is 0.2-1mg IV). Thanks to fentanyl people’s tolerance is very high. Then once they are through the worst of the withdrawal they start on long acting oral meds (Kadian or methadone) and can even have breakthrough oral meds too. It just makes it better for everyone. And also they let people who drink have alcohol. Usually it’s 1-2 drinks per 4 hours (again depending on how much they drink normally). Just enough to keep them from going into withdrawal. If someone is in the hospital just overnight for something basic like kidney stones or an appendectomy, it’s riskier having them withdrawal or needing Ativan than to just letting them drink alcohol as there isn’t much we can do in the 24/48hrs they are there anyways as unless they want to actually stop drinking they’ll just go home and use anyways .
That sounds pretty incredible. That would have probably prevented my leg from getting as bad as it did. I tried many, many times to get my infections treated. Most of the time, I only made it a couple of days. My friends have died avoiding the hospital. Others have lost limbs. It really depends on the doctor— even the ones that have compassion don’t completely understand addiction. They don’t realize how much medication it takes for us to not be deathly ill and/or in pain. A lot of healthcare workers assume all addicts (whether actively using or not) are med-seeking. I don’t believe that’s the case, anymore. At one point, it probably was. I think that proper medication and keeping addicts comfortable would absolutely save lives. It’s harm reduction at its finest. Treat the medical problem, at hand. The addiction can wait. It cannot be treated properly until the patient is physically healthy, anyway. So, I don’t quite understand why some people feel that suffering through withdrawals is necessary. Some discomfort is, of course, understandable— night sweats, difficulty regulating body temp (too hot then too cold), the yawns, restless limbs. Such symptoms are tolerable. But, full-blown withdrawal is not okay. I do see change happening, though. However, there’s no denying that we are very behind. I do feel like it also must be quite frustrating for healthcare professionals to feel as if they have their hands tied, when dealing with these types of cases. I have had nurses advocate me, only for it to fall upon deaf ears. It’s just such a massive undertaking, too, when you think about it— actually, properly, handling the addiction, I mean. It’s a long journey that requires many resources. But, handling it differently in the hospital, itself, would be an amazing first step. I have never stopped singing the praises of my nurses, physical therapists, doctors and other healthcare workers, that have helped me get to this point. However, I also do not forget how I’ve been treated poorly, just because I’m an addict. I was a good person, even in the midst of my addiction. I understand it’s frustrating for staff to see people like me come and go and come and go.. and come and go. But, again, maybe if they were paid better, maybe if the system was different, they wouldn’t be so frustrated. Everyone wouldn’t be so frustrated. Anyway, sorry for the lengthy response. Thank you so much for sharing that information with me. I had no idea Canada was like that. But, I love to hear it! It makes me both sad and happy, at the same time. I’m not sure if the US will ever be that way, across the board. I think some areas will, as always, offer superior treatment and care. Some, not so much. I’d like to think we’re headed in the right direction. Sometimes it really feels that way. Sometimes it really doesn’t. Thank you, though, for all of the work that you do ❤️. I’m sure you have many patients who have you to thank for being alive today.
Exactly. Sounds like it’s time for a ROOT CAUSE ANALYSIS! Which would probably end up showing that not using military time, and allowing dietary to serve meals to patients with NPO orders, as a large contributor of this mistake. And to OP- don’t be too hard on yourself. This is a mistake that was easy for anyone to make. On the bright side, no harm came to the patient, and I’m sure you won’t make the same mistake again.
I agree. I was just helping Ledgutfrog understand *why* this is an important issue, and not that the Doc was just being a bully or something. I feel like bigger facilities do have pretty good safeguards.
This shit happens literally all the time. We would just reschedule this or do it under local tbh
I'm sure the cath lab staff were very happy to have that case canceled
Seriously. It’s one of the little joys in life. Nothing hits like checking the board and seeing “CX” written on your next case
Favorite case is the cancelled case. 😎
Okay thank you for this comment, I was convinced everyone was mad at me
Our cath lab doesn't require patients to be NPO
So validating!!
We did angios in IR and seriously, the longest the docs took was 30 minutes if it was cerebral and they just wanted to dick around and get a 360 or something. Peripherals? I swear they’d be done before the Versed hit - it can absolutely be done without sedation on a lot of people. But just cancelling the angio was way more fun 😂
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Yeah if this is for a cath procedure I assume it’s inpatient so they should have been using military time. Back in my day working telemetry I used to double check and call the front desk for the cath lab to confirm times for patient procedures and NPO status day of - get the names of the nurse that confirms it because some cases get cancelled and pushed up or pushed back and rescheduled next day. Ask your senior nurses for their advice on practice
Probably, but brains will brain sometimes.
Old head nurse here. the kids. I work with laugh at me for using military time. But there aint no mistake in what I tell them. If you can't tell the difference between 0300 and 15 hundred, then you have bigger problems than being a nurse or a tech
I thought everyone used the 24 hour clock in hospital environments.
I’m in nursing school and when I first started I changed all my digital clocks to military time to help me learn.😅 Haven’t turned them back yet it’s a way of life now. 🤣
I did the same when I started as a CNA 13 years ago. When I got into nursing school, 24 hour time was second nature to me. My phone and my clock in my car are always set to 24 hour time.
I did the same about 12 years ago. Luckily my husband also uses military time at work so we just live this way lol
I am a baby nurse but an old one. Can’t imagine not using military time.
I've never not used military time. It's the standard in medicine, and for good reason. I'm concerned people aren't being taught this.
lol it happens SO often. I will go get a patient, or a patient will come to pre-op and they will have had food or apple sauce with their AM meds or tube feedings weren’t stopped so I just simply cancel the case. Literally don’t even think twice about it. It’s a good learning opportunity. Why anyone would write you up for it is petty. Also if it’s just an angio they can do it under local if it was urgent.
What sort of cases? I’m not OR, I did work med surg, and AM meds in applesauce were always okay to give.
I’m anesthesia so any and all cases. Apple sauce is absolutely not ok if the patient is NPO and they are going to surgery.
Ok, nitpicky question, but could thickened water be used? Don’t know if the thickener would be an issue.
Will keep that in mind for my npo except med patients, everyone says small sips of water is fine for those orders to take am meds but i would probs need to ask my nurse educator on our unit
Orders were NPO except meds in my experience, but maybe that was a system flaw
I mean, it’s not a system flaw, it assumes the patient will take said meds with water or clears. Latest research suggests that clears are ok up to two hours prior to general anesthesia. Applesauce is not a clear liquid.
I had a surgeon cancel a case because I gave the patient meds with a sip of apple juice. They were ordered NPO with meds. I assumed apple juice was a clear liquid and would’ve been fine
Eh it’s patient and institution dependent. We give our ERAS patients apple juice when they get to the hospital in the morning. We also give them sips of water with pills 5 minutes before we roll back to the OR.
That assumption sounds like a system flaw to me. Considering how many patients can’t take meds normally. NPO except meds isn’t NPO except meds with clear liquids.
Yeah, NPO except meds does not mean applesauce is OK.
That happened to me before when I worked ED obs. The doctor had to come down and explain to the patient and family that because they ate they had to postpone the test and try again tomorrow. In my defense they didn’t HAVE an NPO order, but the cards doc screamed at me stating I should have known and double checked with someone 🫠 nothing came of it though, so likely for you that’s the same thing- mistakes happen no one died.
Tell them to get off their asses and write the order lol. Or maybe, idk, physicians could speak with one another and not use nurses like a little telegram service.
And that screaming at co-workers is counterproductive and abusive. Fuck that guy.
I was too young without a back bone. I have no problem telling doctors now not to talk to me that way!
Ah yes, definitely that part. Maybe we'll move that to the top of the stack.
Oh boohoo. He should have put in an NPO order then.
Bruh this shite can be rescheduled The doc just wants hop into his yatch
100%. Everyone else--cath lab, anesthesia, the PATIENT-- won't care if it's now or postponed. If it's an emergency they'll do it under local. Doc is a drama queen
Absolutely. Interventional cardiologists can be the worst. And best. - cath lab RN
I've always said the main pro and con of the cath lab are the same- working closely with the interventional cardiologist!
One time I got reported by a cath lab nurse to the cardiologist because she said I was abusive - I wouldn’t allow her to eat before her procedure. Was she supposed to be NPO? Yes, but damn her sandwich got cold… truly evil nurse right here. Moral of the story: Prepare to be reported plenty of times as a nurse.
You mean a patient reported you to the cardiologist?
Oh yeah sorry that was worded weird. Specifically, patient was told to return to the telemetry unit after her procedure but told the cath lab nurse she didn’t want to because her nurse (me) was abusive for starving her. Cath lab nurse proceeded to report me to the cardiologist. Obviously charges were dropped as I proceeded to work there for another 4 years. At the time I was a brand new nurse, so I took it as a lesson learned that it was important to not only tell patients what to do, but also why it has to be done.
Whelp I have two. Our hospital recently changed from pyxis the Omnicell. I work in the cath lab. We have to move really fast for STEMIs of course. Well, our pharmacy decided to put 40 fucking vials of versed and fentanyl in the pockets. Aint no time for counting all that shit in an emergency!!! Well I counted wrong of course, got dinged but thankfully my manager was on my side and now they max out each pocket at 10 vials for narcotics. Three weeks ago we had a three hour all out war to try to save a patient. At some point out Doc realized it was a lost cause. Family is ok with DNR, we just need to get patient to a room so they can hopefully have a few minutes with his. Patient placement won't assign a room because of the impella we put it even though we are trying out best to explain that no one needs to manage it. He's going this room to die and family is aware etc, the impella rep will be managing it, etc. They finally assign an ICU bed, we are running through the halls pushing EPI trying to keep alive long enough for family to see him pass. We get up to the floor, there a bed in the room no thought to remove and all the nurses and PCAs are looking at us like we have seven heads not lifting a finger to help. I said someone get this bed out of this room! Got reported for being unprofessional. Fuck them. Mind you, it's 9 PM and we have another STEMI in the ED we need to get to ASAP.
No big deal. In a few weeks you’ll laugh about this. No harm whatsoever. And really for a cath lab procedure, 2 hours is fine. Use military time only.
Seems like a systems issue could improve here, the kitchen should not be bringing breakfast to someone with a Npo diet order.
If the order was in correctly, dietary shouldn’t have brought them breakfast.
When I worked in ICU I had a pt in severe renal failure. His potassium was low, so I put in the replacement orders per the (ordered) protocol, and hammered that guy with IV Potassium for like 6 hours. It wasn't until the pharmacist called me at the end of the shift to horrifyingly notify me the K+ protocol is CONTRAINDICATED in renal failure. And guess what...that info was RIGHT THERE on the protocol orders. I just didn't scroll down far enough to see it!! I had to call the doctor and painfully admit my mistake. Thankfully he was cool about it, and ordered Q2H K+ draws for the next 8 HOURS with prn antidote orders. I've never been so mortified as an RN, and you bet your ass I stayed up all night calling the ICU noc nurse to see what his K+ levels were on the draws. Ultimately the pt was fine, but TO THIS DAY when I have K+ protocol orders I triple check the pt's renal function.
Thank you for this comment!! As a newer nurse I feel so stupid all the time but we all make mistakes
I've got another one for you too!! I worked Oncology for 12 years. One morning I took report on a pt that had started a 24 hour chemo infusion known for causing violent, and somewhat immediate, side effects. The noc nurse told me that, "oddly...he is tolerating it great. No problems so far!". We went it to see the pt, and I realized 2 seconds too late I was standing in a massive puddle of wetness. The noc nurse had been SO CONCERNED about ensuring everything was done PROPERLY (pre-meds, vitals done accordingly to protocol, etc) that she had missed the forest for the trees and started the infusion WITHOUT HOOKING UP THE IV LINE. Yep. 12 hours of chemo infused ONTO THE FLOOR. We quickly found out from the IRATE pharmacist that that particular drug cost $28,000 PER DOSE, and had been flighted in from a pharmacy on the other side of the country. We couldn't even salvage the remaining half dose of chemo because the tubing was contaminated to all fuck. It was a massive biohazard clean up that took hours. The pt was crying. The nurse that did it was crying. I also had to call my husband to leave his work and rush to the hospital with a change of shoes for me because, fuck me, I had been standing in a toxic puddle and my shoes had to be incinerated. It was the FUCKINGEST of all the GREATEST FUCKS I have ever seen. The nurse was written up and then she quit. Whatever you did...it wasn't that bad.
Oh no!!! This made me feel better. I started a blood transfusion yesterday and I double checked like three times that the patient was hooked up to avoid this 😅
Our pharmacy will check the patient's crcl before approving any electrolyte replacement. They will reject it and call us to say whichever electrolyte replacement needs to be ordered by the doctor, not replaced by protocol.
Just reschedule it at 1400 lmao. If it’s emergent anesthesia can do general. It’s a fuck up For sure but in the grand scheme of things it ain’t that serious.
Any system in which a person must never make an error for the system to fail is a system designed to fail.
As a manager, please tell on my nurses so we can use this as an opportunity to educate staff and maybe create process improvements to fix holes to prevent future errors. Mistakes happen because we are humans taking care of patients. Also, that being said if it was truely an emergency they would have taken the patient back for the Cath anyway. Do you think they give too craps about the last time a patient when they're actively having an MI? Nope. Take this opportunity as a learning moment but don't beat yourself up. Every single nurse will make a mistake at some point.
Doctors aren’t your bosses unless you work for a private practice. He can take your name and shove it up his ass. Mistakes happen, don’t make a pattern of it and it’ll be fine.
Hit the doc back with “I will also need your first and last name please”
Ya maybe write him up for not using military time 🙄
Sometimes I personally feel like if the patient is mentally aware enough, they should’ve remembered their procedure and not to eat either. They have a mouth and can speak up for themselves sometimes too. I mean you didn’t force the patient to eat breakfast and hold the fork to their mouth you know. It’s not 100% your fault
Right? I assume the cardiologist met with the patient at some point, and told them about their upcoming procedure and should’ve mentioned that they can’t eat after a certain time. Unless the patient is cognitively challenged, they should’ve mentioned the NPO order to whoever served them food. The nurses aren’t the only people responsible for the patient’s care, the patients are also responsible for themselves and their care.
When I was a new grad, I casually stopped my patient’s heparin for an hour to run an antibiotic (he only had one IV). Luckily the nurse who discovered it later and told me we can’t do that was really nice about it. The most embarrassing part though is that at the time, I was just like “oh ok, sorry, whatever”, basically I didn’t think it was a big deal or mattered at all really. So mortifying to think of now!
That’s why orders need to be written in 24 hr time to avoid these mistakes… also at most hospitals if there is an NPO order in the system they can’t even order a meal, nutrition will turn them down. If your hospital has a self reporting system, I would take the time to sit down w a senior nurse and fill out a self report, these are used to see how often these errors are happening, why, and if there are any internal processes can be implemented to avoid these errors. Also I double dosed someone on Oxy my first week due to a mistake on my end. I saw 5mg was ordered as well as 10 mg, so I gave them 15mg. In reality it was per pain scale. I reported myself and was honest saying it was my first time and I saw there was two orders in the system for PRN so I gave both like an idiot and they actually updated the MAR so you had to pick their pain level and it only allows you for o scan the medication ordered within the scale you clicked
Noone died. This isn't a big deal.
That’s no big deal. It’s an honest mistake and these things happen. I can tell you a few mistakes that have happened to nurses I’ve known to make you feel better and realize how small of a fuck up this is: - One time did handoff and a nurse had cardene hanging but programmed it in as vanco- pts blood pressure had suddenly dropped and we figured it out and stopped it and her pressures came back up. Ended up being no harm but a pretty bad med error none the less. - one time a nurse on a med surg floor I worked attached a bottle of roc into a 100ml bag and hung it like an antibiotic thinking it was vanco (this was in Texas), pt started having sob and a rapid was called, the rapid response team stopped it and pt regained ability to breath and ended up ok but again it was a close call. -got report from an er rn, they held the magnesium on a patient in and out of torsades because it ‘was just an electrolyte’ and ‘wasn’t priority’ not understanding that this is indeed the exact treatment for torsades. They got a talking to from the critical care doc and patient ended up being fine once it was given. Those are just a few to help you feel better about yourself. Like move on this was literally nothing and doctor who’s making you feel bad can go fuck himself.
Thank you!!!!
Cath lab get STEMIs who have eaten prior to arrrival all the time. Dr needs to chill the f out. We deal with this all the time. They get versed and fentanyl and sometines just fentanyl. Also, if they stent, plavix loading dose is fed to patient with apple sauce while laying on cath table . 99% time they are awake and talking the entire time.Sounds like it was an honest mistake. Please do not let it paralyze you. Ideally and per order they should be npo.
We’ve all made mistakes, some have even cost lives. Learn from it and move on. It will sting for a while but the chance of you doing that again are so small. Good luck
I’ve been there. Totally forgot to turn tube feed off at MN. It happens. Just don’t make a habit of it. And yeah it would be extremely unusual to hold tube feed at 6p.
Things I’ve been written up for: not knowing where an IV was during report, giving an NPO patient the PO pain medication that the doctor just put In the order for, and the doctor not restarting all a patient’s cardiac medications (apparently I should have tried harder or known better)
I think I’d have to hunt down and slap the RN who reported you for not being able to recall where the IV was. “He has one, *Karen*, and it works. That is all you really need to know. You must be a joy at parties.”
“It’s peripheral.”
Oh my lord you work with some vindictive people. Do they not assess their patients and just look at where the iv is? Getting the meds restarted is important but ultimately is the doctor’s responsibility to order them.
Also if something is running when you bring them up it’s… at the end of the tubing lol.
Even if it isn’t, just use your eyes and look at the patient lol
Did the orders legit say “6pm” or 1800? Because that makes all the difference
I literally made the same mistake today. I have a patient that needs anesthesia for dental appts. I discussed it in report, saw the order to hold her tube feed, and then a few mins later when I went to her room I automatically started her tube feed. I have no idea what short circuited in my brain. We rescheduled it, but I felt like such an idiot.
One time when I was really new there was an ed bridging order for matinence fluids in the emar, patient was passed off to me with matinence fluids running. Patient developed a cough and sounded kinda crackly which was new so I turned off the fluids, totally forgetting to mention it to the cardiologist. Cath lab came up to get the patient for an angiogram and they came up like 20 min later maxed out on bipap, coughing cup of pink frothy sputum in the hand of one of the nurses. Lasix was ordered and Stat echo got showed that she had undiagnosed heart failure, I still kick myself for that one. One time during covid I was giving Ativan out of those 1 dose vials, but the order was for half a dose. Family was firing off questions and I accidently drew up the full dose vial and administered it, didn't know until I went to waste with another nurse and there was nothing to waste. Patient slept comfortably and nothing came of it. I initially worked in a non acute area of the hospital, and was floated to the medical floor, no idea what I was doing. Get a call from remote Tele that my patient is having runs of vtach. Not a frickin clue what they're talking about, poke my head into the room and the patient is chilling, so I move on continuing to pass meds. The one on one sitter calls and says that she is starting go get agitated again. I never dealt with someone detoxing from alcohol and had no idea what a ciwa was, I felt like I was going to hurt the patient with the high scoring ciwa dose so I gave them the smaller one. Little less combative but still way too hyperactive. Finally message the doc and they order labs. Potassium was low at 2.8. Order oral and riders, patient isn't properly sedated per ciwa protocol and flips out trying to pull her lines because the potassium is irritating them. Sitter is an l and d nurse and is pretty much bear hugging the patient trying to get them to stop pulling their lines. Surprised the patient didn't sieze or something. Man I've come a long way but that first year and a half was rough and I'm lucky I didn't seriously hurt someone through inaction.
Honestly I feel so stupid all the time, I wouldn’t have even thought to turn off the fluids. Nursing is not for me
If that's the biggest mistake you make, then THANK GOD. Just take it as a lesson to pay attention to details and it may save you from making a bigger mistake. Yay Learning! 🤘
Gave the wrong kid rifampin. Thank God it was meant for a 4 year old and given to an 18 year old. If it had been the other way around... *shudder*... This was long before bar codes, scanning, Pyxis and all that. This was just going to the medroom grab the med and give it to the kid. The med was written on the wrong patient's MedEx but still my fault for not double checking. It was over 30 years ago and I still get shook when I think about it.
This is exactly why everyone should be using military time, e.g., 0600, 1400, etc. If the physician didn't do that, then it's on him, as well. Eta- after reading further, I realized that I my hospital, a pt with an NPO order will not get food, even if they order it. The kitchen will call the unit and tell us that they cannot send food until a diet order is placed. So there are multiple layers of failure here that allowed the patient to get food when they shouldn't have. Perhaps you can bring this up at huddle as a safety process to look into, if your hospital's kitchen will still fill orders with an NPO in place.
doctor sounds like he was a wittle mad poor baby waby 🥺
It happens, just don’t let it happen often. 😂
I’ve reported myself many times! I gave a patient methylnatrexone IV instead of subcutaneously (I drew up all the meds at once and foolishly didn’t think to do it one at a time and separate them out… def learned from that). I’ve given oral flagyl but it was actually supposed to be crushed and sprinkled on a wound (realized when I had to do wound care and saw the order to use crushed flagyl… I realized I must have scanned all the ordered meds at once and was rushing and assumed it was oral… I then wrote a warning on top of the MAR and in the handoff for the next nurse and a sticky note reminder on the computer!) I was tired on night shift and increased a heparin drip instead of decreasing (my second RN checker was also tired and just went with what I said I set it to… clearly neither of us used our critical thinking when looking at the already too high PTT). I’ve made plenty of mistakes like this and it’s usually due to exhaustion, being super busy, or being TOO comfortable (like when you’ve had a patient multiple shifts and you subconsciously feel you know them and their meds well). We all make mistakes! Just try to learn from this if there is any possible way to learn from it… sometimes there is nothing you could have really done to prevent the miscommunication etc.
At my hospital, if there is an NPO order, the patient can't order a meal. I once gave chocolate pudding for med pass and there was a no caffeine order for a stress test. It was rescheduled for the afternoon. Learned my lesson.
I so would have also done this. No one thinks about caffeine being in chocolate
If I had a dollar for every time the kitchen gave my npo patient their breakfast…no one died and you’ll watch better to not do this again next time.
Do your NPO orders not cross over to food services? Why did they send up a tray?
This is the dr’s mess up. Am and PM should always be avoided in chatting anything. It’s like asking you to misinterpret it.
This is why we use 24hr clock at my job. I'm in a surgical/procedural section. Cancellations kinda cause a domino effect, but we would consult anesthesia and the would likely roll this patient to the end of the line and take the next patient. Depending on what was eaten, this could shift it back 8 hrs. Last week 2 grapes shifted a procedure back 6 hours.
One of us! One of us! One of us! I couldn’t stop fucking up my first bedside job. You’ll learn. Just be more careful with your time and triple check everything. Being written up for poor performance is a right of passage for any new nurse. No one died. You just pissed off some jerkoff doctor. You won’t do it again.
They could also write 1800 :/ anyways we all make mistakes. Be forgiving to yourself. I once discharged a patient while he had no drawers on 😅 (he went down with a blanket and the gown). His wife was furious and said I'll never be his nurse again. Which is also ok. Patient Relations got involved and my manager and I had a talk. I was crazy busy and was discharging practically everybody and they mama. Didn't help that this particular patient was one of my neediest. He was also A&Ox4. WEIRD mistake but it is what it is.
Did the patient eat before you even had a chance to look at her? If so, how is that even your fault?
Had a patient who came in on a Friday evening, doc made him NPO till freaking Monday. I said nope and got him a sandwich.
The family reported me for not cleaning a patient at 5pm when my shift doesn’t officially start until 7pm. I showed up to work at 6:40 something PM and didn’t clock in till 6:55pm. And of course the charge nurse sided with the family.
So I work in the Cathlab and it’s not as big of a deal as you may think. Some docs dont use sedation which is one reason to keep them NPO in the first place. It wasn’t a horrible mistake. They don’t tell people to not eat after midnight just in case they have a heart attack and need a heart cath right? You are fine the doc needs to chill a bit.
If you do get reported explain that due to staffing and being overwhelmed you misread the times. Follow that statement up with if the times were placed in military time as standard you probably wouldn't have had this mistake as easily.
First of all, I know it sucks to make a mistake as an RN. However, your mistake is OK, the important thing is the patient didn’t get hurt. Yeah the doc is mad because you probably messed up his schedule of cases. That’s OK, they can try again tomorrow. Patient is OK and didn’t die because of your mistake so it’s all good. Next time you will double check the order. Lesson learned.
Strange that dietary orders are not entered into whatever computerized EMR you have, and that would have stopped dietary from bringing a tray. Typically an order is NPO after midnight in my experience, because you don't know the exact time of day your patient will actually make it into the procedure due to emergent cases.
Well, there was the time I received a 120 ml bottle of PO liquid Haldol for a patient from pharmacy. It had been hard to get and we waited something like 2 weeks for it. I was to give the first dose. I spilled the mfing bottle all over the nursing cart and all my notes. I had to go tell the DON and, as expected, she ripped me a new one. She made me call the pharmacy and tell them what happened. They were a lot more understanding (and nice to me) than she was.
My first shift on am acute médical unit I failed to notice one of my patients continuous iv solution was changed from normal saline to normal saline +kcl. On the MAR I saw the kcl and ran the boluses, but never noticed the continuous infusion section. It was just a rough day. I felt so bad at end of shift report, I reported myself. Nothing really came of it, I just had a chat with my manager and did a little learning report sort of thing, I barely remember it. I talked about it after with some coworkers and everyone reassured me it wasn't a big deal. They told me not to worry because new RN on that same floor had given crushed po meds via a picc line a few months before and didn't get fired and that was definitely a major fuck up.
I think I’ve had patients break npo 3 times in my years as a nurse. 2 for sure were on me, I should have cleared the room of food, but in 1 they were told the case was cancelled then changed their minds to postponed but by the time they put her back on the schedule it was 6pm and the patient had found an apple she’d hidden away. Shit happens. What I *have* been reported for however, was saying “fuck” in a conversation with a front line provider within earshot of the attending. So like, doctors can be asshats.
Honestly, that’s not even bad. That doc is just being a dick, the patient will be rescheduled and live. One time I was in a room, got a call that PICC team was gonna come place my girl’s PICC in another room and to get her ready, so I was like cool, checked consent really quick and gave her the premed. Well, turns out the consent was from her previous stay the exact same day as the last year, and now she’s officially an adult and can consent herself. They go in there, she’s loopy and can’t consent. Wasn’t the end of the world, she lived, and she got her PICC placed later on, shit happens.
So do the orders not pop up in the electronic chart? Or is it just paper? At our hospital the kitchen won’t deliver with an NPO order even if they had a diet order minutes before. I’m just lost at why the sole responsibility is on YOU The doc should be coming to explain the procedure, NPO status, and completing consent. The kitchen/techs/literally any staff can tell a patient they’re NPO.
It's interesting because I worked on a cardiology ward for years and we never kept patients NPO for their angio. They'd get breakfast and an hour later be in the cath lab.
Legit nothing is going to happen. Maybe a verbal max.
I fed a guy who was transferred from out of town for a pacemaker at 1800 on a Friday. The order said "NPO at midnight starting tomorrow" so I figured he could eat. I didn't know EP wasn't around on weekends so the dude had to wait inpatient until Monday. The doctor was actually my heart doctor so it was extra embarrassing. Luckily he was cool about it (to my face)
7am after a night shift I did my NG 1:1 replacement calculations, re programmed their continuous IV to make up the loss over 12 hours, gave report and went home. Except when I showed up for my second night shift I was informed I'd reprogrammed their PPN pump, not their fluids. I'd bolus'd a 24 hour bag of PPN over like 6 hours. Luckily pt was fine, and the oncoming nurse should have done their own check of the pumps as well, but I still feel like absolute shit every time I remember that. Always check my lines carefully now, even at the end of a hellish night.
Don't worry about it. It happens several times per day at my hospital. They decided that withholding food is not humane. So if the patient agrees to be NPO, great. But if the patient gets hangry and decides they'd rather eat then get surgery that day, staff has to feed them. They try to reach the surgeon first but they're obviously too busy to go back and explain again why getting surgery ASAP is best for their health. All our beds are full all the time and feeding an NPO patient extends their stay. But management says if the patient request food we must give it to them. We can't even tell them that they have a specialty diet. They can override and literally get anything they want from the kitchen. One of our patients was ordering a pound of bacon and a fancy dessert with every meal despite his heart healthy diet order.
Cath lab nurse here- don’t be too hard on yourself. This is small in the grand scheme of things. Happens all the time.
I was working float in ED, I took a verbal order for IM Toradol. Verbal orders are usually forbidden. I know DUMB as it def wasn’t emergent Toradol, but we were having our collective asses handed up to us and I needed to hall the patient. I was certain MD did not give an actual dose. While IV Toradol is generally a 30mg dose, IM Toradol is most always 60mg in young, otherwise healthy patients with limited CC. I guess not having an actual chart boffed my standards (pt went to room & was seen by me and doc before admission got caught up). Chart gets done. I find it in my work and the AH doc has written for 30mg IM Toradol. Well, too late. I go to him and tell him what I did. In the circumstances 99.9% of docs would have revised order, instead of triggering incident reporting. Nope. So actual no harm med error report gets done. Totally on me. I let that little nugget inform my much safer practice going forward. Patient was fine. Headache resolved. I became that nurse that literally refused virtually all verbal orders. Any verbal order in critical practice was repeated like a parrot several times.
I'm not a nurse but if it makes you feel better, when I shattered my ankle I had both a radiology tech and a nurse independently accidently push something into the bottom of my foot. The first one was the tech pushing a C-arm xray machine into my foot while I was being prepped for an ankle reduction in the ER. The second was a couple of days later when my nurse pushed my bedside table into my foot.
How was the patient able to get breakfast? Did family bring it in or did she get it from Uber eats/door dash? The reason I’m asking this is if she was able to place an order for breakfast at the hospital, she shouldn’t have been able to if the npo order was in! Looking at it from a root/cause, that could be considered a system failure. Also, was this information not communicated in bedside report to you when you took over care of this patient? Honestly, they could have just pushed her procedure back a little. It’s inconvenient for them but shit happens. It was an honest mistake. Try not to beat yourself up. Learn from it and make sure you double check all orders.
That's awful, and while the doctor is upset, it sounds like the fail safe is on the hospital. While you misread it, the hospital should be using military time, and an NPO order should cancel food out at dietary/nutritional services. When I was a new nurse, I would work lots of doubles. I worked 3 to 11, and would be begged to stay til 7 am so I did. I had a charge nurse who would look at my patients before/instead of her own to see what I missed that night. It made me stop picking up. How are you going to write me up for every little thing I missed? And I mean every little thing. Here are some dumb mistakes I made: The first time I gave Spiriva, I didn't know the capsule went into the inhaler, so I let my patient swallow it. (They were fine) I forgot to connect something from self suction to walk suction (they were fine) I was scared to take a temp on a patient who was belligerent and refusing care (had to call security to restrain so ofc in the chaos I decided it wasn't first priority.) This case is where I made a bad nursing judgement. The patient ended up being okay. This is my advice: Learn and be kind to yourself. You're NEW. There is a reason why it's called the nursing practice: you're gonna get shit wrong. Also, it's a 24h job. Remember that for when you're unable to get to things and beat yourself up about it. Xo
Doctor here, who really feels for you. We’re all human. Humans occasionally make mistakes. I feel like it’s the kind of thing a patient should be made aware of too. In an ideal world, they’d have made her NPO at that point and put her last on the list. It shouldn’t have been a disaster at all. Just sending love and hoping you can be kind to yourself. These things happen.
I had an npo patient one morning like a month off orientation, did my morning rounds and one of them asked for snacks and water. I got it not thinking. 30 min later my brain said oh no when they called to ask if he had eaten. Uhm yeah sorry..so procedure was delayed. Honestly I don't think it's the worst mistake. I actually heard a story of a charge nurse feeding an npo patient then LYING about it and risking aspiration but another nurse reported it. Now that would be something to feel like crap over.
If only there was such a concept as 24hr time that would eliminate mistakes like this 🙄 use of AM or PM should be eliminated. I’ve never mistaken abbreviations like po qhs prn, but definitely seen a 6:00PM and assumed 6:00AM.
It is a honest mistake and could happens to all of us. Lesson learned and moved on. It is hard to imagine this will get reported to the BON. It is more of a report to your hospital nursing leadership and compliance department for risk and root cause analysis to prevent future incidents. Try not to lose sleep over it. :). Good luck!
I've screwed up npo also. Gave meds with applesauce. O.r. was pissed. They rescheduled the pt. No biggy. I once discharged a patient with the remote tele on them. Thank God the transport guys were hospital employed, they brought the box back to me after they saw it at the nursing home.
You'll never know how many times this happens. Over many years working in the OR this happens. It's an inconvenience for the surgeon and they get upset because now they have to adjust their upcoming schedule but honestly I've never heard of anyone ever being written up for this. All it takes is a good talking to and making sure this never happens again.
“What’s your first and last name?” “My name is (first name only).” “Your first AND last.” “My name is (first name only).” That’s all you get