Nur464 clinicals day 5

Today was a real bummer in clinicals. I feel like I did pretty badly with documentation and made a stupid medication error--I interpreted an order for 2 Lorcet as an order for 1-2 Lorcet. Actually, I didn't misinterpret. I thought (as I always have--I don't where I got this idea) that, as a nursing measure, an order like this for analgesic tabs could be given in partial doses. Of course, that doesn't really make sense on reflection. I wouldn't have considered giving 0.5mg morphine IV push when the order is for 1mg... or maybe I would have, I don't know. Anyhow, obviously the reason Lorcet is ordered in tabs has to do with the manufacturing and not so nurses can administer partial doses. I don't know why I never thought about this before, although I do think this was the first time I've had an opioid/APAP combo ordered as a straight number of tabs rather than a range of tabs.

As we use a computerized medication administration record, I caught my error when I went to give a second tab of the Lorcet after the patient requested it (I had offered one now, another if ineffective). The computer told me I couldn't give Lorcet again for another 3.5 hours. Doh! I over-rode the computer so the patient could get the med, but...

I fessed up to my clinical instructor, who didn't make a big deal out of it because I wasn't overdosing the patient or making a mistake that would have put the patient in danger. However, she did say she was going to follow up with the attending nurse. It will be interesting to see what happens, as I've never made an outright medication error in clinicals before, and I don't know what the consequences to a clinical error might be.

Again, as I've mentioned before, we don't get enough clinical hours in this Bachelor's program. Although I take responsibility for this error, it also represents a systemic failure as more hours under the closer supervision that we receive in the earlier med-surg courses might have caught this mistake in my thinking.

As for the documentation--again with the I+Os. The patient is drinking from a pitcher I'm not monitoring and up to the bathroom ad lib. How am I supposed to do these I+Os? I don't know. Also, a patient has an IV drip but the "clear totals" function on our Symbiq Hospira pumps doesn't work, so we record hourly totals by calculating the rate x time? In my book, that's tantamount to lying--we don't have a record that the pump pumped the whole time. I haven't had the courage to ask these documentation questions, and after the mistake today, I'm in a worse spot. I will have to see the clinical instructor's disposition tomorrow.

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