I was allocated a patient the other day, who was admitted to hospital following a fall which resulted in a R Colles fracture and a R fractured pubic ramus. This elderly lady is legally blind, and lives at home alone.
The handover from nursing staff was that the patient was to mobilize FWB as tolerated (also documented in notes) with no further information given. On reading the integrated notes, I noted that she had been given her anithypertensives earlier that that the prescribed time that morning as she was hypertensive overnight.
When I saw the patient, her BP was 135/70 (ish), and reported to be feeling OK. I stood her up and attempted to walk with a quad stick, but her pain was too severe so we sat down on the edge of the bed. Then she reported that she was starting to feel giddy, and became very pale and sweaty. As I then began to try to move her into supine, she became unresponsive (vasovagal episode). I lay her down across the bed sideways, but could not get her any further onto the bed. Still not getting a response, not 100% sure what was happening, and in my panic not being able to find a pulse I decided it was time to hit the emergency button.
The patient was in a 4-bed room, and as I looked around the room for someone to press “the button” that was located on the other side of the room, I realized that the youngest person in the room was about 80 and wasn’t going to get out of bed and across the room in a great hurry.
So, I left my patient half-on, half-off the bed as a ran across the room to hit the emergency button. 10 seconds later the room fills with half a dozen nurses and several doctors, by which time I have found a pulse and the patient has responded to pain and has begun mumbling. I felt very reassured when a nurse told me that I had done the right thing – as it was the patient was OK, but better that way than me waiting a little longer to work out was was happening to the patient and then potentially calling a code blue (is was difficult to tell what was happening as she was asymptomatic until right before it happened).
Her BP had dropped to 98/58, but with positioning in head-down tilt this slowly came up. An ECG was also done. I then found out that in addition to her usual dose of antihypertensives being given early, she was also given them at the usual time (effectively a double-dose) which was not handed over or documented anywhere else other than in the med chart.
So I wonder what peoples thoughts are? In reading the med chart, I always ensure that I know vaguely what each drug is for (if it is a HTN med, a cardiac drug, a steroid, an antistatin etc), and check the most recent dose of drugs such as pain killers, sedatives and anti-mimetics (metclopramide/maxalon).
The co-ordinator should have included info re the double-dosing in the handover, but should I have checked the time of the last dose of every single medication?
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2 comments:
wow, that sounds like quite a stressful situation, which I think you handled really well. In regards to the med chart I tend to do the same as you do and glance at the meds, I also have a quick look at what time they were given it particularly nebs in cardio or pain meds in ortho IP. The fact that the patient was essentially double-dosed on anti-hypertensives is something that should have been written in the handover, problems like this are probably more common than we'd like, so I think that's why it's always important to always talk to the patients nurse before-hand, they can often tell you a lot more than what's in the notes.
Hey Kate, you handled this situation well, I think that when you are unsure it is best to err on the side of caution and hit the button. You did all you could prior to seeing the patient, you weren't to know that the patient was double dosed, it should have been documented. This highlights the importance of checking the drugs chart, hopefully the drugs have been administered properly!
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