It’s an overcast chilly day in Chicago, just the kind of day for a good joke. And I got one this morning from a former nursing student at Trinity Christian College, now a seasoned grad. She’d had a “crazy” day yesterday. Here’s why:
Our primary IV tubing is on back order. This means we can’t use our IV pumps. I’ve never not used a pump. DRIP RATES? Seriously.
Did she expect my pulse to race in sympathy? Not a chance. Instead, my mind raced back to a PM shift in the 70s. I’d started that shift on my usual floor – twenty-eight med-surg beds. Half-way through report, the PM supervisor “floated” me to another med-surg floor. Thirty-two beds. Starting report late—it was oral in those days, given by the day nurse in a conference room—got me off to a frazzled beginning.
I walked out of report closer to 4:00 than 3:30, and bee-lined to make rounds, just to make sure all my patients were in their beds and breathing. As the only RN with four aides, I was especially worried about the eight post-ops, with more to come back yet from surgery, plus the eleven IVs to monitor. (Yes, monitor means to personally count the drip rate of each one.)
My rounds were cursory. In bed, yes. Breathing, yes. Bleeding, no. IV infiltrated, no. IV bottle (yes, glass, no plastic bag), marked with adhesive tape by day nurse with the amount out at 3:00pm, yes. Right drip rate, yes (i.e., x number of cc’s per hour to have a 1000cc bottle run for a specific time period). Good. On to next patient.
Just routine rounds. Fly, fly, fly. Fly back to med room and start setting up five o’clocks. 9-1-5-9 meds. No unit dose. No med carts. Cafeteria-sized aluminum trays papered with medication cards color-coded for time to be given. Phones ringing, no unit secretary.
Is your pulse racing yet?
I worked in overdrive the whole shift. More post-ops came back from surgery. In a really stupid policy move, the RN on the floor had to go to the recovery room to accompany the patient back to the unit. I’d think how dumb that I was leaving thirty-some patients with four aides while I’m gone for at least fifteen minutes to make sure of the safe arrival of one patient. I prayed for no emergency.
Back from surgery, I’d have orders to note, doctors to call, nine o’clocks and sedations to set up. In the flurry, as I made my after supper rounds (only there was no time to go to supper), I stumbled over something next to a post-op’s bed. Pushing the bed curtain aside, I got that sudden feeling of a boulder crushing my chest. Checking my feet, I saw the familiar crossbars of an IV pole. Slamming the curtain way back, I saw IV tubing leading to the patient’s arm. An IV I didn’t know about, hadn’t checked.
The bottle was dry. Empty. Blood backed up in the tubing at the insertion site. Bad enough that the IV would have to be dc’d and restarted, but bad also, of course, that the patient had gotten them too quickly. The tape on the bottle, so much out at 3:00pm, indicated the bottle was supposed to run most of the PM.
I hadn’t been told about this IV in report. And clearly, the day nurse had not counted this drip rate correctly, or had counted it when the patient’s arm or tubing were a bit bent, so that the IV went whoosh when they were straightened out. I still choke in horror thinking the patient could have died if all 1000cc’s (about a quart) had been infused within minutes. Then I might have found the patient cold. And dead.
The fear of IVs gone awry lives on in my bones today. I was happy to read my former student’s solution to her drip rate counting dilemma:
Found a new website www.rncalc.com.
In my day, that information on how to calculate drip rates was in our heads. No smart phones then.
When I asked if I could use this incident for a blog post, this nurse said, “Yes, you may quote me, but you have to try to feel a little sorry for me.”
Sorry, did you say? No way.