May 25, 2018

Check Your Pumps | Nursing Hacks # 1

This is a new series of quick little reads on things I've learned throughout the years.

Check Your Pumps

When I receive bedside report, I write down the information I'm given, and I immediately confirm the drip rates and make sure the concentrations match from bag to pump. I scan the infusion pumps quickly so the outgoing nurse can leave. But, I make sure I've laid eyes on the drips BEFORE he or she leaves. Too often, I'm told one thing, and see another when I assess the pump configurations. Mistakes happen, numbers could be inverted, and wrong medications programmed. It is too easy to input the false information. Once I accept the responsibility of a patient, I make sure the infusing drugs are accurate, and the order in the chart matches the drug infusing. Yes, it sounds crazy but I've had many instances where a drug was hanging without an order. If a provider walks by your patient's room and sees this on your shift, you will definitely have problems.

Here is an example:
The patient weighs 135 lbs.
Information given during report: Neosynephrine concentration of 50mg/250mL is infusing at 1 mcg/kg/min
Infusion found at bedside: Neosynephrine concentration of 100mg/250mL is ACTUALLY infusing at 1 mcg/kg/min
The drug concentration programmed into the infusion pump: 50mg/250mL

Problem: Double concentrated medication infusing at the wrong rate

The patient should receive 18.41 mL/hr (1 mcg/kg/min) if receiving 50mg/250mL bag
The patient should receive 9.20 mL/hr (1 mcg/kg/min) if receiving 100mg/250mL bag
(Need math help? I always do, check this out...

See the difference there? You are infusing double the dose. And what does your pressure look like? Is it 290/150? Oh, I wonder why. This is why I say always inspect, it takes a second but can save you from inheriting a problem or being accused of something.

Now, this isn't your fault, but if you find the discrepancy at 1 PM (and you started work at 7 AM), that's six hours the drug was infusing on your shift. That is your fault, 100% for sure. I love my co-workers and value them, but I always confirm drips because mistakes are easy and interruptions are plentiful. Computers are great, but they require accurate information.

Don't even get me started on wrong drugs being hung! You told me insulin, why do I see a heparin bag hanging?! Yeah, check your drips, it can get confusing but label and confirm everything. It's your license. Once you accept responsibility, it's on you, and you will be at fault if you accept a problem and find it later. I've seen it. I surely wouldn't believe you if it's been five hours and you start blaming the previous shift... sounds shady. You might be telling the truth, but it doesn't look right.

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