Lost in Transit
You print breastmilk labels and go to the front desk to have them verified, but the care partner is not present. What important step must you take to avoid giving milk with incorrect labels?
What is double-checking the names on each label with another RN or the parent before giving the parent the labels?
A vasopressor was titrated based on the patient's heart rate instead of the blood pressure, leading to unsafe fluctuations. What is the clinical risk and the correct titration practice?
What is improper titration criteria—titrating medications based on the wrong clinical indicator can lead to instability; always follow the ordered parameters (e.g., MAP, BP) and document all changes clearly?
This commonly used inotrope is incompatible with sodium bicarbonate and must be run through a separate line in neonatal infusions to prevent precipitation.
What is Dopamine?
This simple but essential step is often skipped during shift change, leading to missed discrepancies in fluid or medication rates.
What is verifying infusion and medication pump settings during report?
When using the Arctic Sun for therapeutic hypothermia in neonates with HIE, this is the standard duration, in hours, for maintaining the target temperature.
What is 72 hours?
A parent hands you a bag of expressed breastmilk bottles that appear to be labeled. You place the bag in the freezer without checking each bottle individually. Later, it’s discovered that one bottle had no label and must be discarded. What error has occurred?
What is failing to verify and individually inspect each bottle of breastmilk for proper labeling before storage?
A nurse accidentally programs an opioid bolus higher than the ordered dose into the pump. What critical safety step was likely missed?
What is failure to double-check high-risk opioid orders and pump settings?
Dilaudid (hydromorphone) should not be mixed in the same IV line with this class of drugs due to the potential for precipitation and altered drug efficacy.
What are benzodiazepines? (i.e. versed)
You take report and begin your shift without reviewing the MAR. Later, you realize a scheduled medication was due an hour ago and wasn’t given. What important step was missed, and how can this be prevented?
What is failing to check the MAR during shift change—this can be prevented by reviewing scheduled medications and administration times as part of the handoff process?
This is the target core temperature (°C) typically maintained during therapeutic hypothermia using the Arctic Sun in neonates with HIE.
What is 33.5 degrees C?
During ling change, a TPN bag is found without heparin, which was part of the prescribed order to maintain catheter patency. What complications could arise and what immediate action should the nurse take?
What is increased risk of catheter occlusion and thrombosis; the nurse should notify the provider/pharmacist & withhold the bag until new fluids are prepared.
What are the 5 components needed in a titration order?
1. Starting dose
2. Clinical indicators or vital signs to guide dose adjustments (e.g., blood pressure, heart rate, pain score).
3. How much to increase or decrease the dose or rate with each adjustment (e.g., increase by 2 mcg/kg/min).
4. Maximum and/or Minimum Dose
5. How often to assess the patient and adjust the dose accordingly (e.g., every 15 minutes).
This electrolyte, when added in excess or improperly ordered with phosphate in TPN, can cause precipitation.
What is calcium?
A break nurse flushed a line incorrectly, resulting in unintended medication delivery. This communication tool could have prevented it.
What is a proper handoff report or SBAR?
Therapeutic hypothermia is most effective when initiated within this number of hours after birth for neonates with moderate to severe HIE.
What is 6 hours?
A bag of PRN hydralazine syringes is sent up from pharmacy. They are ordered for 0.2 mL, but each syringe only contains 0.1 mL. What do you do?
What is calling pharmacy due to a mismatch between syringe labeling and actual medication volume? (Do not combine doses.)
What are 3 symptoms you would anticipate assessing in a patient who has received an overdose of an opioid?
What is Bradycardia, drowsiness/unresponsiveness, hypotension, apnea and/or bradypnea?
This antifungal must be given through a dedicated IV line in neonates because it is incompatible with most drugs and TPN, risking precipitation and line occlusion.
What is amphotericin B?
During shift change, you notice that two medications (TPN and a bag of precedex) are connected to the wrong IV pump channels and running at opposite rates. What is the clinical risk, and what should you do immediately?
What is risk of under- or overdosing both medications (very sedated, hypotensive, dehydrated); actions include pausing both infusions, tracing each line back to its source, correcting the channels, notifying the provider, and closely monitoring the patient for any adverse effects?
Rewarming after hypothermia therapy with the Arctic Sun must occur slowly, typically at this rate per hour, to avoid seizures and hemodynamic instability.
What is 0.5 degrees C per hour?
You’re about to give a medication when you notice the syringe label says 0.5 mL, but the syringe clearly contains 1 mL—and the medication order is for 1 mL. What’s the safety concern, and what should you do next?
What is a mislabeled syringe that could lead to a dosing error—you should stop, clarify the dose with pharmacy, and never administer medication with labeling discrepancies?
What are the correct steps to verifying and programming a PRN medication?
What is:
-visually verify the dose in the MAR with a second RN and calculate based on patient weight
-program the dose with 2nd RN visually verifying what is programmed matches what was ordered and calculated
This loop diuretic is incompatible with both TPN and aminoglycosides when mixed in-line, risking precipitation and reduced drug efficacy.
What is furosemide (Lasix)?
During change of shift, the clonidine patch location was not verified or documented. Hours later, during your assessment, you find the patch missing. What error likely occurred and what is the best immediate nursing action?
What is failure to check and document patch placement during handoff, leading to unintentional patch removal—and the best action is to notify the provider and apply a new patch as ordered while monitoring for potential agitation.
One critical complication monitored during therapeutic hypothermia is this electrolyte disturbance, often due to cold-induced diuresis.
What is hypokalemia?