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what would you do in this situation
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Aleesha

318 Posts

Posted:  25-Mar-2017 12:56
yesterday the GP knocked on my door during a very busy clinic while I was seeing a pt, he said I need help with a very sick baby and I am waiting for an ambulance, he said could I get the oxygen and some Benzylpenicillin for injection. I did not get to know at that point what was the problem with the baby but then told after he suspected meningitis. I had never given Benzylpenicillin before and was quickly trying to read the leaflet on how much to give and how much to mix it with but the GP told me to mix it quickly with 3 ml of water for injection and give the full 600mg, I did what he asked but felt very uncomfortable about the whole thing. Looking back I should have told the GP to give it himself because it put me in awful position not knowing how much I should be given and what it was being given for at that point. Is this me over reacting?? what would others have done? It has made me reflect and hopefully learn from this,

littlenurse
tigger1

1032 Posts

Posted:  25-Mar-2017 14:47
I like you would have followed the instruction of the GP as he is prescribing it not me, I would have assumed given the drug involved that it was for suspected meningitis and with the doctor giving and exact instruction stating amounts I would trust they knew what they wanted. On reflection it may be better to ask the doc to document it so you have a written instruction, but in the circumstances I would probably not have thought to ask for this first.
MamboJambo

106 Posts

Posted:  26-Mar-2017 12:38
Ales ha thank you for sharing your situation, it is difficult to think rationally in an emergency situation, I would have probably done the same but perhaps repeated what he said to check if he is sure of his verbal prescription. In emergency situation we are allowed to take verbal instructions to administer medication.

We are all learning quite a lot from each other here, what I have learned from your situation today is to make myself familiar
with Benzylpenicilline administration, which I actually don't remember even though I was partially involved in administration few year ago. And perhaps if possible to grab a pen and paper and ask GP to write down all given verbal instructions, again easy said than done but I may try to remember after reading your situation.

Did u find out if GP gave u right instructions ?
Good reflections for Revalidation.

Best wishes

MJ

MamboJambo

106 Posts

Posted:  26-Mar-2017 12:41
Forgot to add you have done a wonderful job, Administered meds to a suspected meningitis probably save life, so we'll doe Aleesha, and I'm sure from now on you will be expert ion this particular drug that we rarely give.
anp1

4 Posts

Posted:  26-Mar-2017 20:04
we have had a similar situation and as a practice sat down and worked out a protocol to follow with dosage and easy to read instructions. As previous post says well done.
mumnurselover

1399 Posts

Posted:  26-Mar-2017 20:18
This might help to write a protocol.
http://www.gpnotebook.co.uk/simplepage.cfm?ID=980090918


Aleesha

318 Posts

Posted:  26-Mar-2017 22:17
thanks for all the replies and your kind words. I have read the leaflet and the only difference in the leaflet to what the GP told me to do was it states mix the Benzylpenicillin with 1.6 to 2.0 ml of water for injection and the GP told me to mix it with 3ml of water although I don't suppose that would make much difference. Reading that gpnotebook has helped so thanks for that mumnurselover.
It has been a learning experience for me and I am going to write up a protocol and keep it with this injection in case it ever happens again. I should also make myself more familiar with the drugs in the emergency trolley as you just never know when they will be needed and GPs just expect us to know. I did get a nice email from the GP thanking me for my help, he said it made him feel less anxious just with me being there and he thanked me for keeping calm although I did not feel calm x

littlenurse
blue.tunic.syndrome

1416 Posts



Profile Picture
Posted:  26-Mar-2017 23:53
Hi Aleesha, looking at the SPC you would have to have a very cool head to locate the section specifically for suspected meningitis, check how much to mix with  and how much to give. Your situation has really made me think about how to make this clear in our emergency drugs so that we could administer asap. 
Difficult situation for you and the gp. 3mls seems quite a volume to give into a young child but then this is not an ordinary circumstance. 
You've obviously spent a fair amount of the weekend reflecting and it sounds like the gp has too, hope the child is stable now. Glad the gp said thanks. We all need reflective pieces for revalidating, you've read all the guidance and thought long and hard so filling  in the nmc form shouldn't take long. 
Hope you feel more comfortable now x

Faith x
Sisters function as safety nets in a chaotic world simply by being there for each other.
karen.rudd

11713 Posts

Posted:  26-Mar-2017 23:55
Well done!
Also remember to include instructions re the alternatives for those allergic to penicillin in your kit and protocol. ( that threw me once in a walking centre shift ) You can't keep these things in your head but having a crib handy in the kit makes any emergency easier to deal with.

Please be informed that the above is the opinion of the author and is in no way meant to be taken as instruction.

karen
iPhone App Posted on my iPhone
Aleesha

318 Posts

Posted:  27-Mar-2017 14:49
thanks, aw yes Karen I did not think of the alternative, thanks for reminding me x

littlenurse
Aleesha

318 Posts

Posted:  27-Mar-2017 15:02
What would you give instead if a pt is allergic to penicillin ?

littlenurse
SharonFarrow

1 Posts

Posted:  27-Mar-2017 17:17 Log in to like this post
thanks for sharing aleesha
based on your experience I have checked oue emergency drug supplies and added laminated instructions to each of the drs bacgs for home visits and the emergency drug trolley.
Many thanks
sharon
Aleesha

318 Posts

Posted:  27-Mar-2017 19:59 Log in to like this post
it is a learning curve for us all, this is an excellent forum for sharing our experience, I have learnt a lot from others in the past so I feel pleased to share this with you all thanks x

littlenurse
karen.rudd

11713 Posts

Posted:  27-Mar-2017 22:05
Cefotaxim is what we used to carry but sometimes difficult to get

Please be informed that the above is the opinion of the author and is in no way meant to be taken as instruction.

karen[applogo=iPad]
Aleesha

318 Posts

Posted:  28-Mar-2017 19:14
thanks Karen, i will look into getting this

littlenurse
tiredandemotional

4016 Posts



Profile Picture
Posted:  28-Mar-2017 21:06 Log in to like this post
We have ceftriaxone as our first second-line drug 

This is just my opinion and not an instruction. T&E x
holi

429 Posts

Posted:  29-Mar-2017 06:12
First well done and I hope the child is now fine.
Second - in response to tigger1 in hospitals we were always told accountability always lies with the person who gives the drug regardless of what Dr prescribed or pharmacist dispensed. We always felt this was somewhat unfair as ward nurses are not prescribers but was told that is how it is.
Haras

2 Posts

Posted:  29-Mar-2017 20:04 Log in to like this post
Great post!. I will go back and make a policy with Gp and find out second line if penicillin allergy as we only stock that.
StephiB

14 Posts

Posted:  05-Apr-2017 09:45 Log in to like this post
Thanks for sharing. I too have now done a protocol and crib sheet to hopefully help things run smoother in such a situation.

Well done.
Workinggirl

4 Posts

Posted:  06-Apr-2017 12:54
I have the microguide app on my phone and so access to the dosage for all antibiotics. It's free and you can link to your healthboard so covers local variations.
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