A patient has been admitted with a fever of 102.8 F (39.3 C), with an unknown origin.

The patient’s urine is cloudy, foul-smelling, and dark amber.

Orders have been given to obtain urine and blood cultures immediately and to administer an antibiotic intravenously.

In what order should the nurse complete these orders?

Choice A rationale:

Administering the medications using a 3-mL medication syringe is not the best practice. While it is possible to use a 3-mL syringe for medication administration, it is not the most efficient or safest method. A larger syringe allows for easier administration and reduces the risk of creating too much pressure which could potentially damage the PEG tube.

Choice B rationale:

Applying firm pressure on the syringe’s piston to infuse the medication is not recommended. This can create too much pressure in the PEG tube and could potentially cause damage. It is generally advised to allow the medication to flow into the tube via gravity. Choice C rationale:

Flushing the tubing with 30 mL of saline after the medication has been given is the correct technique. This helps to ensure that all of the medication has been administered and also helps to keep the tube clear of any potential blockages.

Choice D rationale:

Using the barrel of the syringe, allowing the medication to flow via gravity into the tube is a common practice. However, it is not the only step in the process. It is also important to flush the tube before and after medication administration to ensure all medication is delivered and to maintain the patency of the tube.

Choice A rationale:

Reporting a near-miss using the facility’s recommended protocol and correcting the error on the MAR is the appropriate action. A “near-miss” in healthcare is a situation where an error could have happened, but didn’t, either by chance or timely intervention. It’s crucial to report these incidents as they provide valuable information for risk management and quality improvement. By analyzing near-misses, healthcare facilities can identify potential hazards and take preventive measures to ensure patient safety. Correcting the error on the MAR is also important to prevent the same mistake from happening in the future.

Choice B rationale:

Reporting the near-miss to the next shift before the next dose is due is not the best course of action. While it’s important to communicate any potential issues to the next shift, it’s more crucial to report the incident immediately using the facility’s recommended protocol. This allows for a timely investigation and corrective action. Waiting until the next shift could delay these processes and potentially put patient safety at risk.

Choice C rationale:

Correcting the MAR error but saying nothing because nothing happened is not an appropriate response. Even though the error did not result in any harm, it’s still important to report it. Near-misses are often indicators of underlying system issues that need to be addressed. By not reporting the incident, the opportunity to improve patient safety and prevent future errors is lost.

Choice D rationale:

Notifying the pharmacy about the error they almost caused is not the most appropriate action. While it’s important to communicate with the pharmacy if they were involved in the error, the first step should always be to report the near-miss using the facility’s recommended protocol. This ensures that the incident is properly documented and investigated, and that appropriate corrective actions are taken.