Complete medication reconciliation form, noting rationale for holding Glucophage and Digoxin (Safety ) Daughter says come my mother is not getting Explain to daughter reasons for holding Digoxin and “How her diabetes medicine and her pill? She has been Glucophage on these meds for years Call MD to obtain alternate for diabetes management (Collaboration) Read back and confirm telephone order for sliding scale insulin and write in chart (Safety) Result of finger stick glucose ( 220) 4:15 pm Delegate blood glucose monitoring to nursing assistant to obtain blood glucose (220) MD gives telephone order for Sliding Scale Insulin. (Teamwork and Collaboration) BG 150-200: 2 unit Regular Insulin sc Delegate insulin administration to Nurse B (Teamwork and BG 201-250: 4 units Regular Insulin sc Collaboration) Nurse B administers 4 Units Regular Insulin BG 251-300: 6 units Regular Insulin sc BG 301-350: 8 units Regular Insulin sc BG 351-400: 10 units Regular Insulin sc BG over 400 call MD Recheck finger stick glucose in one hour after Insulin Nurse A Prioritize nursing interventions on admission orders. 4:30-5 pm Identify incorrect IV solution hanging from ER (D5% /0.45 % NS). Change IV solution to 0.45% NS as ordered. Complete a variance form to report the error. (Safety) Observers conduct a root cause analysis of the error (Quality Improvement, Safety) Start IV 0.45 % @ 80 ml per hour (prime tubing, hang bag, program pump) Prepare to change urethral catheter
4:15 pm Daughter says “How come my mother is not getting her diabetes medicine and her pill? She has been on these meds for years Result of finger stick glucose ( 220) MD gives telephone order for Sliding Scale Insulin. BG 150-200: 2 unit Regular Insulin sc BG 201-250: 4 units Regular Insulin sc BG 251-300: 6 units Regular Insulin sc BG 301-350: 8 units Regular Insulin sc BG 351-400: 10 units Regular Insulin sc BG over 400 call MD Recheck finger stick glucose in one hour after Insulin Complete medication reconciliation form, noting rationale for holding Glucophage and Digoxin (Safety ) Explain to daughter reasons for holding Digoxin and Glucophage Call MD to obtain alternate for diabetes management (Collaboration) Read back and confirm telephone order for sliding scale insulin and write in chart (Safety) Delegate blood glucose monitoring to nursing assistant to obtain blood glucose (220) (Teamwork and Collaboration) Delegate insulin administration to Nurse B (Teamwork and Collaboration) Nurse B administers 4 Units Regular Insulin 4:30-5 pm Nurse A Prioritize nursing interventions on admission orders. Identify incorrect IV solution hanging from ER (D5% /0.45 % NS). Change IV solution to 0.45% NS as ordered. Complete a variance form to report the error. (Safety) Observers conduct a root cause analysis of the error (Quality Improvement, Safety) Start IV 0.45 % @ 80 ml per hour (prime tubing, hang bag, program pump) Prepare to change urethral catheter
112.Simulation-Chronology.docx