I had a “moment” at work the other day, and while it left me feeling flustered and a bit like a spaz, I think there’s a valuable lesson to be learned. I was taking care of a patient who had a whole host of problems…one of which was pretty severe heart failure. He needed a powerful inotropic medication that I’ve never given before so I was understandably a bit nervous. Luckily, I had this reference sheet available, but I still had a nagging feeling about it. The dosage was ordered as follows:
Give 50 mcg/kg as a bolus; then give maintenance dose of 0.375 ml/kg/min.
Pretty straightforward, right? So I pulled out the good ol’ dimensional analysis method and proceeded to figure out my loading dose. The problem is, I kept getting really weird answers that made NO SENSE. So rather than go with the really weird answer I kept getting, I asked another nurse to do the calculation. Low and behold she got a different answer than I did…so I called pharmacy and they got the same answer my friend did. What had I done wrong? Dimensional analysis works every time for every calculation, right? I am telling you this was bugging me to no end…and the fact that it was annoying me made me even more nervous about giving this particular medication to someone so very very sick.
After taking a few deep breaths I realized what I had done to cause my calculation to be off…it was my conversion factor…I had written it as 200 mcg in 100 ml, whereas it was 200 mcg in 1 ml (the whole bag was 100 ml). This was a huge reminder that a simple thing like a conversion factor can muck up your calculations, mess with your brain and leave you feeling like a frazzled mess. We ended up confirming the correct dosage and all was well, but the whole experience served as a reminder that a good nurse must ALWAYS ask questions, especially of him or herself. I have always said the nurse who never asks questions is the most dangerous nurse on the unit…so even if you are worried about swallowing your pride and asking for help…do it! Your patient deserves it, and you will probably learn something in the process. What did I learn? I learned to sloooow down, check ALL my numbers before doing my calculation, and to always have another nurse independently do the math as well. Next time, I hope to not feel like such a spaz (do people still say spaz? I’m a product of the 80s!).
Be safe out there!