I’ve been a psych nurse for four, almost five years now. I’ve got almost a decade of experience in psychiatry. I have a decent amount of basic medical knowledge, but nothing like an ICU or even medical-surgical nurse has. This event also occurred after several years practicing independently without a preceptor. If this had happened during my new grad year, especially with a preceptor who had worked in other specialities, they might have been able to point me in the right direction sooner. It didn’t help that we rarely gave IV medications at all (you could strangle yourself with the tubing so it requires a staff member to sit with the patient), so our med cabinet didn’t even have slots big enough for IV bags.

We also didn’t have our own pneumatic tube Station; we shared one with the unit next door. So every time you requested a medication from pharmacy, you had to make time to visit the other unit to go check if it had arrived. And often those nurses would be so kind as to bring medications over but often they also did not have time and would even need to use the available tube capsules so they would unload them and leave the medications on the desk or (if they were feeling naughty) on top of the crash cart right next to the tube station.

So I had a patient who needed vancomycin. Their bloodstream infection was mild enough by that point that they had been deemed medically stable enough for psychiatry (and it was a University hospital so it wasn’t like I couldn’t just call RRT and have a top notch ICU nurse helping out in under 10 minutes anyway). Which was good, because the vancomycin was gonna get hung late because I couldn’t find it. I put in a request for another bag after checking the patient’s personal bin, the medication room counter, all through the nurses station. I even checked on top of the other unit’s crash cart.

If you’ve given vancomycin before, you may have already spotted my mistake. See, I knew what vancomycin was, I knew it was given IV for more serious infections, I knew it had a very narrow dosing range and required blood testing to monitor the dose. I knew all the academically important facts from school. But I’d never actually personally hung a bag of it.

I kept moving through my other tasks, giving time for the request to get filled. I pop over to the other unit and no vancomycin. Huh. I check the computer and it says they sent it. I double check all the places. Error maybe? I order another. This cycle continues more times than I will be admitting to. The important thing is that the patient ultimately suffered no ill effects. Like I said, stable enough to suffer the reduced medical knowledge of a psych nurse.

I finally manage to get a bag out of the tube station. It is in a bright blue bag that says in very large letters: “KEEP REFRIGERATED.” Huh. I go and hang the bag because I’m running late but after that I check the medication room refrigerator. We gave meds that require refrigeration so rarely that I’d almost even forgotten the med room had a refrigerator. All the missing bags are in there (well, between there and the other unit’s med fridge). All of my coworkers had very helpfully and diligently made sure the bags went where they were clearly meant to be stored. All things considered it was actually very kind of them.

I put one more comment into the medication request system. Not an actual request, just a comment. I briefly explained my follies and begged forgiveness. They did not answer. I’m hoping they at least got a good laugh out of it…