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A prisoner from a county jail was hospitalized for gallbladder surgery. During his first postoperative day, he developed a bad case of hiccups. His nurse tried several comfort measures to relieve the hiccups without success.
The patient soon became agitated by the constant tension on his suture line. His two guards also began to be concerned, and the three men bombarded the nurse with constant demands for relief of the hiccups.
Yielding to their pressure, the nurse called the patient's doctor, who ordered chlorpromazine (Thorazine), 50 mg I.M., stat. She quickly obtained the drug from floor stock and administered it, planning to chart the medication order afterward.
When the nurse checked the patient a short time later, he said,
"That shot really helped. What was it anyway?"
"Thorazine," the nurse told him.
"Thorazine-I'm allergic to Thorazine!" yelled the patient.
The nurse checked his chart. Sure enough, both his chart and his medication administration record (MAR) had large stickers reading Allergic to Thorazine. Also, the patient was wearing a red hospital bracelet with the same warning.
The nurse immediately called the doctor, who told her to watch the patient closely. Fortunately, the patient, who'd had a dystonic reaction to Thorazine in the past, and not really an allergy, had no adverse reaction this time.
A tense situation caused this nurse to panic and skip a vital step in the medication administration process, which is: Check for allergies or a history of adverse reactions before administering a drug. She should have checked the patient's chart, his MAR, his identification bracelet, and any other places where this information is routinely listed. She could even have asked the patient whether he'd ever had any reaction to a medication.
But this incident has still another lesson for nurses: Don't let patients, family, friends-or even prison guards-interfere with your nursing actions. You're responsible for your actions, and you know how they should be carried out. Don't let a tense situation make you deviate from the correct procedure.