How often in your nursing career have you taken an order for midazolam? For most of you, likely never unless you’re a perioperative nurse or under the scope of extended practice. Versed, as it’s commonly referred to, is a short-acting benzodiazepine given for sedation. In acute care, Nurses need certification to give it in a controlled setting with resuscitation equipment available. I recently learned of an order taken by a supervising RN in a LTC facility for midazolam 5mg IM q2h for anxiety. Yes, that was the order. Pharmacy confirmed it and a box of 5ml amps showed up and were now stocked unlocked on a unit staffed by LPN’s/LVN’s. The facility had 101 residents in 4 separate units (37+37+15+12=101). Although an in-house RN was the standard of care, it didn’t always happen. Many night shifts were staffed with 1 LPN/LVN (RN was o/c from home) for the entire building and 1 HCA for each unit. Adding to the skeletal staffing was the LPN/LVN still hadn’t written the licensing exam. The order was brought to attention the RN who took the order, the RN director of care, and pharmacy. All saw nothing wrong and the Versed remained in stock as an option to give.
How many standards of care do you see breached? What conversation should have taken place when the Dr gave that verbal order? Or the next nurse confirming the order? Do you see anything wrong with that order? What should the DOC have done when made aware of this order and the Versed stocked with the PRN meds? What is the pharmacy’s role in this?
There are many red flags here. How many do you see?
