I made it! I made it through 8 weeks of a completely different learning experience, unlike any I’ve ever encountered before, and now I’m on the other side. It’s SPRING BREAK!!
I figured I’d give a recounting of my check off, and also highlight why it is so important that you check the MAR (Medication Administration Record) 3 times before you give medication to a patient. Doing that last check against the MAR saved me during my check off yesterday!
A week ago Friday my clinical group was given a piece of paper with 10 different time slots on it, starting at 0800. We had to sign our names in a time slot of our choosing, in order to pick when we would begin our check off. I tried to get the first slot, but I ended up with the second slot – at 0835 – which I was super happy about considering I was one of the last to sign the piece of paper. I’m one who would rather just get it done and over with and not wait for the dreaded moment; I was also told by my mentor that I should sign up for the earliest spot possible so that I don’t have to wait around and hear about my other classmates’ experiences before doing it myself. Pretty good advice if you ask me!
So yesterday I got to school around 0700, prepared to sit around and go over the 4 case studies one more time to review the steps and put myself in the mindset for the check off. In reality, however, I got to school, went into the classroom, and then talked with my classmates for an hour until my first classmate was called up to go do her check off. But I’m thankful it turned out that way, because while I was reviewing the steps of the different check offs with my classmates – in between chit-chatting about all sorts of other topics – it was in a much more laid back and relaxing manner and I felt the tension drain out of my body. We all knew we were ready, whether we were nervous about it or not.
At 0835, right on the dot, my clinical instructor came to the classroom and called me. Instantly I felt my nerves go on high-alert and my heart started racing. We walked into the high-fidelity lab area (I can’t wait until I’m a J2 and actually have labs in that area!) and my clinical instructor pointed to a bowl with folded up pieces of paper in it and told me to pick a number.
I was just praying and hoping I got the insulin administration/sterile dry dressing change case study when I pulled out that piece of paper…
And I did!! I felt my heart calm just a tad and I was instructed to go “shopping” for my supplies and then meet my instructor in the patient room.
My supplies consisted of an insulin syringe, the insulin itself (both Regular and NPH), alcohol swabs, sterile gloves, 2 packages of 4X4s, bacitracin ointment, and tape. I took myself and the supplies into the patient room, washed my hands, and then…just stood there.
I was frozen! I knew I was supposed to get the morning blood glucose from my instructor but I just could not remember what to do next. And this wasn’t even a hard skill! I think it was just the fact that my instructor was just sitting there watching me, with a timer going (we only got 30 minutes), not saying anything, that messed me up. But I finally took a deep breath and just let my hands take over, knowing that I knew the information and just needed to get over myself.
I got the blood glucose from my instructor, compared it to the sliding scale in order to know how much regular insulin to give, calculated the total amount of regular and NPH insulin to draw up, drew everything up correctly without any air bubbles, explained the procedure to the patient, checked the patient’s wristband against the MAR, double-checked the medication on the MAR…
…and realized that I read the sliding scale wrong and was only giving 2 units of regular insulin when I was supposed to be giving 4.
I actually said this out loud, and then cringed, looking at my instructor to see her smiling a bit. I apologized for my language (I wasn’t sure that word is one that offends her or not, but either way it’s not professional) and I told her about my mistake. She nodded her head and then told me it’s a good thing that I’d checked the MAR again the way I was supposed to and caught my mistake! I told her I’d go ahead and draw up more insulin in a new syringe, with the correct amount, but she told me that that wasn’t necessary since the check off was about seeing if I could complete a skill correctly and she’d already seen me draw up the insulins correctly – even though it wasn’t the correct amount.
So I went ahead and injected the insulin into a nerf football (we can’t inject the dummies), pulled the syringe out, activated the safety feature, and then threw it away into the sharps container. After washing my hands,making the patient comfortable again and cleaning up my area, I then prepared myself to perform the sterile dry dressing change.
I completed the sterile dry dressing change without any problems whatsoever, and thankfully didn’t contaminate my sterile field when I had it set up! Once I was done with that, I again washed my hands, cleaned up, and made the patient comfortable. My instructor gave me a few pointers to look out for in the instance that I HAD given an insulin injection with too little insulin (the patient would be hyperglycemic by lunchtime), reminded me to always perform those checks against the MAR, and then told me a did a great job and I needed to finish up by documenting.
My documentation was sloppy, in my opinion. Not because I didn’t get all the information down that I needed to, but because my handwriting was shaky and all over the place, and on the MAR I wrote all over it and it wasn’t organized very neatly. But, I finished my documentation, gave it to my instructor, she told me I passed, and I was FREE!!
It is amazing how fast the time flew through that check off. I know I used every available minute due to just being nervous and slow, but thankfully I didn’t run over and I passed. Again, I’m SO glad I checked the MAR again before administering the medication…and I’m so thankful that that wasn’t a REAL situation in which I gave an insulin injection with the wrong amount of insulin!!
I don’t have any big plans for this week of spring break, other than to catch up on some assessment reading, write my resume (I want to get a job as a tech this summer!), write a short 2-pg paper for concepts class, get my hair done, and hang out with family and friends! Hopefully by the time school starts up again I’ll feel relaxed and rested, and ready to give my ALL for the next 8 weeks of J1 semester. 🙂