When something goes wrong with a patient or a med

When a visitor changed the pump or touched the line

Someone else paused the heparin and you walked in after. What to chart before the fix, and how to keep their story theirs.

7 min read built on 0 cases updated 2026-11-03

Written by a med-surg RN, ten years, day shift. Why there is no name on it · How this guide is made

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You walk in and the heparin is paused. Or the rate doesn't match the order. Or a family member is holding a disconnected line and telling you it came loose. You have to fix the infusion, and you have to write it up. The note needs what the pump said, what the order said, what you saw, what you were told, who you called and what you did. Put it in the order it happened.

Key points

  • Before you touch anything, write down what the pump shows: channel, drug, rate, dose, VTBI, volume infused, and whether it was running, paused or silenced. Then check it against the order.
  • Keep what you saw apart from what you were told. The visitor's account belongs to the visitor. Use their words and mark it as reported.
  • Assess the patient and the site before you chart the fix. The infusion matters because of what it did or didn't do to the patient.
  • Chart every notification with name, role and time, plus the response or new orders.
  • Chart exactly what you did to the infusion: stopped, corrected, restarted, line replaced. Add the time and the settings you left it on.

What to write

How it often gets charted How it should be charted
Family messed with heparin pump. Fixed.1410: Entered room, heparin channel B paused, display showing 0 mL/hr. Order: heparin 18 units/kg/hr = 14 mL/hr. Volume infused since 1200 bag change: 18 mL (expected approx 29 mL). Son at bedside states he pressed the button to stop the beeping around 1330. Time of pause not confirmed by RN.
Pt's wife silenced alarm, IV fine.0215: Alarm silenced on arrival, pump displaying downstream occlusion. Wife states she pressed silence twice over the past 10 min. R forearm PIV: arm flexed at elbow, no swelling, no redness, flushes without resistance. Arm repositioned, infusion resumed at ordered 75 mL/hr.
Rate was wrong, corrected per order.1640: Found NS w/ 20 mEq KCl running at 250 mL/hr. Order: 100 mL/hr. Last RN-verified rate 100 mL/hr at 1500. Volume infused since 1500: approx 400 mL. Rate returned to 100 mL/hr at 1642. Dr. Patel notified 1645, BMP ordered.
Visitor disconnected IV, reconnected it.2005: Found PIV tubing disconnected at hub, end of tubing lying on bed linen. Visitor (pt's niece) states she reconnected it once earlier and it came apart again. Infusion stopped, tubing discarded, new tubing primed and connected. Site assessed: no infiltration, no bleeding.
Educated family not to touch pump.Explained to son that pump settings must only be changed by nursing staff and to use call light for any alarm. Son verbalized understanding. Charge RN Lopez aware.
No harm to patient.VS 1415: BP 132/78, HR 84, RR 16, SpO2 97% RA. Pt denies chest pain, SOB. aPTT drawn 1420 per Dr. Kim.

Look at what the right column does:

  • It has times. Found at is one time and visitor states it happened at is another. They stay separate.
  • Found numbers sit next to ordered numbers.
  • It estimates the volume difference wherever you can calculate one.
  • The visitor's account is marked states.
  • The patient assessment is facts. No harm is a conclusion, so it's out.

Template

Chart note (nursing narrative)

[TIME]: Entered room. [DRUG/FLUID] on pump channel [CHANNEL] found [RUNNING / PAUSED / STOPPED / ALARM SILENCED].
Pump display: rate [FOUND RATE] mL/hr, dose [FOUND DOSE], VTBI [FOUND VTBI], volume infused [VOLUME INFUSED] mL since [LAST VERIFIED TIME].
Order: [DRUG/FLUID] [ORDERED DOSE] = [ORDERED RATE] mL/hr. Last RN-verified settings: [LAST VERIFIED SETTINGS] at [LAST VERIFIED TIME].
Estimated difference from ordered volume: [OVER / UNDER] by approx [AMOUNT] mL over [DURATION].

Line: [DESCRIBE WHAT YOU SAW, e.g. tubing connected / disconnected at hub / clamp closed / tubing kinked].
[RELATIONSHIP OF VISITOR] at bedside states: [WHAT THEY SAID THEY DID, IN THEIR WORDS], at approx [TIME THEY REPORTED]. Time of change not observed by RN.

Assessment [TIME]: BP [BP], HR [HR], RR [RR], SpO2 [SPO2], temp [TEMP]. [RELEVANT FINDINGS, e.g. LOC, pain, bleeding, glucose].
IV site [LOCATION]: [APPEARANCE], [FLUSHES / DOES NOT FLUSH], [PATENT / NOT PATENT].

Action: [STOPPED / RESUMED / RATE RETURNED TO ORDERED RATE / TUBING REPLACED / LINE REMOVED] at [TIME].
Settings verified against order at [TIME] [WITH SECOND RN [NAME] IF REQUIRED BY POLICY]. Infusion running at [CURRENT RATE] mL/hr.

Notified: [PROVIDER NAME, ROLE] at [TIME]. Response: [ORDERS RECEIVED OR "no new orders"].
Charge RN [NAME] notified at [TIME].

Visitor education: explained that pump and line are to be handled by nursing staff only and to use the call light for any alarm. [RELATIONSHIP] [VERBALIZED UNDERSTANDING / RESPONSE].
Plan: [RECHECK TIME, LABS, MONITORING].

Message to the provider (SBAR, phone or secure chat)

S: This is [YOUR NAME], RN, calling about [PATIENT NAME], room [ROOM]. I found [DRUG] [PAUSED / RUNNING AT WRONG RATE / DISCONNECTED] at [TIME].
B: Ordered [ORDERED DOSE/RATE]. Pump showed [FOUND RATE/STATUS]. Last verified correct at [LAST VERIFIED TIME]. Visitor reports [BRIEF ACCOUNT]. Estimated [OVER / UNDER] infusion of approx [AMOUNT] mL over [DURATION].
A: Current VS [VS]. [KEY FINDINGS]. IV site [STATUS]. Infusion now [CURRENT STATUS AND RATE] as of [TIME].
R: Requesting [LABS / DOSE ADJUSTMENT / BOLUS DECISION / FURTHER ORDERS]. Do you want any change to the current rate?

Safety event report (facility system, per your policy)

Event date/time found: [DATE] [TIME]
Location: [UNIT], room [ROOM]
Device: [PUMP MODEL], channel [CHANNEL], asset/ID number [PUMP ID]
Medication/fluid: [DRUG/FLUID AND CONCENTRATION]
Ordered settings: [ORDERED RATE/DOSE]
Settings found: [FOUND RATE/DOSE/STATUS]
Last verified correct: [LAST VERIFIED TIME] by [NAME OR ROLE]
What was observed: [FACTS ONLY: WHAT YOU SAW ON THE PUMP, LINE AND PATIENT]
What was reported: [RELATIONSHIP OF VISITOR] stated [THEIR ACCOUNT].
Patient assessment: [VS AND FINDINGS]
Actions taken: [WHAT YOU DID TO THE INFUSION AND WHEN]
Notifications: [PROVIDER NAME/TIME], [CHARGE RN NAME/TIME], [OTHERS]
Device status: [LEFT IN USE / REMOVED FROM SERVICE AND TAGGED FOR BIOMED, PER POLICY]
Follow-up: [LABS, MONITORING, VISITOR EDUCATION GIVEN]

Words to avoid

Word or phrase Why Use instead
tampered, messed with, played withImplies intent you didn't seeDescribe the action: pressed stop, changed rate from X to Y
family silenced alarm (when you didn't see it)Charts something you were told as factWife states she pressed silence
fixed, corrected (alone)Hides what was wrong and for how longFound setting, ordered setting, new setting, time
infusing per order (alone)Says nothing about the time before you walked inAdd the found settings and volume infused
no harm, no adverse effectsA conclusion, often drawn too earlyVS, assessment findings, labs ordered
as usual, againSuggests a pattern you haven't documentedChart each event on its own, with its own time
per family (with no details)Which person? What did they say?Name the relationship and give their account

Charting the fix and skipping what you found

The usual mistake is charting the fix and skipping what you found. Pump rate corrected, infusing per order tells the reader the infusion is right now. That's all it tells them. It doesn't say how long it was wrong, by how much, or how much drug the patient got or missed. Whoever reads the chart later needs the before numbers: the provider adjusting a heparin dose, pharmacy, quality, the next nurse. After numbers alone won't do it.

The second mistake is turning the visitor's story into fact. The daughter says she only pressed silence, and you chart Daughter silenced alarm. Now you've recorded as observed something you only heard. Maybe she also pressed stop. Maybe she changed the rate trying to make it quiet. The pump's own history may not match either version. So write daughter states, use her words, and chart separately what the display showed. Then your note stays accurate whatever turns up later.

Third: blame words. Family tampered with pump is a conclusion about intent, and you don't know their intent. Most visitors who touch a pump want the noise to stop, or they're trying to help. Describe the action. Leave the motive out.

Bottom line

Write down what the pump showed before you change anything. Chart the visitor's account as what they told you.

Official guidance

  • Any time an infusion restarts or its rate changes, check every programmed value against the order before you leave the bedside. That includes restarting a pump someone else paused or reprogrammed. (FDA, Medfusion 4000 Operator's Manual)

What this rests on

No published decision turned up for this question. We looked, and the searches are in the record. So this article stands on published guidance and on how the question is asked on the floor, not on a court opinion. That is a weaker footing than the rest of the guide, and you should know it before you rely on it. The decisions behind the other articles are all in one place.

From nurses online

Quoted as written. Opinion, not a source.

  • On Alaris pumps there is a lockout button on the back that most nurses don’t even know about. If I have a touchy family I make sure it’s on. ... Yeah, always lock critical drips. Also most pumps have them, we use ICU Medical pumps and they also have them. I’d be shocked if a pump didn’t have one. ..

    r/nursing on Reddit: Family members touching medical equipment reddit

  • Just don’t touch it. ... The strictly correct answer is please never touch the buttons. In the real world where the nurse can't always get to the room promptly, the answer is still never touch the buttons. ... That “infusion complete” message just means that the volume in the bag has ...

    Patients turning off infusion alarms? : r/nursing reddit

  • I usually just tell them not to touch my pumps. ... Had a resident turn off pts heparin pump. It was in an AC and she had her arm bent during an US , she said “it said occluded so I just paused it”. I said thank god it wasn’t her levo or her prop. Shed die two times.

    r/nursing on Reddit: Why do residents think they can mess with our IV pumps? reddit

  • This medication is levo/doapmine/neo... blah blah... it's important that you don't touch the pumps/vent or any of the monitors/xyz. If you are concerned about anything feel free to come get me. If you have any questions, I'm happy to answer. I'm going to be the nurse throughout t

    r/nursing on Reddit: Visitors touching IV pumps....need to vent reddit

Other guides

Advice, not law.