A Close Call...

  1. I had a really sick baby the other day in the ER and I was preparing to give a medication. The order was given by one of the doctors verbally because this was an emergent situation and we didn't want the kid to crash. I was told to give the full vial.

    Something didn't strike me right about the situation so I confirmed it with the charge nurse stating the amount in the bottle and that I was giving the whole thing. However, she was really busy at the time and seemed a little distracted. As a side note, she was busy helping ME since, as I mentioned before, the kid was critically ill, so I don't want you to think I'm complaining; I'm just explaining the situation.

    I draw up the medication and prepare to give it, but because I still felt uneasy about the dosage (used to work with only adults, still unfamiliar with some pediatric dosages). I decided to confirm it once more by asking the attending "I'm giving 4mg of medication x. Is that ok?" The doctor responds with "What? I don't want that much for him. I only need 1mg. That's how much is in the vial." I show her the vial which to the attending's surprise, contains 4 times the amount of medication in there than she thought. Apparently, we were getting this drug from a new company that manufactured medicine X differently. Had I given the full bottle, the baby would probably have died very quickly.

    Let this be a lesson to all. If your gut instinct tells you something is wrong, escalate. However busy you may be, errors in delivering proper care will only make your day busier. Also, make sure to confirm the dosage in mg or mcg rather than mL. I shudder to think of what would have happened if I had given the full mL of medication.
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  2. 5 Comments

  3. by   bagladyrn
    Great catch! And extra kudos for persistence!
  4. by   Guy in Babyland
    I wouldn't have accepted the order of "give the whole vial". If they had said "Give 1 mg, I think it is the whole vial." you would have given only 1 mg despite it not being the whole vial.
  5. by   JKL33
    Quote from evastone
    Let this be a lesson to all. If your gut instinct tells you something is wrong, escalate. However busy you may be, errors in delivering proper care will only make your day busier. Also, make sure to confirm the dosage in mg or mcg rather than mL. I shudder to think of what would have happened if I had given the full mL of medication.
    And!!! If you are asked to double-check a medication, for the love of all that is holy STOP what you are doing and pay attention. If you're unable to do that you need to ask the person to find someone else to do the check!
  6. by   adventure_rn
    Ugh, I absolutely despise taking med verbal orders for babies, even in emergency situations. There's so much potential for error, especially when you're distracted because a kid is rapidly declining.

    This is also a huge win for closed loop communication (i.e. when you repeat the verbal order back to the provider to ensure you heard/interpreted it correctly). Any time I get a verbal, I always read it back. I'll occasionally get annoyed docs who say things like "Isn't that what I just said?" but to me it's worth the 10 seconds it takes for the second safety check.

    Good catch!!
  7. by   blondy2061h
    Even if taking a verbal order for a medication during, you need to confirm the "5 rights" of medication administration to confirm you are accurately following a complete order. This includes confirming the dose and route of a medication, neither of which your "give the whole vial" "order" included. I'm glad you took the time to question it and learned from the experience!

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