Digoxin Error, How should it be handled? Worried for a Pt.

medsurgrnco, BSN, RN · Jul 27, 2008

Pharmacy should have been contacted to get the correct dose. And a med error occurrence report should have been filled out.

Dixielee, BSN, RN · Jul 27, 2008

The physician needs to know what dose the patient has been getting and for how long, and what is happening to his heart rate. He probably needs and EKG and dig level as well. Kudo's to you for catching the dosage error and trying to follow up. Good job!

ilstu99 · Jul 27, 2008

Half of .125 is .0625.....not .6

What form was it in? Any chance the order was for a partial package? I've never seen Dig come in anything other than .125, .5, .05, etc.

WVStarFish · Jul 27, 2008

Yes, it was 0.06. The pharmacy had split the 0.125 pills and then they are put in individual packets with the name and containing dose.

The 0.06 is printed on the package as well and it's clear that the pill is halved. I can't believe I typed that wrong in my original post, but I DEFINITELY meant that the order and MAR calls for 0.125 but he was only getting half of that. :)

Thank you for pointing that out, I write better than I type

ilstu99 · Jul 27, 2008

Gotcha. :)

It's tough to say what the other RN's and shifts might have done, unless there's a VERY clear trail....like a computer override or something.

It the patient didn't receive the incorrect med on your shift (YAY, you!), then it's at least a pharmacy error, and you should follow your facility's policy on how to document that. I would have to write it up, cc: my NM, HO and send it to QA.

Cathlabnurse46 · Jul 27, 2008

in short, i was orienting for a week as a new lpn at a ltc home. on day one, a certain pt's ahr was only 50 so i held his dig.
on day two, i noticed that the mar and the doctors order called for 0.125 of dig, but the pharmacy had sent a box of only half that dose, which is what? 0.6

i hope this is the bigger error! half of .125 is .0625.

technicalities! at half the dose the pt serum dig level would be too law to cause harm. the issue is, is his heart rate now too fast (which would lead to a mural thrombus)? does he need to be rebolused with dig? yes it is a med error and you need to follow your facilities policy. digoxin is becoming less popular over the past ten years. there are other ways of managing a-fib without using dig. with the increased use of beta blockers and ep studies and atrial ablations, afib and the use of digoxin is now more managable than ever in my life time. many cardiologist just opt for a single chamber pacemaker and put the patient on beta blocker therapy and not fool around with serum blood levels and digoxin. for nearly 1000 years, digoxin has been used as a poison and with the difficulty in managing serum blood levels monthly.... it's starting to fade away. much like in my days when i first got out of nursing school, we still used dilantian for heart failure and as an anti-arhythmic.

anyway... yes, it's an incident report.

WVStarFish · Jul 27, 2008

I know that he was getting a very very low dose, and his heart rate was only 50 when he was getting it.

What worried me most was that, after one day of not getting that little dose, his HR was so fast and erratic. And nothing was said, nothing was done. The nurse never even checked on him that day, much less contact the doctor.

I just didn't know how urgent this would normally be, what to do or how to handle something like this. Considering that I was being "oriented" as a brand new nurse, you would think I would have been told what to do in that instance.

Cathlabnurse46 · Jul 27, 2008

i know that he was getting a very very low dose, and his heart rate was only 50 when he was getting it.
what worried me most was that, after one day of not getting that little dose, his hr was so fast and erratic. and nothing was said, nothing was done. the nurse never even checked on him that day, much less contact the doctor.
i just didn't know how urgent this would normally be, what to do or how to handle something like this. considering that i was being "oriented" as a brand new nurse, you would think i would have been told what to do in that instance.

you have a nursing license.... it is your responsibility, if he is your patient, to notify the physician. it is my understanding (i don't work in a long term care facility... but i owned several aclf's in the past and have an administrator license) that an assesment still must be done and changes in a patient status must be communicated to the physician and documented. sss or tachy-brady syndrome is usually managed with dig (esp in managed care patients) or in the manor i discribed above.. with beta-blockers and a single chamber pacemaker. un-controlled rapid hr can lead to embolization, cva, syncope, chest pain and other issues if not treated. complications are likely to cost more health care dollars if he is not treated.this is why it is important for nurse to do there jobs.

SuesquatchRN, BSN, RN · Jul 27, 2008

YOU HAVE A NURSING LICENSE.... it is your responsibility, if he is your patient, to notify the physician.

In her position, her responsibility as an LPN is to report to the RN, who was charge.

An LPN "gathers data" and reports it to the RN, who then "assesses" what the LPN already has. However, it is not within our scope to assess, but to report to the RN under whom, by law, we work.

Were she to go above her charge's head there would be hell to pay.

Cathlabnurse46 · Jul 27, 2008

In her position, her responsibility as an LPN is to report to the RN, who was charge.
An LPN "gathers data" and reports it to the RN, who then "assesses" what the LPN already has. However, it is not within our scope to assess, but to report to the RN under whom, by law, we work.
Were she to go above her charge's head there would be hell to pay.

Agreed, LPN's scope is a dependant lic. However, I have seen LPN worth 2-3 RN's and would trust thier judgement.

Is there another nurse who you work with that can make a call? :banghead:

WVStarFish · Jul 27, 2008

I don't remember if I clarified in my original post that this was my second day orienting, and as a new graduate. :clown:

I was "shadowing" an RN, and all I knew to do was report to her, and bring it to another nurses attention at shift change.