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| |  I gave too much morphine... please read and advise
Updated
Mar 01, 2009 at 11:34 PM by man23SN
So I'm supposed to graduate and march in 2 months from now. I'm currently doing my critical care rotation and I had a 7 hour observation/clinical experience in the ER tonight. The nurses were great, they were letting me start IV's (I was 1 for 2) and give meds with little to no supervision at all. I didn't feel like an outsider and the observation was going super. So one of the nurses told me I could give an IV push of morphine, and the order read 1-10 MG titration. She told me to go ahead and give him 3 MG, and that the full 10 MG was in 2 ML. So I was good to go, she left the room and I started to push the morphine and for some reason while I was pushing the med and talking to the patient, I was thinking that the 2 ML was 3 MG, not the full 10 MG 
So, around 10 minutes later the nurse comes up to me and asks if I dumped the rest of the morphine out, since she told me to give 3 mg. I was like ohhh crap, I gave all of the morphine, and she started freaking out, but she said she would just tell them that we gave the 3 mg and dumped the rest out. Side note: the patient broke out into hives and we found out he was allergic to morphine, so she gave benadryl and it fixed the problem.
I then told her, "Should we file a medication error report?" and she said that she was afraid they wouldn't let me graduate if we were to do that. I then told her that, "Shouldn't we be okay, since the order said up to 10 mg of morphine is ok to give?" And she was like, ohh yeah you're right! You're right, we have nothing to worry about since the order does say to give 1-10 mg titrated. She also said that if anyone asks why we gave so much, she'll tell them it's because he was a big guy, and he uses meds all the time at home (which is true).
I feel TERRIBLE, and i've been beating myself up over this since I just got home a little over an hour ago. On one hand, I feel like I could have killed the poor guy, and on the other hand, I'm afraid the nurse is going to say something to another nurse and it will get back to my program and they'll kick me out or something. The nurse reassured me that I have nothing to worry about, but I worry about everything.. I have learned my lesson on the 5 rights of meds and I will ALWAYS remember this day. Please feel free to respond and advise...
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| | Advertisement Sponsored Links | | | | No. 2 | 
Mar 01, 2009, 11:28 PM
 Re: I gave too much morphine... please read and advise
I agree with you about filing the report, but the nurse said that it wasn't technically an error because it was the right med, and it read that the patient could receive 10 mg. However, the 10 mg was probably not to be given all at once..
| | No. 3 |
Mar 01, 2009, 11:31 PM
Re: I gave too much morphine... please read and advise
You didn't state what size syringe you had.
I think probably the bigger error was not in the amount you gave (b/c the order was vague..which is not a good thing either), but the fact he was allergic to it.
| | No. 4 |
Mar 02, 2009, 12:59 AM
Re: I gave too much morphine... please read and advise Originally Posted by BabyLady  I think probably the bigger error was not in the amount you gave (b/c the order was vague..which is not a good thing either), but the fact he was allergic to it.
The fact that the patient was allergic to the med would only be an error if that information was known, had been disclosed by the patient, and was included in the med profile. Giving the patient a med that causes a new or undisclosed reaction is a side effect and should be added to the patient's profile, but it isn't an error if it wasn't already listed. Falsifying a report/chart or not accurately reporting would be more likely to get you kicked out PLUS the nurse could lose her license.
I don't see where there would be any falsifying of a report. Giving the 10 mg vs. the 3 mg the nurse told you to give was an error in the sense that you did something other than what she told you to do, however, it doesn't appear to have violated the order as you explained it. Neither you nor the nurse did anything contrary to the order, so, technically there is nothing to report.
That said, you really need to keep your head in the game. You were covered this time by a vague and generous order and the distraction of a med intolerance. Consider this a huge learning opportunity and be exceedingly grateful that you fell within the parameters of the order when you stumbled. Because you really did stumble. Had this order been for just the 3 mg, you would have given more than three times the correct amount, and you could have ended up with major repercussions.
Take the energy you are using to beat yourself up and redirect it to becoming more diligent in your approach to meds overall. Concentrate on what you are doing. Ask yourself what the injection-ready syringe should look like before you actually prepare it. Be determined that you will never take a stroll through a minefield like this one again.
BTW, if you had violated the order as written, I would be encouraging you to file an incident report.
| | No. 5 |
Mar 02, 2009, 05:37 AM
Re: I gave too much morphine... please read and advise Originally Posted by rn/writer The fact that the patient was allergic to the med would only be an error if that information was known, had been disclosed by the patient, and was included in the med profile. Giving the patient a med that causes a new or undisclosed reaction is a side effect and should be added to the patient's profile, but it isn't an error if it wasn't already listed.
I'm sorry, I should have clarified...you are right, I was assuming in my post that the allergy may have been known and that the student may not have been aware or may have assumed that the percepting RN already checked this...as the percepting RN seemed to a little out of touch from the OP's post.
Even though I check the chart, we are taught to ask about allergies one more time before giving meds in the ER in case it was missed in triage.
Now, I have no idea if this matters or not...but I have received morphine 3x in my life. Twice when I had children, one other time when I was in a car accident.
All three times (and at different hospitals) I remembered the nurse specifically asking me, "Have you ever had morphine before?" I don't remember other drugs being presented this way..just the standard allergy questions and that is it.
Is there a reason?
| | No. 6 |
Mar 02, 2009, 06:17 AM
Re: I gave too much morphine... please read and advise
Thanks to all for replying. You are right m/writer his allergy was not listed in his chart, and we did chart that we gave the full 10 mg. We also charted the reaction that he had, and that benadryl was given and that it neutralized his reaction.
I will always be more careful from this day on, and i have been hugely humbled by this experience. The nurse I was working with was being so nice and trusting me, and I feel like a huge idiot for making this mistake. The last thing I want is for other nurses to think, "That guy's a lawsuit waiting to happen."
| | No. 8 |
Mar 02, 2009, 08:03 AM
Re: I gave too much morphine... please read and advise
I'm inclined to think that the nurse who didn't want to make a fuss about reporting this was thinking of her own butt as much, if not more, than yours.
Even though you are graduating in a couple of months, you are still not a nurse. You have no license and you are not even employed by this facility. The fact that she left you alone, with a narcotic, and had you push that narcotic IV without a licensed nurse supervising you is just plain reckless on her part. If I were in your shoes, I wouldn't have put myself in that position and would have refused to do it without supervision. However, I understand that you got caught up in the situation and how they were letting you do cool stuff. She was the responsible party though, and she should never have allowed you to be in a position of making such a mistake! She has no idea what really happened with the remains of the narcotic. OK, we all understand that you pushed the whole amount, but she didn't know you from Adam. For all she knows, you could have pushed 3 and saved the rest for yourself.
I'm sorry, but she is doing you no favors. She is looking after her own license by not reporting this. Hopefully you will learn from this (and so will she!).
| | No. 9 |
Mar 02, 2009, 08:15 AM
Re: I gave too much morphine... please read and advise Originally Posted by TakeTwoAspirin I'm inclined to think that the nurse who didn't want to make a fuss about reporting this was thinking of her own butt as much, if not more, than yours.
Even though you are graduating in a couple of months, you are still not a nurse. You have no license and you are not even employed by this facility. The fact that she left you alone, with a narcotic, and had you push that narcotic IV without a licensed nurse supervising you is just plain reckless on her part. If I were in your shoes, I wouldn't have put myself in that position and would have refused to do it without supervision. However, I understand that you got caught up in the situation and how they were letting you do cool stuff. She was the responsible party though, and she should never have allowed you to be in a position of making such a mistake! She has no idea what really happened with the remains of the narcotic. OK, we all understand that you pushed the whole amount, but she didn't know you from Adam. For all she knows, you could have pushed 3 and saved the rest for yourself.
I'm sorry, but she is doing you no favors. She is looking after her own license by not reporting this. Hopefully you will learn from this (and so will she!).
I agree with the above.
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