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| |  My first medication error-help!
I am a brand new RN. I just graduated in May and passed my boards one month ago. I am still in orientation. I am terrified I am going to be sued, and just needed some reassurance and advice. I was with a preceptor from a different floor the other night. I had never had experience with someone going through alcohol withdrawal, so I was pretty apprehensive and I had 5 other patients (two of which were post-op) I was caring for. There was an order for IV Valium 10 mg qhour prn. I asked my preceptor if that was a reasonable dosage, and she told me not to be scared that it was impossible to overdose someone having DTs and that there was no need to call to clarify the order. Well, to make a long story short, I am ashamed to say that I followed the physician's order. Every time my preceptor came by, she asked me if I had medicated him yet. By the time I left at the end of my shift, he was still agitated. However, when I returned the next night, the charge nurse came up to me and told me that they had to reverse the Valium, that the patient became unresponsive. I abseloutely sobbed. He received a total of 90 mg of Valium during my shift. The patient is doing fine now, they didn't have to intubate him or move him to ICU. Everyone reassured me that I was not responsible, and I overheard the wife telling the mother that "it wasn't the nurse's fault." But I haven't been able to get over it. I am so scared that I am going to be sued and so frustrated that I have had such an awful orientation. It's really making me question a lot of things. My question is, though I was working under a preceptor and am an orientee, am I legally responsible for this error?
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Jul 17, 2008, 12:12 AM
Updated
Jul 17, 2008 at 01:29 AM by Kyrshamarks
Re: My first medication error-help!
90 mg of valium on a severe alcoholic over the course of a shift is not a lot of valium. It may seem like it is but I will lay odds he also had other drugs during the course of the day that potentiated the valium that he was getting. Hell, my brother takes 60 mg of valium every morning when he gets up thanks the the vaunted VA system that has made him addicted to it. He has been on it for 20 years and at one point was taking up to a 100 mg at a time as was ordered.
| | No. 3 |
Jul 17, 2008, 12:27 AM
Re: My first medication error-help!
I am also a new grad, and I completely understand and relate to that feeling of feeling responsible for every little thing that goes wrong during a shift. So sorry you had to have an experience like this.
Reading your post made me wonder if your hospital has a protocol for alcohol withdrawl. The ICU I work in has a specific protocol for that, and I'll have to look at it to see what doses of benzos are listed. Off the top of my head, 10 mg of diazepam does not seem excessive, especially for an ETOH withdrawl patient.
You definitely did the right thing by questioning the dose and asking your preceptor. My thought is the dose was not inappropriate per se, just not right for that particular patient.
| | No. 4 |
Jul 17, 2008, 12:44 AM
Re: My first medication error-help!
We do have a DT protocol to administer Serax. The patient was initally on Serax, and he was doing beautifully! Even though he was scoring high enough on the protocol to have the max dosage of Serax, the physician D/C'd the protocol because she didn't believe he was in alcohol withdrawal, and started the Valium. Plus, the guy was taking Xanax at home and they D/C'd that on admission. The charge nurse was pretty nice about it and told me that because he had no permanent harm done, I am not responsible. Everyone on the floor told me I was not responsible, and my manager has not said a word about the situation. My main concern is that I am going to be sued.
| | No. 8 |
Jul 17, 2008, 12:28 PM
Re: My first medication error-help! Originally Posted by LovelyLucky  I am a brand new RN. I just graduated in May and passed my boards one month ago. I am still in orientation. I am terrified I am going to be sued, and just needed some reassurance and advice. I was with a preceptor from a different floor the other night. I had never had experience with someone going through alcohol withdrawal, so I was pretty apprehensive and I had 5 other patients (two of which were post-op) I was caring for. There was an order for IV Valium 10 mg qhour prn. I asked my preceptor if that was a reasonable dosage, and she told me not to be scared that it was impossible to overdose someone having DTs and that there was no need to call to clarify the order. Well, to make a long story short, I am ashamed to say that I followed the physician's order. Every time my preceptor came by, she asked me if I had medicated him yet. By the time I left at the end of my shift, he was still agitated. However, when I returned the next night, the charge nurse came up to me and told me that they had to reverse the Valium, that the patient became unresponsive. I abseloutely sobbed. He received a total of 90 mg of Valium during my shift. The patient is doing fine now, they didn't have to intubate him or move him to ICU. Everyone reassured me that I was not responsible, and I overheard the wife telling the mother that "it wasn't the nurse's fault." But I haven't been able to get over it. I am so scared that I am going to be sued and so frustrated that I have had such an awful orientation. It's really making me question a lot of things. My question is, though I was working under a preceptor and am an orientee, am I legally responsible for this error?
Hi.
I hope this info can be of some help to you. According this info you didn't do any mistake.
(Saunders, Nursing drug handbook 2007, page 346)
alcohol withdrawal
IV, IM: adult, elderly: initially, 10mg followed by 5-10mg q3-4 hr.
So the max dose per day: 10mg+ 10mg*8 (q3hr)= 90mg/24hr.
I think that the patient developed an adverse reaction to this drug. It is possible that some other drug potentiated the action of Valium. During your shift did you notice some changes in the patient? Anyway, there is always place for an adverse reaction. In my opinion, you didn't do anything wrong. It can happen to any of us and we have to be ready for this.
| | No. 9 |
Jul 17, 2008, 08:17 PM
Re: My first medication error-help!
No, during my shift there was no change. He slept for about 15 minutes after I gave him each dose and then he was right back to trying to pull out out the restraints. DaMaleNurse, I guess you are right that it wasn't a med error. Everyone just made such a huge deal about it.
Much thanks to each and every one of you for replying to me. I feel so much better now.  |
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