Patient died from 8GMs of Dilantin

When and if I discovered I would be drawing up 32 vials of anything I would be calling pharmacy and asking them to mix it and send it to me. I don't have time to draw up 32 of anything ever. I learned in school that if you have to give more than 2 of anything to check and question the order. This is so bizaar that I have no further comment. But did you notice in the 2nd news story that the nurse in question was working at a different hospital before going to Jamaica.

Our pharmacy will not accept a order written as .8, must be 0.8. Let's see, which pt saftey rule is that?
Don't think you can give a conti drip of Dilantin, it is only good a short time after mixed .

In the ER they have alot of stat meds that they can get without going through pharmacy I believe.

The Doc stated that he was talking and laughing with her before he left....wouldn't you think that he would wait to see if she stablized before going on his merry way?
jean & houdini

Many people, including myself, are astonished at the "32 vials" not raising many red flags. If I recall correctly, Dilantin IV usually comes in 50 mg per ml. and the vials come in 2ml and 5ml, so she obviously used 32 5ml vials. It also says she had to start a second IV. My question is did she use three 60cc syringes? Has anyone EVER adminstered this much of any undiluted medication IV push?

Also, if pharmacy had been on the ball, she should have been informed that IV Dilantin should never be pushed faster than 25 mg/minute - and I doubt she had the 5+ hours to push that much med.

It also prompts me to ask, why are hospitals still using IV dilantin?

you have to use a filter, and it can be dangerous to the tissue with an infiltration...

CEREBYX!!!!!


Even the last UC where I worked used Cerebyx...

That being said, the nurse deserves to be fired and brought up before the board...

Okay . . I'm still in school but did they not teach nurses nine years ago that if you don't know the drug (action, therapeutic dose, possible side effects) you look it up before you think about giving it.

I'm pretty much with everyone else here . . . if you are drawing up multiple vials and apparently don't know the range of a correct dose - LOOK IT UP! Thats why they make drug books.

sometimes doctors doesnt write legibly. the nurse must have read it wrong for whatever reason and did not check with the doctor and other nurses.

32 vials is a lot! i could jst imagine myself drawing up all those vials. that takes time to draw them all up!!!!

there's something wrong in her head.... and it was wrong what she did....

i dont see any reason why they fired the doctor... the doctor should not be fired...

what happened to 5 rights...?

this is a lesson learned...

prayers and support to all parties......

Sad. Common sense in nursing isn't too common sometimes. Ditto on the prayers and support for those involved, especially the nurse.

for those that are wondering why the doc was fired, please reread the OP, it was clearly stated .....