help please! morphine side effects!

[missnurse2012]

so a resident has been prescribed .1ml of mophine. when checking out the bottle and narcotics sheet the resident had 30ml. the last person to give the medication wrote 29ml. STUPIDLY ive been reading the mar as 1ml and seeing the narcotic book from 30 to 29ml and thought i was correct. the resident was sent out due to shallow breathing. she IS on a vent and was highly anxious for the past couple of days. she does have a hx of anxiety and the last prn that was given was her prescribed ativan. im freaking out right now. because of my med error could it be possible that im the reason that the resident was sent out? the last time she was given morphine was over 24 hours ago. being that it was a higher dose than ordered i cant help but feel guilty that im to blame. im wondering how long would the effects of morphine last in the system? im so scared of losing my license but most of all scared that ive hurt the resident. please anyone with any answers let me know asap!

[tothepointeLVN, LVN]

Unfortunately I see a lot of orders like this for Roxanol / MS where the volume is stated rather than the doseage.

[tewdles, RN]

Unfortunately I see a lot of orders like this for Roxanol / MS where the volume is stated rather than the doseage.

I imagine that all of us nurses know that this is a "bad practice" setting the scene for serious medication errors. I am surprised that your nursing or facility management does not put a stop to it for their own corporate liability reasons.

[tothepointeLVN, LVN]

I imagine that all of us nurses know that this is a "bad practice" setting the scene for serious medication errors. I am surprised that your nursing or facility management does not put a stop to it for their own corporate liability reasons.

Well here's the thing. A lot of hospice companies in my area all do this in many cases the standard order set is in mL not mg. I can see writing it like that for the family but for the nurses no. The nurses even document in mL

Also I've always wondered about calling it by it's brand name Roxanol rather than MS which is always what is on the bottle. What if a nurse reads the med sheet and is well she just have some Roxanol but hasn't had any Morphine yet so I'll go ahead and give her some. I didn't know Morphine had a brand name before I started doing hospice.

[tewdles, RN]

The hospice agencies may be prescribing morphine in ml rather than mg but it is a dangerous practice and should not be encouraged.

There is a big difference between writing medication instructions for patients/families and writing them for professionals. Even so, medication instructions should always include the dosage in mg as well as a volume descriptor, even for families, and especially when the medication is a controlled substance.

I think that many people use the name "Roxanol" because it is easier than saying morphine sulfate, is fewer letters to write, and everybody knows what you mean. Roxanol is always 20mg/ml, whereas morphine sulfate could be any variety of things given in a variety of routes. We should order using morphine sulfate rather than a brand name, to be correct.

[tothepointeLVN, LVN]

No disagreement on that. It's like pulling teeth sometimes in report to get the last dose given in mg. Because they won't say 0.25mL they'll say 25 or 5 or 1 meaning 0.25mL, 0.5mL and 1mL (supposedly)

[allysun1]

Learn from this NON mistake. Check and double check. This is a blessing. Something like this has happened to me.

[maelstrom143]

Is it wrong of me to nitpick at those of you who typed ".1" instead of "0.1?"

OMG!!! THANK YOU! THANK YOU! THANK YOU! Three pages of this most interesting post and I kept fretting over the .1, .1, .1!!! It was driving me nuts! So glad to know I was not the only one...

Please, use a leading zero before the decimal point? It drives me absolutely bats when others write orders like this without leading zero or with a zero after a decimal point