For our collective benefit, list some of the med errors you've seen committed or caught before they were committed.
The only rules are:
1. No blaming.
2. No naming names.
3. State what the error was.
1. Mag and KCl hanging without a pump. ---Both need to be administered on a pump.
2. Regular insulin, pulled up in mg's, not units ---Self-explanatory.
3. Digoxin 0.125 mg po qd ----Given with an apical HR of 42.
4. Order for Vistaril IV ---Never give Vistaril IV.
5. Lopressor 25 mg po bid, 1 tab ----Pt. got 50 mg. because this med only comes in 50 mg tabs and should've read "1/2 tab."
6. PRBCs hung over the 4 hour limit. PRBCs piggybacked into ABTs. ---PRBC total hang time may not exceed 4 hours. This might include time taken from the blood bank in some facilities. ---Never piggyback anything into PRBCs.
7. PRBCs not hung for over 24h with a Hgb of 6.8.
8. "Demerol 100 mg. IVP q2h prn" --Classic case of "too much, too soon."
9. "Percocet 1-2 tabs po q4h prn, Darvocet N-100 1-2 tabs po q4h prn, Tylenol ES gr. X q4-6 h prn" ---Tylenol can potentially exceed 4 gm/day max.
10. Dilantin piggybacked into D5. ---NS yes, D5 no.
You can't give Vistaril IV? Huh, it SEEMS like we used to give it all the time--in combination with Demerol--in very early labor for pain relief (granted, this was back in the '70s, before anyone had even HEARD of epidurals.) Maybe my memory is faulty, and we gave it IM.
I can't say I've even seen Vistaril used in any operating room setting, even IM, since Versed became available--but I have heard it is still used in ER settings for migraines--perhaps also in combination with Demerol.
What's the reason that it should not be given IV?
OK, maybe 5 years ago, I was circulating on a D&C for retained placenta. We had a Pitocin drip going to control the resultant post-partum hemorrhage, but her uterus remained boggy, and just wouldn't clamp down.
The anesthesiologist resident attempted to give Methergine IV. I stopped him and offered to give it for him I.M. in the deltoid, (and did so) because I was trained to never, ever give Methergine I.V.--as its effect is on the smooth muscle of the uterus, it should be given I.M., and, in fact, since the lady was already up in stirrups undergoing a D&C, the ideal route would have been to have the surgeon inject it with a spinal needle directly into the uterus, or even paracervically.
Now, I've since learned that you CAN give Methergine I.V. but it's not recommended except as a last resort, because it can preciptiate a hypertensive crisis or even a CVA. Anresthesiologists tend to give everything rapid IV push, and I shudder to think what this lady's outcome would have been had he proceeded to do so.
How about the rest of you? Have you ever seen Methergine given I.V.? Could it have just as easily been given I.M. in the situation in which you saw it done, and did the patient suffer an acute hypertensive crisis?
We also had to give this lady Hemabate and transfuse her.
Last edit by stevierae on Nov 30, '04