Administered expired medication. Oh no!

[Beanyamean]

I am a pretty avid follower of the forums here but I've never really had too much of a reason to post as I have always found the answers I am looking for. However, Today at work I administered a steroid to a pediatric patient. In my haste to administer the medication I did not realize until after I injected it that it was expired by about 2 months. Since it was a pediatric patient I had the medication double checked by a provider. The provider also did not notice that it was expired. I realize this does not excuse my error. What do I do? Do I report this to my supervisor? Do I just let it go? Should I bring this up to the provider? At this point I am the only one aware of the error. The way we document does not require us to document expiration dates. I realize that I need to pay more attention to what I'm doing. Not looking for a lecture just looking for guidance. Thank you for your advice.

[iluvivt, BSN, RN]

Most medications retain their potency and continue to be efficacious for years after the official expiration date. There are some exceptions such as insulin, nitroglycerin, some temperature sensitive medications and some antibiotics such as tetracycline. Many drugs will also lose their potency over time but not necessarily cause harm just not work as well. The expiration date placed on each medication is the date to which the manufacture guarantees complete potency and does not always correlate with the actual facts since most of the drugs have not been studied.

OK so with all of that..... the fact that pharmacy dispensed a medication that was expired means that they had a problem. They forgot to check or have a flaw in their system. That cannot be looked at or corrected unless someone like you reports what happened. You as the nurse are the end user of the dispensed product and did not catch the expired date until after you gave it and thus have a responsibility to report it. So IMO you do have a responsibility to report it.

Recently a patient I had experienced a medical complication that was time sensitive and needed some medication that is not a common medication at all. We had to buy it from a nearby medical center and the pharmacist had a courier service bring it over.The second of the doses had expired by a few mos but our pharmacist noted that and called me.We had a discussion about it and I determined that the benefit of giving it outweighed not giving it and waiting for a second dose. Had I waited any longer there was potential for a loss of a limb so I gave the medication and it worked immediately to reverse the damage.

[Anna Flaxis, BSN, RN]

Exactly what iluvivt said.

To add to this, many drugs begin to lose potency once mixed with a diluent, but are shelf stable for a long time in their original form.

Absolutely, you should report this med error. Otherwise, how can the system be analyzed to find out where the breakdown was and corrected?

Your workplace should have a process for reporting medication errors. The first step, IMO, would be to find out what this process is.

It's scary when you realize you've made an error, and it could be tempting if nobody else knows about it to just keep it quiet, for fear of discipline. This is really unethical, because until the system is improved, the same mistake could continue to happen, and this puts patient safety at risk.

I don't know what it's like where you work, but many (most?) health care systems take a non-punitive approach to medication errors. Rather than blaming the individual and disciplining them, they take a systems improvement approach where they look at the chain of events to figure out a better way to do things to prevent the same error from occurring again.

On a personal level, standing up and taking responsibility for your part (not checking the expiration date) is the grown up, professional, ethical thing to do.

This isn't intended to be a lecture; just hoping to clarify my thought processes for you.

[amoLucia]

At home, I would imagine that all of us have taken a med that had 'technically' expired. And we did so without any negative aftereffects.

Of course, your situation with a pediatric pt and an injectable med does push the concern up a notch.

As PP points out, there is a flaw in the system and the potential for another professional to repeat the same mistake is very real. And that occurrence could be VERRRY serious that time. Thus that needs to be prevented. To me, that is the biggest issue, so reporting the problem is the correct way to go. Hopefully, all the higher uppers will 'see the bigger picture' and not negatively knee-jerk punitively.

>>>>>>>>>>>>>>>>>>>>

To iluvivt - I ask what drug you were talking about? This inquiring mind would like to know for my own information/learning. I really don't know, but I have 2 guesses - some kind of clot buster??? Or an antivenom drug???

[KelRN215, BSN, RN]

Why was pharmacy stocking/dispensing expired meds? It's a systems error, so you should file a report so they can get to the bottom of it.

How did you realize it was expired after you'd already administered it?

[iluvivt, BSN, RN]

Hyaluronidase to treat a horrid Calcium Chloride extravasation. The worst part of the story is the patient had a CVC and the nurse chose to use a PIV instead. She was clueless that should this extravasate it could cause severe tissue damage and believe me it did just that. I was not notified right way either and not until the patient complained of pain at the injury site and it started to appear blister-like .

[amoLucia]

To iluvivt - thank you. Will read up on it.