Demerol 75 mg was given IV instead of IM. Fired!!!

kcmylorn · Apr 25, 2011

I didn't think demerol IV or IM( esp. IM), was being given anymore? Because of the risk of seizure. I though the gold standards post op was Morphine or Dilaudid. I was under the impression it was only still being given for conscious sedation and rigors.

FNPdude74 · Apr 25, 2011

I didn't think demerol IV or IM( esp. IM), was being given anymore? Because of the risk of seizure. I though the gold standards post op was Morphine or Dilaudid. I was under the impression it was only still being given for conscious sedation and rigors.

We rarely give demerol also because of the potential build up of metabolites (normeperidine) that could be associated with increased risks of the seizure. ESPECIALLY in the elderly. If this nurse was giving it for pain, then yeah PO or IM is preferred. I think you can even still give it as an IV but slowly every 4 hours as needed..or continuously at about 15 mg per hour, correct me if i'm wrong, but the max would be 30 or 35 mg per hour? Again, we rarely give it. Even for moderate sedation (formerly conscious sedation), it's not being used as much as Ketamine, pentobarbital, propofol, dexmedetomidine (procedural sedation, intubations, LMA, etc. But unless you were (including but not limited to) an ICU nurse in an ICU, I don't think medsurg nurses would be administering these sedatives.

For future references, I would check meds before it's given and use either a book or iphone/ipad/ipod touch...

caroladybelle, BSN, RN · Apr 25, 2011

I believe that the bigger issue is not with the error itself, but how the OP is handling their errors and work issues.

When someone has been frequently called to the office for issues, they need to do some serious self examination. Especially if others are not having the same issues. Yes, their some seriously toxic workplaces, but there are also difficult employees.

If the OP demonstrated in their post some acknowledgement of the seriousness of the injury that could be caused or of doing some self examination of the cause, posters would probably take it easier on the OP. Instead, we get a shpiel on how working for 7 monthes should entitles them to unemployment, and worries about the phrase misconduct. This was also not a fly by night, one error and fired situation. There have been prior issues and a pattern of warnings.

Yes, sympathy is nice but it doesn't get the OP another job or pay the bills. Encouraging the OP to examine their issues and acknowledge them in an effort to improve practice, is maybe not as warm and fuzzy but ultimately much better for them and safer for the patients in the OPs care.

hope3456, ASN, RN · Apr 25, 2011

I previously worked in a hodunk rural hospital where Demerol IV (25-50mg) was ordered frequently (probably b/c it is cheap). I never saw adverse reactions. Usually the patient would be complaining again of pain within an hour. I heard it could be caustic to the veins so i would push it in slowly usually into a running line or diluted. Not that I agree with this exactly but it was standard practice in this facility.

OP did you self report this error? or how was it caught?

Administration should not be so punitive when nurses self report med errors. It just pushes them underground when they fear they will be fired.

iluvivt, BSN, RN · Apr 25, 2011

This was not a simple drug error. My qustion is how come you did not know that a 75 mg IV dose of Demerol is a huge dose to give IV. Is is neither here nor there that she got fired over this . Each employer can decide what they consider a critical enough error to warrent termination. Maybe this is a gift in disguise . Learn what your shortcoming are and work diligently to correct them. It does not matter that you had to pay twice to move..that is your problem not the employers..what does that have to do with anything. ALWAYS acknowledge the mistake you made..review the cause and circumstances and make an action plan to prevent it from happening in the future.

Kyrshamarks, BSN, RN · Apr 25, 2011

The most telling line of the OP was when she not even contacting the doc to back order it. That is a sign of someone not wanting to take resposibility for her mistake and instead trying to cover it up so it looks like no mistake was made. That alone really is misconduct.

Delete_Me_Please · Apr 25, 2011

Personally, I'm more inclined to think poorly of you for even considering filing for unemployment as a nurse. You work in about the most employable profession there is, so instead of being a part of the problem, lower your standards and apply for whatever job is out there. I'm personally beyond sick and tired of working more and more hours each week to pay for people that just don't feel like working for a job for which they're perfectly qualified and able to work. If you're honestly that lazy, leave the profession now and do all your future potential co-workers a favor - lord knows, they don't want to have to work harder to pick up your slack any more than the rest of us do.

As for IV instead of IM, its not the end of the world. It's not the "major" med error that people are describing it to be, I don't think... to me, a "major" error would be something along the lines of giving vistaril IV or giving lantus IV. Giving something by the wrong route is still an error, and shame on you for even considering asking the physician to change their order to cover your mistake, but at least the route was correct and the dosage was still within acceptable parameters. Basically, and I hope you know this already but, you got very lucky. They taught us the five/six rights in school for a reason.

WIN007 · Apr 25, 2011

Demerol 75 mg was given IV instead of IM. Fired!!!
Is it a misconduct? I was terminated and denied unemployment insurance.
Patient was not harmed. I started practicing under my RN license of Oklahoma 7 month ago. This was my first nursing job and I relocated for it (paid my relocation twice) from Texas to OK and back, when lost the job. The real reason for termination was a snow storm and I could not drive to work from the place I lived. I called the emergency truck to pick me up. My manager was furious and called me to her office few times for another reason. I was so fearful that she is going to fire me and I made an error. The time I found about it was next day in Human Resources, when I was fired. No variance report, no calling doctor for back IV order, no disciplinary, just simply terminated for misconduct.
Word MISCONDUCT bothering me. This is just a human error, which happens every day in hospitals!!! This was a personal issue not a misconduct. So, I filed the appeal for hearing with employer. At least my OK license is still displayed current online.
It is so hard to find an employment with only 7 months of experience! I believe that my 7 months of hard work 84 hours per pay period allow me to be qualified for unemployment insurance. I am just a human who wants to work, I am not asking for welfare.
Please, advise me what to do. If anyone was in similar situation. Thank you!

I sincerely don't want to make you feel worse than you do but putting 75mg directly into a pt. bloodstream that was not intended to be, this was not a small mistake. I think you can take some good lessons here: as a new nurse when administering medications, any you are unfamiliar with customary dosing, please look it up before administering.

As for the rest, I think your best bet is a policy of honesty. Explain you made a mistake and learned a lesson from it rather than try to defend it. I feel pretty confident someone will give you a break sooner or later if you take this approach.

FNPdude74 · Apr 25, 2011

I sincerely don't want to make you feel worse than you do but putting 75mg directly into a pt. bloodstream that was not intended to be, this was not a small mistake. I think you can take some good lessons here: as a new nurse when administering medications, any you are unfamiliar with customary dosing, please look it up before administering.
As for the rest, I think your best bet is a policy of honesty. Explain you made a mistake and learned a lesson from it rather than try to defend it. I feel pretty confident someone will give you a break sooner or later if you take this approach.

To add to this, if you're absolutely clueless, ask another nurse on the floor who has more experience. Better to ask to make sure if you still aren't sure after looking things up yourself rather than just doing things without critical thinking.

You know, I'm wondering if this is even a real situation or if someone is making this up to get a long forum post going to get a kick out of it...flame on!

WIN007 · Apr 25, 2011

Maybe it's just me but I hope anonymity is your friend here. I say delete this post and say no more about what could be interpreted as a serious medication error. Sentinel event? Possibly...
You should go quietly and thankful you're just getting let go. You really don't want anything to get to the Board of Nursing where you could find yourself fighting to keep your license.
Say nothing more on this site. Learn from your mistake and move on.
Good luck to you

I have to second this.

Every site you visit knows your ip, and you're very easy to find if need be. And not only that, it is permanent record. Even after deletion, text from the webpage indexed by keywords may still well be indexed in search engines across the wide world and it's still on backup. I don't mean to sound scary but please, consider this - PARTICULARLY when you're in trouble, before you post about your wild night out on facebook, etc.

canesdukegirl, BSN, RN · Apr 25, 2011

OP, there have been plenty of responses, but I am curious to YOUR response. Several posters have asked for more background info, and I was scrolling thru the posts to see your response. I only see one. Would you like to post an update?

Five&Two Will Do · Apr 25, 2011

Unforunately for you, you lost your job. Looking in micromedex, the largest dosage range that I found for meperidine is an a continuous infusion/PCA with the dose being no more than 50mg/hr IV. Some people with stronger tolerance or more of a narcotic history might require more of any one substance. This is a common thing. We either switch medications or go over the usual dose by a little bit, but probably not 50% more. Sadly I hear the tone of a victim in the OP message. Some employers might have done something different. Many probably would have fired. I should say very fortunately for you however, your patient did not lose his/her life. There is always narcan!!! Please learn from this. Take your time when giving medications. It is not worth the risk. Once I give it, its pretty hard to get it back. Just curious, Over what period of time did you push it?