Extra dose of septra ds

[krissy29RN]

I work in LTC where meds are in packets and grouped accdg to the times they are to be given. My partner is quite new and is assigned to meds. She left early and i had to finish the med pass. BEfore going home, i check every bin to see if everything has been given. I chanced upon a pack of Septra DS scheduled for 5pm that day that was not detached in the strip. SO i took it and gave it to the resident. WHen i came back to sign the record, there was a signature there already. I don't know now if she had signed it by mistake or if she had taken a PRn packet of Septra ds and gave it earlier. I endorsed this to the next shift but did not get the chance to contact my partner anymore. ANy side effects of having an extra dose of septra? Should they hold the next dose if ever? Resident's order is septra ds bid x 5 days.

help!

[tyvin, BSN, RN]

If the resident hasn't shown any untoward effects then there are no side effects with an extra dose and don't hold the next does since the medication is time specific.

She probably signed off the MAR ahead of time and missed that one since it's not on the sheet with the routine meds. That is the way I always knew that meds had not been given is if they were left over. Ask her next time you see her.

[OttawaRPN]

Why would there be a prn for an Abx? I'm wondering if you mean like an emergency drug box. At any rate, you will never know if a dose was given until you ask your partner; just goes to show to check the MAR first before giving a med, even if it's still sitting in the strip pack. You didn't mention if it was the patient's first dose and sometimes a loading dose is given initially but not usually with a DS. At any rate, hopefully you reported it as a med error.

[Kooky Korky, BSN, RN]

The lesson here is - do not play detective or try to fix other nurses' errors.

Proper procedure would have been to contact her, find out if it had been given, notify the doctor if not or if you could not have reached her, get MD orders. You were well-meaning but wrong to do what you did. Now, you are in trouble, even if no harm comes to the patient, which it most likely has not and will not.

[caliotter3]

Where I worked there was usually a time lag between the ordering of, and receipt of, meds from the pharmacy, with the first dose usually given from the med box. The complete course received from the pharmacy would be given.

[NurseKatie08, MSN]

We also have the bubble-packed med system, however, if the MAR is signed, I wouldn't be playing detective either. If it's signed off there is no real way to know that it wasn't given, d/t the possibility of a dose being borrowed or taken from an e-kit.

[tyvin, BSN, RN]

Where I worked there was usually a time lag between the ordering of, and receipt of, meds from the pharmacy, with the first dose usually given from the med box. The complete course received from the pharmacy would be given.

Oh yes so right; usually want to start the Abx ASAP.

[krissy29RN]

i didn't play detective. I just didn't look at the MAR before giving it. I know, big mistake. It's not really like me to do it and there ain't any excuse for that. Now, i will never ever take it for granted, even if time seems to be running shorter than usual. Anyway, i reported the med error, md said to continue with regular dosing and resident showed no side effects. I'm very well aware of my mistake and will not do it ever again. Thanks for your replies, guys! I appreciate the reminders.=)

[indigonurse]

This possible med area could have possibly been avoided if you followed the step of Right pt. Right dose, Right time, Right route, Right amount this would have been on the MAR if you would have looked at the date before you admin. you would have noticed a signature. If there is a signature there you have to assume it was given by someone at the wrong time then right up an incident report and to protect the res. call and report the situation the MD and see how the MD wants to handle it. Yes a med can become toxic if given in a higher dose than it was prescribed. If it is an antibiotic the blood levels need to be maintained in order for the drug to be effective.