So I was in clinicals in the ER the other day and I had a pt who was dx with appendicitis and needed some pain relief. The Dr ordered 40 mcg Fentanyl IVP. So I went and drew it up and double checked it with my nurse. The Dr was standing there and he said "actually go ahead and just give him the full 50." So I went back and drew up the rest of the dose. Since we don't scan meds in the ER, I threw the vial away after I was done. We went in and I pushed the Fent. We then went up on the floor to start an IV for one of the nurses up there. As we were walking my preceptor asked me what I did with the vial after I was done. I said I threw it away because it was empty. She stopped. I stopped. She then asked, "So how much Fentanyl did you just give our patient?" I remembered the dose on the vial was 50 mcg/ml and it was a 2 ml vial. My heart stopped beating for a second. And as I doubled over in shock I uttered "100 mics." So we went back down and I assessed my pt and he was doing very well and said his px was much better. My nurse then took me aside and said "I know you didn't push 2 ml's in his IV. I watched you push it." I didn't believe her and I was still freaking out about it so she went digging through the trash and pulled out the vial which had 1 ml still in it. I was so relieved and that's when the tears came. I had never cried in nursing school up to this point. And I cried hard. I know Fent is a pretty forgiving med, but that's not the point here.
What I did wrong/What I learned:
1. I drew up the other 0.2 ml of that vial without my preceptor. Should not have happened.
2. I can't remember double checking the second time. Also bad. I will always always always double check from now on.
3. I didn't read the label on the vial before drawing up the med the second time. I don't care how many times I've drawn up a med, from now on, I will always read the label and make sure my calculation is right before I even leave the med room.
4. I did not waste properly. I should have wasted the medication down the sink with another nurse and my preceptor before I ever threw that vial away. Never again.
this had such a profound impact on me that I know that I will never make this mistake again. Why? Because I will follow the rights of medication administration. Forever. And I will ALWAYS keep this in the back of my mind: once you push a med into that IV, it's gone. You can't get it back. So you better be damn sure you're putting the right medication in the right dose to the right patient at the right time.
AnnieOaklyRN, BSN, RN, EMT-P
2,610 Posts
100 mcg of Fentanyl is not really much for an adult.. I would learn from it and move on.
Annie