I just have to ask...giving expired meds

[NewlyGradBSN]

Yesterday, my sister had stuffy nose. So, my mom asked me, the registered nurse in the family, if we could give nasal drops of Sodium Chloride. So she checked the expiry date, I checked it also. After giving it, I realized that it was past 3 months its expiry date. I only read the year, I don't know why I did not bother to look at the month. I know this was just as mistake at home, or it's just sodium chloride but I am beating myself up. I kept thinking to myself that if I make small mistakes, what more mistakes am I capable of even though I am triple checking everything else in the hospital. I researched about it, and mostly I read that the expiry date, for this case, only affects the sterility since it's salt and water. Any thoughts? thank you:) sorry but I am really bothered by something so shallow, I think.

[talaxandra]

Research by the US Armed Forces showed that medications past their expiration dates were for the most part unaffected in terms of efficacy and safety; exceptions include insulin and sublingual glycerin trinitrate. This doesn't mean that you ought to give expired meds, or not check the expiration date, but it does mean you don't need to stress :)

It's also not a bad thing to be reminded early that drug errors can happen however careful you are. Most people learn from their mistakes, but there are any number of things that can go wrong with medication administration, and so there's no point when you can wholly relax about it - I recently celebrated my 21st anniversary since I began nursing, and I still make drug errors, because the ward's busy, there are so many meds, and I get interrupted. Plus I'm human.

The important things to keep in mind are: be alert, but don't freak out about medication administration; check the order, the medication, the patient and follow the Rights of med adminstration; seek assistance (another nurse, pharmacy, MIMS) when you need it; put your hand up when you make a mistake - however bad it is, covering it up is worse; and learn from both your mistakes and those of your colleagues.

[mamamerlee, LPN]

talaxandra - - what an EXCELLENT post!

I check expiration dates on everything, these days. I have found many items in the supermarket that are well past their sell-by dates. My husband recently brought home packaged deli meats and chocolate milk that were past their sell-by dates. He never looks. But he will start - I made him go back to the market with them!

That being said, I am very careful with commercial eyedrops, and will toss them if I see they are expired.

[NewlyGradBSN]

Research by the US Armed Forces showed that medications past their expiration dates were for the most part unaffected in terms of efficacy and safety; exceptions include insulin and sublingual glycerin trinitrate. This doesn't mean that you ought to give expired meds, or not check the expiration date, but it does mean you don't need to stress :)

It's also not a bad thing to be reminded early that drug errors can happen however careful you are. Most people learn from their mistakes, but there are any number of things that can go wrong with medication administration, and so there's no point when you can wholly relax about it - I recently celebrated my 21st anniversary since I began nursing, and I still make drug errors, because the ward's busy, there are so many meds, and I get interrupted. Plus I'm human.

The important things to keep in mind are: be alert, but don't freak out about medication administration; check the order, the medication, the patient and follow the Rights of med adminstration; seek assistance (another nurse, pharmacy, MIMS) when you need it; put your hand up when you make a mistake - however bad it is, covering it up is worse; and learn from both your mistakes and those of your colleagues.

thank you talaxandra:) that was really helpful. I am ok now. I think I need to always BE vigilant.:) thank you so much I appreciate it:)

[talaxandra]

You're very welcome :)

And for anyone who's interested, the article I mentioned is here.

[PacoUSA, BSN, RN]

Arent there some medications that actually become toxic after expiration? I think I heard that is the case with some antibiotics. Otherwise, I believe I have read that expiration is more of a matter of decreased effectiveness.

[brownbook]

talaxandra, you have one of the best replies I have ever read! As for med errors at home. I had a small white bottle of ear drops (wax removal) next to a small white bottle of eye drops (over the counter allergy relief) guess who put ear drops into her eye!!!!!

[healthstar, BSN, RN]

My instructors said to one day, if you give expired meds to someone...they they just don't treat you....but they do not harm you. I don't know if this is true for all meds, but it makes sense.

Foods are a different story.

[katkonk, BSN, RN]

Arent there some medications that actually become toxic after expiration? I think I heard that is the case with some antibiotics. Otherwise, I believe I have read that expiration is more of a matter of decreased effectiveness.

If I remember my pharmacology correctly, it is tetracyclines that can become toxic after exposure to heat. I don't have time to research that, but that is why I remember that you can NEVER leave antibiotics in the car. Also, aspirin can become bad with age.

[katkonk, BSN, RN]

You're very welcome :)

And for anyone who's interested, the article I mentioned is here.

Thanks so much for the link to the article. I had read this article many years ago, and have thought about it many times in my career, but have never re-read it. Very nice info. to keep around.

[PetiteOpRN]

If I remember my pharmacology correctly, it is tetracyclines that can become toxic after exposure to heat. I don't have time to research that, but that is why I remember that you can NEVER leave antibiotics in the car. Also, aspirin can become bad with age.

That is correct. Tetracyclines become very nephrotoxic over time. Heat speeds up the process. Never take or administer expired tetracycline.

[talaxandra]

If I remember my pharmacology correctly, it is tetracyclines that can become toxic after exposure to heat. I don't have time to research that, but that is why I remember that you can NEVER leave antibiotics in the car. Also, aspirin can become bad with age.

You're right that there have been cases of Faconi's syndrome (a rare renal tubule disease) associated with expired tetracycline - though the drug has since been reformulated and is now less unstable, I would never purposefully give an expired medication of any kind to a patient, and I would exercise caution before taking one myself. For me, reading this article made me realise that I didn't need to get new scripts every year or two for anti-migranoids, when I'd only use a couple of doses each year.

Your comment about aspirin reminded me that I left out something in my earlier advice. The composition of some medications can change, even within the expiration period, particularly if improperly stored:

- aspirin can yellow and become crumbly;

- liquid formulations can separate, crystalise and (if made with sugar) become mouldy;

- eye drops are easily bacterially contaminated and should always be discarded within four weeks of opening;

- oral antibiotic mixtures are less stable than capsules and quickly degrade;

- even a small loss of potency can have a significant effect with drugs that have a narrow therapeutic window (eg warfarin, digoxin, anti-convulsants).

Always check the appearance of the drug and if in doubt chuck it out!

There are surprisingly few articles on the topic, but I did find another useful one, information from which contributed to the above list - skip past the drug disposal table to page 5.