I have a problem that I neded your opinions on-First, let me say that what I'm about to describe DID NOT happen to me, or in the hospital where I work. I was talking to another nurse who works FT in a nearby hospital, and occasionally with us. At her FT job, she is a Charge Nurse of a med/surg floor days.Last week her floor got a patient who was a DNR.This patient was an elderly lady who's family agreed to comfort care. She was placed on a morphine drip and trans. out of the ICU, to the floor to let nature happen. The pharmacy sent the 50ml bag of NS with 50 ml morphine for a 1ml/hr drip around 1230. The patient got to the MS floor around 1430ish. The patient's family was there. The granddaughter was there, along with her MD boyfriend. I do not know who this MD is (the nurse wouldn't tell me his name), but apparently he is known to that hospitals' staff- I got the impression he might have been employed there at some time, but isn't now???(Loss of privelages??) So- Grandma gets settled in, and the boyfriend/MD approaches her nurse and states "Can we get her a morphine bolus to speed things along?" She directs him to the CN, who immediatly tells him NO, and calls the supervisor to let her know what was said. The boyfriend/MD insists on speaking with the attending MD, who just happens to be inhouse at the time. Again, the boyfriend/MD asks if he can order a bolus to "Hurry things along." The attending calls the CN, asks how the patient is looking- Cn tells him resps are 8/minute and pt. doesn't appear to be in any pain. Attending Doc says OK, keep everything the same, NO BOLUS ordered.The family and Boyfriend are made aware. Approx. 1/2 hr later, the call light goes on- BF says "She needs another IV bag, cause this one is EMPTY"- There should have been at LEAST 40 ml of NS/morphine left in the bag.Supervisor and Attending MD are called, up the hospital chain of command it goes, hospital lawyer gets called in, EVERYONE has to submit an incident report. The CN puts right in hers that she felt the bf/MD did it.Now here is where It gets even worse. The administrators/lawyer orders the pump taken out of the room.It isn't saved for the police. Either is the IV bag. The hospital tells everyone involved that they will handle it internally, and NOT to speak about it.The lady had severe liver damage to begin with, and didn't die for several hours.Am I wrong, or is the hospital trying to cover up a possible attempted murder? Aren't they bound by law to alert the police?? Isn't that "Elder abuse" if nothing else, and a state reportable incident? The pharmacy was contacted and made aware that 40 mgs of morphine is gone.Don't they have to account for controlled drugs? And what about this MD?? I really don't like the idea of someone like that being around patients.Obviously the hospital will try to cover it's own buttocks, but what about the poor nurse who had the patient. Couldn't she get in trouble because 40 mg of morphine is missing? What about the other RNs involved. Couldn't they have problems with their liscenses, ect. if it comes to light that they knew about a possible felony, but never called the police/nursing board ect.? Don't they have a legal responsibility to alert someone about this possible murdering Doc.? I was floored that she didn't seem concerned about those things. She felt that because she reported it to the hospital, she is covered. But if a patient is suspected of being abused and they are child/elderly the nurse HAS TO REPORT IT, even if it turns out not to be true, they are still mandated to report it. How is this ANY different?? What would you have done? I urged her to contact a lawyer-better to be safe than sorry.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
yes ICU/CCU is VERY different than OB.......
but even regarding ICU-----I see tons of people posting right here on allnurses, they have 2-3 patient assignments or greater----- routinely. I have yet to see 1-1 ICU nursing, even when I floated there to ICU/CCU at the hospital where floating OB was routine. Each nurse in the ICU had no less then 2 patients each shift, sometimes 3, if an admit came up. I think it's great some places still do that (1-1). It's becoming as rare as Hen's Teeth, really. Good for you!
no way...don't buy your story at all. No hospital would allow 50cc's of morhine on a regular i.v. pump...no way....I for one as a nurse would never use a regular i.v. pole to hang a controlled medication....this story is bologna!!!
Yes, if you have a PCA or epidural. But in our hospital (as well as the one we are talking about) Morphine gtts. are put on a regular IV pump. There is a "lockout" button on the back, but it's only a toggle switch, used for grabby confused patients.And it says "Lock Out" above it. I'm thinkin if he's smart enough to get through med school, he could figure out a toggle switch marked like that. WE don't usually use that lock out option at our hospital.
In our ICU versed, diprivan and sedating agents are run on a regular pump, this must be quite a common practice since our IV pumps (Abbot plum) let you program for specific drugs. They can be programmed for morphine, but we use PCAs even for just a continuos infusion. As far as th OP the pump should have been immediately taken out of service and checked for malfunction or tampering and a report made to the FDA and the manufacturer if the pump was the cause of the OD. Also if OD was the COD I would have expected it to happen sooner (within 1 hour of a large dose of MS) and would suspect an outside party of helping themselves. Some IV tubings have anti siphon valves to prevent this.
I don't see how it would be murder for the family to deciede to "hurry things up." If the woman was going to die anyway, all they did was speed up the inevitable. Sounds like you might be watching a little bit too much "Murder she Wrote."The missing narcs are a problem, but I wouldn't go around screaming murder.
Specializes in Gerontological, cardiac, med-surg, peds.
At the large teaching hospital in which I used to practice, morphine drips were run all the time out in the open on a pump (and this was in the step down or ICU). About two years ago, the lock-type PCA pump was installed in all the units. It is not too far-fetched to believe that many hospitals still allow this. Nevertheless, it is very dangerous practice for all involved.
My advice to the OP: report the incident anonymously to the state board of nursing and to the state medical board.
It all sound fishy to me. But one of my main questions is, why did the grandmother need to "hurry it along"? If there is some recording of the MD saying this, the hospital should be responsible for submitting it to the proper people.
Specializes in Vents, Telemetry, Home Care, Home infusion.
This thread started with second hand information---remember whisper down the lane? No one can tell the true motive behind this family members request unless personally involved.
Supervisor and Attending MD are called, up the hospital chain of command it goes, hospital lawyer gets called in, EVERYONE has to submit an incident report. The CN puts right in hers that she felt the bf/MD did it.Now here is where It gets even worse. The administrators/lawyer orders the pump taken out of the room.It isn't saved for the police. Either is the IV bag. The hospital tells everyone involved that they will handle it internally, and NOT to speak about it.The lady had severe liver damage to begin with, and didn't die for several hours.
Glad to see that incident reports were requested. Missing some info here: Pump was removed from room....where did it go: to pharmacy or to biomedical engineering for evaluation....or to trash can?
"Hospital is handeling it internally": Hospital has the duty to perform a "root cause investigation" to determine what, how and why med infused sooner than programed time and report info to JCAHO/state if indicated.
"The lady didn't die for several hours", had a DNR order so death due to endstage illness was expected. Don't see how you can equate this to murder.
Like this response from Pain mgmt forum re narcotic infusions:
This is the Principle of Double Effect. The good effect (easing pain and respiratory distress) outweighs the bad effect (possible death). This is considered OK (even good) by the Nursing association.
but even regarding ICU-----I see tons of people posting right here on allnurses, they have 2-3 patient assignments or greater----- routinely.
Our ratios are either 1:1 or 1:2, depending on the acuity of the patient. NEVER more than 1:2 by a law that's been on the books for years in CA. Still, even with two patients we are at the bedside as the two patients are in the same room. I'm never more than 10 steps away from either patient when I have an assignment of 2. This unit is a unique system that was the vision of a very well known cardiac surgeon back in the mid '70's.
To not further hijack this thread, if you'd like detailed description of how the unit is set up, pm me and I can explain.
This might be a silly question, but.... could the bag have been pulled from the pump and squeezed in manually? I do not think I am grasping how the morphine was dispersed...in the solution or piggy back?????If it was dispersed in the solution how do you know it was 40 mgs????? I am just confused by the whole thing..............
All i can say is PCA. I wouldnt touch a narcotic drip like that. Was it murder, i doubt it. She was moved from the ICU for comfort care only. Granted she didnt need a morphine bolus, but she should never have been sent to a med/surg floor with a drip anyway, she should have automatically been put on PCA at the time of transfer. Staffing ratios on a med/surg floor doesnt allow for close enough monitoring of a open narcotic.
The boyfriend/MD insists on speaking with the attending MD, who just happens to be inhouse at the time. Again, the boyfriend/MD asks if he can order a bolus to "Hurry things along." The attending calls the CN, asks how the patient is looking- Cn tells him resps are 8/minute and pt. doesn't appear to be in any pain. Attending Doc says OK, keep everything the same, NO BOLUS ordered.The family and Boyfriend are made aware. Approx. 1/2 hr later, the call light goes on- BF says "She needs another IV bag, cause this one is EMPTY"- There should have been at LEAST 40 ml of NS/morphine left in the bag.Supervisor and Attending MD are called, up the hospital chain of command it goes, hospital lawyer gets called in, EVERYONE has to submit an incident report. The CN puts right in hers that she felt the bf/MD did it.Now here is where It gets even worse. The administrators/lawyer orders the pump taken out of the room.It isn't saved for the police. Either is the IV bag. The hospital tells everyone involved that they will handle it internally, and NOT to speak about it.The lady had severe liver damage to begin with, and didn't die for several hours.Am I wrong, or is the hospital trying to cover up a possible attempted murder? Aren't they bound by law to alert the police?? Isn't that "Elder abuse" if nothing else, and a state reportable incident? The pharmacy was contacted and made aware that 40 mgs of morphine is gone.Don't they have to account for controlled drugs? 
And what about this MD?? I really don't like the idea of someone like that being around patients.Obviously the hospital will try to cover it's own buttocks, but what about the poor nurse who had the patient. Couldn't she get in trouble because 40 mg of morphine is missing? What about the other RNs involved. Couldn't they have problems with their liscenses, ect. if it comes to light that they knew about a possible felony, but never called the police/nursing board ect.? Don't they have a legal responsibility to alert someone about this possible murdering Doc.? I was floored that she didn't seem concerned about those things. She felt that because she reported it to the hospital, she is covered. But if a patient is suspected of being abused and they are child/elderly the nurse HAS TO REPORT IT, even if it turns out not to be true, they are still mandated to report it. How is this ANY different?? What would you have done? I urged her to contact a lawyer-better to be safe than sorry.
SmilingBluEyes
20,964 Posts
yes ICU/CCU is VERY different than OB.......
but even regarding ICU-----I see tons of people posting right here on allnurses, they have 2-3 patient assignments or greater----- routinely. I have yet to see 1-1 ICU nursing, even when I floated there to ICU/CCU at the hospital where floating OB was routine. Each nurse in the ICU had no less then 2 patients each shift, sometimes 3, if an admit came up. I think it's great some places still do that (1-1). It's becoming as rare as Hen's Teeth, really. Good for you!