help please! morphine side effects!

[missnurse2012]

so a resident has been prescribed .1ml of mophine. when checking out the bottle and narcotics sheet the resident had 30ml. the last person to give the medication wrote 29ml. STUPIDLY ive been reading the mar as 1ml and seeing the narcotic book from 30 to 29ml and thought i was correct. the resident was sent out due to shallow breathing. she IS on a vent and was highly anxious for the past couple of days. she does have a hx of anxiety and the last prn that was given was her prescribed ativan. im freaking out right now. because of my med error could it be possible that im the reason that the resident was sent out? the last time she was given morphine was over 24 hours ago. being that it was a higher dose than ordered i cant help but feel guilty that im to blame. im wondering how long would the effects of morphine last in the system? im so scared of losing my license but most of all scared that ive hurt the resident. please anyone with any answers let me know asap!

[RNGriffin]

.1ML, 30ML, 29ML= (maybe I need to thoroughly read through the entire post again)

It is hard to decipher what you are worried with, and this may be due to being over anxious yourself.

Who was the doctor that wrote the order? If there was a discrepancy over dosage amounts, which is not listed here in it's correct form, why was this not verified?

At this point, if no one else touched the MAR aside from you, you will need to step fourth and please be clear on your intents and information!

[CapeCodMermaid, RN]

Our morphine comes in a 30cc vial. The usual concentration is 20mg/cc.It's given sublingually. Every nurse and doctor has been educated and re-educated to write "give 5mg (0.25cc) every hour as needed for pain or respiratory distress."

[RNGriffin]

Your question is the side effects of Morphine overdosage in a PT with HX of anxiety...The symptoms may be acute, but the more prevalent will be resp. depression. Given the time frame of the last dosage and when antivan was administered, the likely result will be fatigue which could last up to 48 hours after administration. The Resident should be fine, but you definitely should alert other medical staff who may be attending to the patient, as Resp. failure, brachycardia, etc. are at higher risk in patients whose nervous systems are already compromised, due to anxiety. A watchful eye on vital signs for the next 24hrs will be ideal. But, this is all depending on the length of admission...

It's rare that the results will be fatal. But, please be more cautious in your administration of narcs, especially if you are uncertain. Morphine is used heavily in OR patients to induce a more effective anesthetic.

[loriangel14, RN]

Did you not realize you were giving 10mls of morphine? That is a high dose. I would have questioned it.

[surferbettycrocker]

the order for .01 ml should come with either a) magnifying glass to dispense .01 ML or b) clarification of said order to mgs. was she supposed to get 0.1 mg of morphine for ....?

i suspect if you looked at it twice and mistook the 1ml for .01 ml you are not the only one.

was this oral morphine?

[tothepointeLVN, LVN]

From what I can understand of the first post it was MS 10mg/mL The bottle had 30mL in it before it was opened. The first nurse gave whatever dose she gave then documented that there was 29mL left in the bottle

So our OP read the order as give 1mL and crosschecked that by the fact that 1mL was missing from the bottle also.

1mL at 10mg/mL doesn't sound totally out of the ballpark if we are assuming that this is given PO/SL and not IM/IV. I often work with MS @ 20mg/mL and for severe pain our orders are often to give 20mg / 1mL. 1mL of MS PO/SL isn't a heck of a lot.

Was it written .1mL without a leading zero. Could it have been just a tiny little pen dot. Being send out 36 after receiving the MS probably means the two events weren't correlated (probably)

[missnurse2012]

thank you all for the advice and comments! so it was brought to my attention that i did give the correct dose. the person informing me of my " mistake " was looking at another persons chart!!!! can you believe it??!? they both have the same medication but different dose. the whole thing was a huge mix up and unfortunately at my expense since ive been worrying apparently for no reason. but thank you all the same for your input!

[redhead_NURSE98!, ADN, BSN]

Is it wrong of me to nitpick at those of you who typed ".1" instead of "0.1?"

[tothepointeLVN, LVN]

So the person who informed you of the mistake was in fact mistaken? Ahh the irony.

[MattNurse, MSN, RN]

i feel so stupid and hopeless. i dont know if im cut out for all this.

It happens, you aren't stupid if you make a mistake you are just human. Nor is your co-worker stupid for their error.

You are stupid if you don't learn from your mistakes.

[Elizabeth 1953]

I am so sorry that you went thru that .Thank goodness it ended well for you.But in a way it helped you learn just how easy a mistake can be made and the problems of not clarifying the orders correctly.I believe that some of these problems occur due to being over worked and under so much stress as a nurse.Being a nurse is a very stressful career.You or anyone else may make a mistake.It happens.The main thing is to learn from the mistakes and not make yourself feel incompetent.Always double check yourself and do not give a dose of med or perform the order until you have double checked it no matter how busy you are.And always clarify orders if they are not clear.This is your license,and I am sure you want to keep it.If you do make a mistake,tell someone asap so it can be corrected or assessed for potential problems.I hope you do not leave your career over a mistake.Even the best nurse can make a mistake.I feel that the mistakes you make can lead you to become a better nurse when you learn from them.You become more aware and pay even closer attention to things.Just take some slow breaths and start a new day.Happy things worked out for you.Remember none of us are perfect.

[tewdles, RN]

As others have intimated, the "mistake" was actually the providers, for writing an improper medication order.