I gave too much morphine... please read and advise

katmarieRN · Mar 2, 2009

Frankly, you'd be a better nurse filling the medication error report than not. Falsifying a report/chart or not accurately reporting would be more likely to get you kicked out PLUS the nurse could lose her license. I don't think they'd kick you out of the program for filing a med error report. I think they'd appreciate your honesty. I know some instructors lurk on these boards, I'd be curious to see what they say.

man23SN · Mar 2, 2009

I agree with you about filing the report, but the nurse said that it wasn't technically an error because it was the right med, and it read that the patient could receive 10 mg. However, the 10 mg was probably not to be given all at once..

BabyLady, BSN, RN · Mar 2, 2009

You didn't state what size syringe you had.

I think probably the bigger error was not in the amount you gave (b/c the order was vague..which is not a good thing either), but the fact he was allergic to it.

rn/writer, RN · Mar 2, 2009

I think probably the bigger error was not in the amount you gave (b/c the order was vague..which is not a good thing either), but the fact he was allergic to it.

The fact that the patient was allergic to the med would only be an error if that information was known, had been disclosed by the patient, and was included in the med profile. Giving the patient a med that causes a new or undisclosed reaction is a side effect and should be added to the patient's profile, but it isn't an error if it wasn't already listed.

Falsifying a report/chart or not accurately reporting would be more likely to get you kicked out PLUS the nurse could lose her license.

I don't see where there would be any falsifying of a report. Giving the 10 mg vs. the 3 mg the nurse told you to give was an error in the sense that you did something other than what she told you to do, however, it doesn't appear to have violated the order as you explained it. Neither you nor the nurse did anything contrary to the order, so, technically there is nothing to report.

That said, you really need to keep your head in the game. You were covered this time by a vague and generous order and the distraction of a med intolerance. Consider this a huge learning opportunity and be exceedingly grateful that you fell within the parameters of the order when you stumbled. Because you really did stumble. Had this order been for just the 3 mg, you would have given more than three times the correct amount, and you could have ended up with major repercussions.

Take the energy you are using to beat yourself up and redirect it to becoming more diligent in your approach to meds overall. Concentrate on what you are doing. Ask yourself what the injection-ready syringe should look like before you actually prepare it. Be determined that you will never take a stroll through a minefield like this one again.

BTW, if you had violated the order as written, I would be encouraging you to file an incident report.

BabyLady, BSN, RN · Mar 2, 2009

The fact that the patient was allergic to the med would only be an error if that information was known, had been disclosed by the patient, and was included in the med profile. Giving the patient a med that causes a new or undisclosed reaction is a side effect and should be added to the patient's profile, but it isn't an error if it wasn't already listed.

I'm sorry, I should have clarified...you are right, I was assuming in my post that the allergy may have been known and that the student may not have been aware or may have assumed that the percepting RN already checked this...as the percepting RN seemed to a little out of touch from the OP's post.

Even though I check the chart, we are taught to ask about allergies one more time before giving meds in the ER in case it was missed in triage.

Now, I have no idea if this matters or not...but I have received morphine 3x in my life. Twice when I had children, one other time when I was in a car accident.

All three times (and at different hospitals) I remembered the nurse specifically asking me, "Have you ever had morphine before?" I don't remember other drugs being presented this way..just the standard allergy questions and that is it.

Is there a reason?

man23SN · Mar 2, 2009

Thanks to all for replying. You are right m/writer his allergy was not listed in his chart, and we did chart that we gave the full 10 mg. We also charted the reaction that he had, and that benadryl was given and that it neutralized his reaction.

I will always be more careful from this day on, and i have been hugely humbled by this experience. The nurse I was working with was being so nice and trusting me, and I feel like a huge idiot for making this mistake. The last thing I want is for other nurses to think, "That guy's a lawsuit waiting to happen."

FlyingScot, RN · Mar 2, 2009

One way to avoid this in the future is to only draw up the amount you want to give in a separate syringe. You can do this with a Carpuject by removing the needle/luerlock apparatus which will expose a stopper. I know many, many people who have made the same mistake because they were distracted.

TakeTwoAspirin, MSN, RN, APRN · Mar 2, 2009

I'm inclined to think that the nurse who didn't want to make a fuss about reporting this was thinking of her own butt as much, if not more, than yours.

Even though you are graduating in a couple of months, you are still not a nurse. You have no license and you are not even employed by this facility. The fact that she left you alone, with a narcotic, and had you push that narcotic IV without a licensed nurse supervising you is just plain reckless on her part. If I were in your shoes, I wouldn't have put myself in that position and would have refused to do it without supervision. However, I understand that you got caught up in the situation and how they were letting you do cool stuff. She was the responsible party though, and she should never have allowed you to be in a position of making such a mistake! She has no idea what really happened with the remains of the narcotic. OK, we all understand that you pushed the whole amount, but she didn't know you from Adam. For all she knows, you could have pushed 3 and saved the rest for yourself.

I'm sorry, but she is doing you no favors. She is looking after her own license by not reporting this. Hopefully you will learn from this (and so will she!).

Valerie Salva, BSN, RN · Mar 2, 2009

I'm inclined to think that the nurse who didn't want to make a fuss about reporting this was thinking of her own butt as much, if not more, than yours.
Even though you are graduating in a couple of months, you are still not a nurse. You have no license and you are not even employed by this facility. The fact that she left you alone, with a narcotic, and had you push that narcotic IV without a licensed nurse supervising you is just plain reckless on her part. If I were in your shoes, I wouldn't have put myself in that position and would have refused to do it without supervision. However, I understand that you got caught up in the situation and how they were letting you do cool stuff. She was the responsible party though, and she should never have allowed you to be in a position of making such a mistake! She has no idea what really happened with the remains of the narcotic. OK, we all understand that you pushed the whole amount, but she didn't know you from Adam. For all she knows, you could have pushed 3 and saved the rest for yourself.
I'm sorry, but she is doing you no favors. She is looking after her own license by not reporting this. Hopefully you will learn from this (and so will she!).

I agree with the above.

rn/writer, RN · Mar 2, 2009

I'm inclined to think that the nurse who didn't want to make a fuss about reporting this was thinking of her own butt as much, if not more, than yours.

I had the same thought.

I'm sorry, but she is doing you no favors. She is looking after her own license by not reporting this. Hopefully you will learn from this (and so will she!).

Here's where we differ. The doctor's order was not violated so there was no technical error to write up. In this case, the student was doing too much and the nurse was doing too little, but as problematic as that may be, they somehow managed to stay within the parameters of the order.

I hope both of them had the bejabbers scared out of them and will conduct themselves much differently from now on. The OP certainly shows evidence of a serious change of heart and mind.

As far as the nurse goes, it would appear that there is an element of self-preservation at work here (she should have at least asked him to show her the syringe before he gave the injection), but hopefully she got as much a jolt of reality as he did.

Asking the OP to throw himself on his sword--when the order was not breached--serves no purpose. The reality is he got lucky this time. Now it's up to him to internalize the lesson and take it with him into practice. He'll be a better nurse--and perhaps a better preceptor someday--for what this experience has taught him.

TakeTwoAspirin, MSN, RN, APRN · Mar 2, 2009

Wasn’t suggesting anyone throw themselves on a sword. Just making the point to the OP (who appears to be taking on the responsibility for this incident all on their own shoulders) that the supervising nurse may not be operating in an entirely altruistic manner by wanting to keep this under wraps.

I don’t think it would do anyone any good to make a Federal case out of this. Like you said, hopefully everyone concerned scared the poop out of themselves and will move on older and wiser, but the OP shouldn’t feel like they are the only ones who have responsibility in this. That’s all.