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

Nursing Students General Students

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So I'm supposed to graduate and march in 2 months from now. I'm currently doing my critical care rotation and I had a 7 hour observation/clinical experience in the ER tonight. The nurses were great, they were letting me start IV's (I was 1 for 2) and give meds with little to no supervision at all. I didn't feel like an outsider and the observation was going super. So one of the nurses told me I could give an IV push of morphine, and the order read 1-10 MG titration. She told me to go ahead and give him 3 MG, and that the full 10 MG was in 2 ML. So I was good to go, she left the room and I started to push the morphine and for some reason while I was pushing the med and talking to the patient, I was thinking that the 2 ML was 3 MG, not the full 10 MG :scrying:

So, around 10 minutes later the nurse comes up to me and asks if I dumped the rest of the morphine out, since she told me to give 3 mg. I was like ohhh crap, I gave all of the morphine, and she started freaking out, but she said she would just tell them that we gave the 3 mg and dumped the rest out. Side note: the patient broke out into hives and we found out he was allergic to morphine, so she gave benadryl and it fixed the problem.

I then told her, "Should we file a medication error report?" and she said that she was afraid they wouldn't let me graduate if we were to do that. I then told her that, "Shouldn't we be okay, since the order said up to 10 mg of morphine is ok to give?" And she was like, ohh yeah you're right! You're right, we have nothing to worry about since the order does say to give 1-10 mg titrated. She also said that if anyone asks why we gave so much, she'll tell them it's because he was a big guy, and he uses meds all the time at home (which is true).

I feel TERRIBLE, and i've been beating myself up over this since I just got home a little over an hour ago. On one hand, I feel like I could have killed the poor guy, and on the other hand, I'm afraid the nurse is going to say something to another nurse and it will get back to my program and they'll kick me out or something. The nurse reassured me that I have nothing to worry about, but I worry about everything.. I have learned my lesson on the 5 rights of meds and I will ALWAYS remember this day. Please feel free to respond and advise...

Specializes in NICU, Post-partum.

...to those of use still in school, it's a lessen to remember what we are taught, remember what we are taught...because the NCLEX hospital still exists when you are in school, and sometimes it's easy to forget that nurses we are paired with have been out of school a long time...they take shortcuts because they can and have the experience and the know-how...but when you are new, everything had to be by the book until it flows like water.

That's a good point. In the ideal world preceptors would be the best of the best and their instruction would be consistent with what the student/new grad has learned thus far. In the real world preceptors are human. They may have learned different protocols, may have forgotten exactly what they learned, may have become comfortable (sometimes a little too comfortable) taking shortcuts that a newbie shouldn't even consider.

Any time a preceptee (if that isn't a word it should be) feels that little tingle of alarm, it's time to ask questions or voice apprehension--not in a way that suggests incompetence, but rather to ask for help in resolving a conflict between what was learned "by the book" and the current situation. Good preceptors will not resent this. They will understand that students and new grads need to have a rationale for departing from what they've been taught.

Addendum: And sometimes, the prreceptors may need to ask themselves if they are crossing lines that really shouldn't be crossed. What we rationalize in our own heads can appear less "comfy" when we're trying to explain it to someone else.

Specializes in Family Nurse Practitioner.

Wow, what a story. Odd that he didn't have a reaction from it when he took it at home. Of course the nurse was protecting herself but its also a lucky break for the OP also because I know nursing students that were tossed out for much less. We weren't allowed to do any pushes even with an instructor present isn't that a universal thing?I'd also just take it as a lesson learned, whew, and move on. Hang in there.

From personal experience, take as much away from it mentally as you can, I guarantee you will be ever so careful now :)

We all make mistakes from time to time, anyone who says they don't or haven't doesn't exist. Now with serious meds like morphine, learn that on administering something like this, the utmost concentration should be paid.

Would I report it? Well, you've rationalized a need not to, so do that. If it really was out of the parameters, then yeah, you'd need to. Some people though will probably tell you to tell your dean while burning a mock nursing diploma...don't do that, they're nuts :)

at some facilities, I can push. At some, I can't. It all depends.

Specializes in ED, ICU, PACU.

Just for some piece of mind, your patient may not be allergic to Morphine; but, instead, experienced histamine release from the higher dosage. Morphine action does release histamine, which can result in itchy skin to short lived hives.

Look at the side effect section, 3rd paragraph:

http://www.nda.ox.ac.uk/wfsa/html/u03/u03_016.htm

I agree with all the above posts. Nothing was done wrong to warrant a report since the order said up to 10. However I feel the nurse was saving her own butt. With narcotics she should have been there looking at the amount drawn up before you gave it. It should need a double sign off also or witness.

The other thing that crosses my mind is that as students were were not allowed to push anything IV push. Nothing, IV push hits the system much faster and there are so many time limits to IV push such as over so many minutes.

A nursing student (not from my school and years before) at the site i did clinical gave potassium IV push and almost killed someone. There was new policy in place no student does IV push not even with instructor or hospital nurse present. I think other places should have this policy before they learn a lesson the hard way. Not saying students are irresponsible just ultimately the hospital and nurse are responsible and a policy like this could save a life. As a nursing student the only recourse is you won't become a nurse. Ultimately the hospital and nurse responsible can be sued, along with the school you attend, and would if something like the IV push potassium happened.

I want to say kudos for fessing up to your mistake and learning from it. I think some students would have covered their butts and said I tossed it already. You took responsibility and that puts you ahead of some nurses I know.

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