Med error? help im going to loose ky mind thinking about this!!!!!!

[avenellpn82]

Ok I'll try to be short. So I have been giving rochephin with lidocaine IM for the past four days its two grams. Now today the last day of the ABT I go to my charge nurse RN to get a 3 ml syringe she tells me I should use a 5 ml. I thought I was wrong all along giving this patient too little of a dose. Now when I looked at the syringe I felt that something was wrong but again my charge nurse told me it was correct so I gave the injection. When I came out of the patients room the DON asked me why did I look so nervous so I told her I just gave a patient an IM with a 5 ml syringe and she is so frail that it just scared me a little. Soooooo now how it gets to a med error......... She asks me what med it was and some other questions about the patient then she says what's the most an IM should be I replied 2 ml then she says well that's a huge med error u gave her dble the dose of lidocaine. Now even though the charge nurse told me to do this I now feel so damn stupid because I know that if u feel unsure about something u should check other resources and btw to make it worst I always have my lipincott clinical skills book :-(

Now the question...... This is my first med error what should I expect? I am freaking out.

[ATWLVN]

Follow reconstitution instruction as to how much liquid you should use but dont give 5 ml IM in one site. For adult, i think we were taught 3 ml Max for a site. If in doubt call pharmacy to verify:)

[Esme12, ASN, BSN, RN]

Sometimes people post and make such definitive statements and a lot of the time they are not correct.

Sometimes when people type these definitive statements it is because within their scope of knowledge and practice....and to them, in their experience, and what they have been tol to do....it is right. I remember years ago being told no more than 2cc per injection. I later re-learned it can go to 5cc which I still am squeamish about, my personal policy is about 2 MAYBE 2.5 cc is the max for me:up:....5cc just seems like a lot to go into someones bottom unless it's a really big bottom, especially if the drug is Ceftriaxone.

Rocephin historically is given with lidocaine due to how painful the injected med is......I can see if this elderly patient in a LTC facility needed the med and it was decided to keep her at the facility would be the reason for the I meds. Calling pharmacy in a LTC is not the reality and we need to remember that not all respond from a place of acute care.

OP....your statements are very unclear about the actual order and if the order was 2 gms rocephin with 5 cc's of lido the actual error occurred when no one clarified the order. 5 cc's of lido.....what kind of lido.....1%, 2%, with Epi, without Epi, lido for injection 1 mg/cc all administering a different concentration of lidocaine. 5 cc's of 2% lido is different from 5 cc's of the 1mg/cc. So, the order should have been clarified. You also should NEVER give a med that you are unsure about giving, it doesn't mater who told you it was ok....you are the one who gave it and therefore you are the one responsible. It's like when we were younger and we'd tell our Mom's "But Joey did it" and Mom's everywhere responded by saying "If Joey jumped off abridge would you follow?" The same applies here.

:hug:.....Now med errors are scary, whether it is your first or not. The corrective action usually coincides with the untoward effect on the patient (if they die you're in BIG trouble ). Take this as a learning experience on how to not have this happen to you again and be thankful the patient is ok.

To err is human, to not repeat them is being a nurse.:heartbeat;)

[leslie :-D]

perhaps you can admninster 5ml in one shot, but i choose to use my nsg judgment, and do so in 2 injections.

the more (rocephin) you give, the more chance of induration.

one could argue that giving 2 separate shots would be more painful...

but still doesn't mean that there will more adverse reactions.

i don't know why, but rocephin is one of those meds that creates confusion amongst those who administer it.

and fwiw, lidocaine doesn't make it any less painful for much of the pt population.

leslie

[Isabelle49]

The FDA just needs make Rocephin IV or PO (if it comes that way already).

I would flat out refuse to give more than 2.5 ml and probably limit that to 2.0 ml IM to any adult. I can't imagine what muscle damage 5ml of an irritating drug could do and I would never be responsible for injury if I could help it.

[Nursey103, ADN, RN]

Did you draw up the Rocephin or did your charge nurse?? Why did you have to go to your charge nurse for a syringe??

[DookieMeisterRN]

This has been a really confusing thread. A lot of speculation with nowhere near enough information. I always suggest and practice myself to look up a med I don't know how to administer, unfamiliar with, etc. I've learned to never take another nurses opinion unless I know him/her well and trust their judgment. I encourage you to speak with your DON and talk through this situation whether you get written up or not. Turn this into a learning moment instead of suffering over all the what-ifs.

[Mulan]

Sometimes when people type these definitive statements it is because within their scope of knowledge and practice....and to them, in their experience, and what they have been tol to do....it is right.

Yeah, I realize that.

However, there has been misinformation put out on this site regarding other topics in the past.

It's unfortunate, because some people see it, read it and believe it and it is totally off the wall.

[cherrybreeze, ADN, RN]

This has been a really confusing thread. A lot of speculation with nowhere near enough information. I always suggest and practice myself to look up a med I don't know how to administer, unfamiliar with, etc. I've learned to never take another nurses opinion unless I know him/her well and trust their judgment. I encourage you to speak with your DON and talk through this situation whether you get written up or not. Turn this into a learning moment instead of suffering over all the what-ifs.

Agree. There wasn't nearly enough info in the OP to even know if an error occurred, or what that error might have been, if there was one. I was hoping that by reading through the thread I would be enlightened....yea, that didn't happen. I wish the OP would clarify some more!!!

[Jenni811, RN]

No clue. oOur pharmacy draws up our IM medications and tubes them up. We just check the concentration on the sticker to make sure it matches what the order says.

[ashleyisawesome, BSN, RN]

i want those 5 minutes of my life back. just read this entire thread hoping there would be a happy ending and my head is spinning.

[chiquiraveloski]

Is the patient OK?>>>>that's all i wanna know.

[DesertRN2, MSN, APRN]

Well the way I see it mistake #1 you listened to someone else and not your instincts.

Always check yourself if you are unsure you are the one administering the medication. Also I would be worried about necrosis or damage to the surrounding tissue with 5 ml unless it was in a really large muscle.

If my memory serves me well 2gm Rocephin should be reconstituted with either 2.2ml or 1.8ml of sterile water or lidocaine per instruction included with vial.