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Discussion

Med Error

AWWWW!!!! I am so disappointed in myself. I made a med error. The patient was fine but still:scrying: . I am also very frustrated. Some of the MD's I work with write orders for Pharmacy to dose things such as Insulin SS, Coumadin and UFH. So when I called pahrmacy to verify about the pts. insulin I was told to give it....well guess what the pt. was not supposed to have it:scrying: . So now that my back end is very very sore, the MD told me not to clarify orders with pharmacy and to always call the MD with questions. SOOOO on the same pt. I asked the MD to check the coumadin orders(to verify that it was right, because now I am really freaked out) the MD looked at me and said "I do not know the dosing,pharmacy does that." So I told the MD they cannot have it both ways, I either call the pharmacy for clarification or them. So now I will not give a "pharmacy dosing" med until I call the MD and have them verify with the pharmicist that the dose is correct. As a new nurse I really rely on pharmacy to check meds and compatibility, now I feel like I can not trust them..Any suggestions?

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Quite frankly I'd be concerned that the DOC does not know the dose of coumadin to give for a given INR and prior dose.

I feel the same way about that doctor. Pharmacy goes by what the doctor writes, if there is a question about it then the doctor needs to clarify. And don't worry about the med error, it happens to the best of nurses. And many will cover it up or tell you they never have had a med error. You will find nurses do alot of the doctors and pharmacy work and are asked to do so until there is a problem. Don't get caught up in this and make them do their jobs because you don't want to compromise your license.

the doctor should know the dosage for this patient

(pharmacy will know typical dosages, and will have a record of this patient's prescription)

Yes, the docs should know. But I have called for orders before and had them not know. For example, once I called to get dilaudid switched from PO to IV or SQ for a dying pt who could no longer swallow. His order was 8mg PO q4h atc. Anyway, when I called the doc and asked him, he said "yeah just make it IV". And I said, "what dose and how often?" He said, "the same as what he's on now". I said, "well, just becaue he's a DNR doesn't mean that I want to kill him. That's too much." He was very embarassed (he was a newbie) and was like "oh, uh...well what do you want to give him?" "I said how about 1 or 2?" and we came up with 1mg IV for 1-5 pain, 2mg IV for 6-10 pain q3h. Sometimes if you catch them off guard they don't know. The other night I asked for robinul and the doc had to ask me the dose. So I mean, yeah they should know or look it up, but they don't always, so cover thy buttt!!!!!!!!

A patient once had a list of home meds,(names only no dosages/frequency) the doctor was in a hurry and told me to just find out the dosages and frequency and write the order down. I told him that was prescribing medicine and I could not do that. He didn't like it but he knew I was right.

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