Med error?

[regerterb]

A pt came in post overdose of Paracetamol..was written up the antedote for 80ml...this was to be put in a bag of 500ml fluid..as per the protocol the dr printed out..for this hospital.so i did this....we.both checked with our in charge that it was correct..she said oh you ha w to remove the 80ml of fluid to make up the 80ml of antedote....then she said oh that should be ok just hang it as we dont have any more stock left...so i hung it...about 40 minutes later i was reading the protocol the dr printed out and on the back (not where the doses are) was written in fineprint about removing the fluid first. I stopped the infusion and re told the in charge nurse who said to ask the dr....so he says no no its fractionally too diluted..just start again. So i tell the in charge and she says oh ok ill just get some.more from pharmacy..to which i said i thought there was none left....as per.previous conversation...otherwise i would not have hung it..... so now i have to put in a report to my manager about how i hung it diluted wrony....i feel like an idiot....iim pretty annoyed and just really dont want to go to work tomorrow. Any wisdom??

[Atl-Murse]

Ummm ok p

[Cowboyardee]

I'm not even entirely sure what happened from your description. That said, it sounds like an easy mistake to make. Still, if you're not sure how to mix a medication, ask your pharmacy or, failing that, the physician, not your charge nurse.

[Meriwhen, ASN, BSN, MSN, RN]

First of all, I extend my deepest sympathies, as the smell of acetylcystine is absolutely horrible. I had the unfortunate pleasure of smelling it once, and I'll never forget it.

I also have to agree that your description of what happened is confusing. So I will second the previous poster's advice: if you are uncertain at all about preparing medication mixtures, you absolutely need to ask the pharmacist before you attempt to do it. And if you are unfamiliar with the medication and need to take a minute or two to look up the medication in the drug reference book or read the reference paperwork, then you take it.

If pharmacy is not available, I'm not sure if it's a good idea to ask the doctor how to mix the medications, as the odds are likely the doctor will just know the concentration desired, not exactly HOW to prepare that concentration. If pharmacy is unavailable, I would go to an experienced nurse instead to ask, but that's me.

And forgive yourself. You made a medication mistake; almost every one makes at least once. Fortunately, it doesn't seem like a serious one, and that your patient is/will be fine. So mope for the rest of the night, and then learn from it. I bet you'll never forget how to mix that antidote :)

Best of luck,

[Cowboyardee]

If pharmacy is not available, I'm not sure if it's a good idea to ask the doctor how to mix the medications, as the odds are likely the doctor will just know the concentration desired, not exactly HOW to prepare that concentration. If pharmacy is unavailable, I would go to an experienced nurse instead to ask, but that's me.

It's entirely possible the physician wouldn't know the concentration he wants offhand. But he's still the one to ask if you don't have a pharmacist you can call. If a charge nurse doesn't know the correct procedure, you're hung out to dry when you follow their advice - this seems to be exactly what happened here. If a doctor doesn't know the correct concentration and a pharmacist cannot be reached, it's on the physician to find out and clarify the order.

[morte, LPN, LVN]

the doc is right, there is minimal difference. if he wanted the dose delivered in a certain time frame he could have increased the flow rate an amount eq. to the difference. the only problem would be with some one on a SEVERE fluid over load watch.

[Meriwhen, ASN, BSN, MSN, RN]

It's entirely possible the physician wouldn't know the concentration he wants offhand. But he's still the one to ask if you don't have a pharmacist you can call. If a charge nurse doesn't know the correct procedure, you're hung out to dry when you follow their advice - this seems to be exactly what happened here. If a doctor doesn't know the correct concentration and a pharmacist cannot be reached, it's on the physician to find out and clarify the order.

I was referring to the actual mixing/preparation of the medication: I don't think the physician is likely to know how the medication is prepared (e.g., would he have known to remove 80mL of solution from the bag before adding the acetylcysteine?). And preparing the medication is where the OP had his/her problem.

[Cowboyardee]

I was referring to the actual mixing/preparation of the medication: I don't think the physician is likely to know how the medication is prepared (e.g., would he have known to remove 80mL of solution from the bag before adding the acetylcysteine?). And preparing the medication is where the OP had his/her problem.

I understand you. I disagree. It doesn't particularly matter if the physician knows how to mix the drug or not. He's still the next one to ask.

My initial point was that the RN is responsible for searching out the correct resources to guide her practice. In terms of how to mix a medication, it is rare that an RN has any specialized training in the matter - so you ask a pharmacist or consult an official policy used by your facility.

Now, I haven't worked everywhere, and I suppose it is possible that in some places RNs are given specialized training in medication preparation, making a charge nurse an appropriate reference. In this case however, the charge RN appeared confused and expressed doubt as to the correct procedure before deciding on, "ehhh.... it probably doesn't matter." So this charge nurse is CLEARLY not an appropriate reference.

So, in absence of an appropriate reference (pharmacist, facility policy, etc), the nurse's responsibility is to question the order back up the chain. To the doctor. It doesn't matter if the doctor doesn't know how to mix the medication. You inform him that no appropriate reference is available and ask for clarification. The doctor may investigate the matter further, or he may decide it doesn't warrant further investigation and give you an order to administer it in whatever manner he chooses. The thing is, that order and your attempt to clarify the order are your due diligence as a nurse and protect you in the event of a mistake. Asking a charge nurse doesn't protect anyone. If a similar situation were to lead to patient injury, risk management will not see likely see asking one's charge nurse who has no training or expertise in the matter as appropriate diligence.

[AgentBeast, MSN, RN]

That extra 80mL of fluid isn't going to clinically make a bit of difference.

[Guest219794]

Wow.

This really isn't that complicated.

Let's assume you were giving Mucamyst. And, for the sake of easy math, lets say the patient needs 800 mg over 4 hours, and your concentration 10 mg/ml. You need 80 ml of medication, which is what is ordered. It is to be infused over 4 hours, and should be mixed for a total of 500 ml.

You now have a bag of 580 ml. Infuse this bag over 4 hours.

The 80 ml "error" is trivial, and I wouldn't have given it a second thought, let alone report it. On the other hand, if your lack of understanding led to a delay in treatment for this patient, that could be a problem.

Doctors generally do not know how to mix medications, and 80 ml difference over 4 hrs is completely irrelevant.

This is why it is important to understand the order,rather than just enact it.