Published
One time I gave Chlorpromazine instead of Promethazine for vomiting. I knew in my head that the order was for PROMETHAZINE 50mg/mL IM, but when I came on shift, the charge nurse that was coming off shift told me about a guy that was detoxing from heroin and xanax that had been vomiting. He said the medication was in the crash cart and I could give it because he already got the order but didn't have time to give it. There was CHLORPROMAZINE in the cart and I didn't catch it probably because the vial was also 50 mg/mL IM. I went white as a ghost when I realized what I did but my supervisor was cool. She said to just watch for side effects and that it would probably help him anyways haha. I was SO humiliated though when I had to tell the patient about the error and take his vitals.
Checkers08, BSN, MSN, RN
43 Posts
Many factors were involved. No harm was done. Appropriate action was taken. It's just so hard not to beat yourself up over these things sometimes.
Thanks for reading. I just wanted to try to get that off my chest (at least a little).