Medication Error: I feel stupid

[Smilie0809RN]

I cannot believe that I made such a stupid mistake!!

So...I get on shift and right after I get report I go to meet the patient, and she is sitting up hunched over grabbing her legs crying and screaming about how much pain she is in. The patient was in the hospital for gastroenteritis and narcotic withdrawal. She takes at home percocet for chronic back pain post MVA.

So my first thought was I have to get her something for the pain. She was crying and screaming. She was being treated with iv Dilaudid 1mg. So I gave that. Then I gave her regular meds which included Metoprolol 25mg. Her bp was 150/78 and HR 65. But the mistake I made was I also gave her Tizanidine 4mg. When I was giving her meds the patient said she takes it at home routinely because of her muscle spasms. I was stupid to give it. I should have waited to let the dilaudid kick in. I guess I was just focusing on getting her out of pain quickly. But what happened was she was bradycardic all night long, her HR was in the 40s. No other symptoms, so the doctor told us to monitor but it could have been a lot worse.

I will always quadruple check everything! And even if a patient takes certain pills together at home doesn't mean its correct.

I feel so stupid!!!

[ED Nurse, RN]

I find this interesting- the pt didn't have gastroenteritis- like you said, she was having narcotic withdrawal and those are some nasty sxs, to include GI issues. Why, if the pt is withdrawing and obviously has dependency issues, would the MDs prescribe additional narcotics? To me, this is just further precipitating the issue and creating a pattern of behavior. The best place for her to withdraw, is the hospital- so why not just provide supportive care instead of contributing further to the dependency?

Sorry, don't mean to hijack the post- just find these situations interesting.

[dirtyhippiegirl, BSN, RN]

She probably takes a lot more than a muscle relaxant and 1 mg of dilala at home if she is going through WDs. That's like pissing in the wind.

I bet she doesn't take her metoprolol like she she should so her provider doesn't realize that she either needs to be on a lower dose or on something that doesn't affect heart rate as much.

[iluvivt, BSN, RN]

Her low heart rate is probably from the metoprolol. I have a home care patient on it and her heart rate is always in the high 40's.The MD is aware and she is totally asymptomatic. That would affect heart rate more than a narcotic and muscle relaxant.

[VANurse2010]

I'm not seeing the medication error.

[Libby1987]

With the dilaudid and tizanidine both being short acting why would the combo cause bradycardia all night long?

Even if you work nights, if you gave them at start of shift at 7p, why would it cause bradycardia in a narcotic tolerant patient 8-10 hrs later?

[ScrappytheCoco]

I'd bet my last penny her non compliance with her beta blocker caused her to be Brady...def not 1 lousy mg of dilaudid and a muscle relaxer. No med

error, carry on.

[Smilie0809RN]

The reason I consider it an error is because for the 2 days that she has been in the hospital she has been receiving the metoprolol and dilaudid and it hasn't affected her like that. It was once I gave her the muscle relaxant, which she didn't receive during her stay until I gave it, that she had a problem. But she claims to normally take it at home and it was on her mar as a prn med. I guess it was too much at that time?

[Guest219794]

No.

Tizanidine and Dilaudid did not cause somebody who is a heavy drug user to be bradycardic all night.

There was no medication error.

[Penelope_Pitstop, BSN, RN]

Bradycardia is only a concern if it's symptomatic.

[iluvivt, BSN, RN]

Yep.. from the metoprolol as I stated ealier and yes if pt is asymptomatic with that HR it's ok.I agree...no med error here

[SubSippi]

It sounds to me like your patient was finally able to get some good sleep. Her heart rate probably didn't drop like that the previous nights because she was tossing and turning. I would expect a drop in heart rate like that on a sleeping patient who just received a beta blocker.