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 agree with the above posters - I don't see a med error here. Sounds like the beta blocker wasn't being taken as prescribed at home, and the patient wasn't used to it. Alternatively, was the patient recently put on a narc withdrawal protocol? Sometimes metoprolol's actions can be amplified by methadone (opiate withdrawal drug).
ETA - Our not seeing this situation as a med error is not to suggest you shouldn't worry about triple checking everything; I can tell from your original post you already realize this. Understanding the pharmokinetics/dynamics of the drugs we give can help prevent bad situations that aren't necessarily med errors. Safe medication administration is about more than just preventing these med errors, and I'm glad you've already upped your awareness factor.
Even if it WAS the muscle relaxant, you couldn't have known or suspected that to happen. If it were that, then that is an adverse reaction, perhaps....but not a med error.
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.
Well, if someone has been on narcotics for a long time, you can't just stop cold turkey, they must be tapered off…or at least have benzos on board. But if the patient is physically withdrawing, they should be tapered off if the goal is to get the patient off the narcotics, right? once the physical symptoms are gone, then maybe the narcotics can be d/c'd.
CamillusRN, BSN
434 Posts
I agree with the above posters - I don't see a med error here. Sounds like the beta blocker wasn't being taken as prescribed at home, and the patient wasn't used to it. Alternatively, was the patient recently put on a narc withdrawal protocol? Sometimes metoprolol's actions can be amplified by methadone (opiate withdrawal drug).
Medscape: Medscape Access
ETA - Our not seeing this situation as a med error is not to suggest you shouldn't worry about triple checking everything; I can tell from your original post you already realize this. Understanding the pharmokinetics/dynamics of the drugs we give can help prevent bad situations that aren't necessarily med errors. Safe medication administration is about more than just preventing these med errors, and I'm glad you've already upped your awareness factor.