MIMS:"hydromorphone causes fatality"

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  1. What drug info resources are best for patient safety during drug round

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In Sydney, a hydromorphone mixup with morphine caused a patient's death in 2013.

The coroner's report just was published.

Audrey McGregor inquest: 'Substantial overdose' given by confused nurses, coroner says - ABC News (Australian Broadcasting Corporation)

Mitigating factors were present but definitely there was educational and procedural failure,

which the hospital has tried to rectify since. One nurse continues to work in the same hospital but the other is no longer doing nursing.

I checked my MIMs smartphone app. for hydromorphone. The Australian version has this warning for Dilaudid injection

"This product may cause drowsiness".

Reading down. There is no mention of potential fatality.

I downloaded Davis Drug Guide for 1 month free trial. I checked hydromorphone

"HYDROmorphone. HIGH ALERT"

Reading down

"High alert: Do not confuse with morphine. Fatalities have occurred."

The nurses in this tragedy may or may not have checked MIMS,

but today thousands of nurses will have checked MIMS about drug info. in Australia

MIMS is really light on safety warnings.

The BPharm authors appear to have missed out on a decade of safety awareness.

Unfortunately MIMs is the major and sometimes only drug resource available in med. prep rooms, in Australia.

Perhaps it is time for MIMS to up their game.

As nurses we need the best info that is available for the sake of the patient.

HYDROmorphone does not just cause drowsiness. hydromorphone causes fatality.

Australia needs better than MIMS.

My question..

What drug info resources are commonly available in the USA/Canada?

For hospital nurses doing the medciation round?

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Specializes in Nephrology, Cardiology, ER, ICU.

Can you clarify what "MIMS" is for those of us in the US?

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Specializes in Critical Care; Cardiac; Professional Development.

Never heard of MIMS

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I googled MIMS and it looks like a site similar to Up-to-Date.

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Does your hydromorphone come as a multi-dose vial or just at a higher concentration? According to the article it comes as 10mg/mL...we don't even have that available to us at our facility. Ours comes in single dose vials as 2mg/mL.

At a high enough dose I figure just about anything can cause death. I'm not quite sure how the actual warning of death would overcome a math error not caught by two nurses. A sad situation for all involved though.

To answer your question though, at our facility we use Lexicomp and Lippincott drug guide. I have my own Davis drug guide that I use, it's just a personal preference over the Lippincott guide.

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Specializes in ICU, LTACH, Internal Medicine.

MIMS is Great Britain Commonwealth analogue of UptoDate, utilizing primarily European - sourced research.

I deal with the issue pretty much every single day, and found that 95% of lay people are not able to understand whatever is written in any leaflets we're giving them. Everything they care for is getting "ma' pain pills". What they do understand is: 1) whoever writes scripts is watched and can be arrested for prescribing too much, so nobody will do it any more for them, compassion or not; 2) ALL scripts are watched and counted for, so please see above; and 3) too many peoples are dying from these pills, with examples in numericals from their own locality. These three things given by a trusted provider usually get them to the point that pill party is over.

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Specializes in Critical care.

Morphine can cause death, fentanyl can cause death, hydromorphone can cause death- ANY narcotic in a high enough dose can cause death. Saying that ANY drug can cause death when given too much. That's why drug dosages need to be verified. Every nurse should know the difference between morphine, hydromorphone, and fentanyl- each one is stronger than the next. I don't understand how any nurse cannot know the differences between the three.

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Specializes in ICU.

My job has a micromedex subscription.

But really... do nurses really need the warning that dilaudid can cause death? I don't think a particular facility or a particular drug reference can be blamed here. There has to be some personal responsibility for the nurse who gave the overdose - not just for overdosing the patient, but for failing to monitor the patient afterwards. Narcan works fast. It is very easy to fix an opiate overdose.

...Okay, nevermind - I actually went back and read the article. 0.5mg of dilaudid was 0.05ml. How the heck are you supposed to draw up an amount that small? What are you supposed to do - use a TB syringe, draw up the medication, inject it into a flush, and then inject it into a patient? And who the heck thinks it's a good idea to package dilaudid in a 10mg/1ml vial?

I blame pharmacy/the drug manufacturers at least as much as the nurse in this case. It would be just about impossible to get a medication dose right drawing up that tiny an amount of liquid, so the nurse would be screwed either way.

Can someone in Australia comment whether they have luer lock style syringes that will accurately measure 0.05ml?

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Hi

TraumarusM

MIMS is a drug info book designed for Australian drugstore pharmacists primarily

(which begs the question why is it used in hospitals)

There are safety warnings for tablet meds but not for IV drugs.

Indexing is based on drug brand name, not generic.

No warnings specific to nurses, but some warnings for prescribers/ dispensers.

There are plenty of warnings about a weak tablet opioid like dextropropoxyphene

(now discontinued in the USA) but none for Dilaudid, which is very uncommonly sold in drugstores.

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Hi snf0903,

It is available as 2mg/ml, 10 mg/ml .

I think most hospitals should have limited the 10mg/ml availability by now..

.. should have...it takes a long time for the ISMP recommendations to filter down..

This stuff was known in 2005 thereabouts.

thanks for the info about Lexicomp/Lippincott.

My preference is Davis, I love the personal family oriented dedication at the front,

the "nursing implications"

and the fact that it authored by one nurse and two pharmacists.

If only we could get a version for Australia

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Hi calivianya,

thanks for your thoughtful comments

Yes Luer is available for several years and used often for subcut.

Globalisation works quick for products but less quickly for medication safety.

Unfortunately some nurses,, there are 3 million or so in the US/Australia, may still not know of Dilaudid,

Unfortunately medication safety is progressed more rapidly by deaths than topdown policies.

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Thanks KatieMI,

Actually the MIMS Australia is a drug info book primarily aimed at community pharmacists and GPs in Australia www.mims.com.au. I think it has little to do with uptodate... "MIMS" must be catchy.

The assertion that 95% of lay people do not understand a CMI , or drug info. leaflet, if a fact,

is surely something of concern.

Which nurses out there have take the time to translate the meaning of one of these leaflets

with 'lay people'. I have found that it takes ages for something like Seretide.

Perhaps this is because the drug info leaflets err more on the side of legal liability rather than

patient understanding?

Just putting it out there.

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