Morphine vial dose...HELPP!!!!!

FLmomof5 · Sep 10, 2011

Here's the story:
What made me question the dosage availability (1mg/ml) was that: I saw an order for on the mar: zofran 2mg/ml, give 4 mg. But when I pulled the med from the Pyxis, the availability was a 4mg/2ml vial instead of the said "2mg/ml" in the mare.

Gotta love med math. 4mg/2ml = 4/2 mg/ml = 2mg/ml. Give 4 mg means give the whole vial.

It is a great lesson for you (an others newbies reading this thread). Always read the dosage on a vial AND the volume in the vial.

Rabid Response · Sep 10, 2011

Our Pyxis always prompts us with a message like--"Are you going to give the whole 4 mg?" to which you must answer yes or no. If you answer no, it will not let you continue without a witness. If your patient is still on the unit, you can go back in the Pyxis under that patient's name and see what exactly you pulled out.

BacktoBasics · Sep 10, 2011

You can go back through pyxis and see what you removed and "gave" using reports. Pyxis will only keep data for 24 hours though, otherwise you would have to contact pharmacy for the report. I would do this ASAP prior to speaking to you mananger (unless you're off today). Even though I've never seen a 1mg/ml Morphine syringe, maybe you did have one.

I think the bottom line is to check check and recheck you meds- both the name and concentration. If you think you pulled out 1ml, could it have been a different med?

Isabelle49 · Sep 10, 2011

Unfortunately, you must be OCD when giving meds. Check the vial when you pull it, check it before you draw it up, check it after you draw it up and check it again before you administer to the patient, of course, check the order for the drug three times, before you obtain the med, before you draw it up and before you administer it. It seems like a lot, but it is quick and can save you.

As recommended above, call your administrator/supervisor let them know you think you made a mistake. They will appreciate this call, but I can't promise there won't be repercussions. I wish you luck.

Isabelle49 · Sep 10, 2011

Something I've experienced. In PACU another nurse pulled what she thought was a pre made Demerol bag for a PCA pump, set the pump up and asked me to check it with her (this is mandatory). While checking the pump, I noted that it was a Morphine bag, not Demerol. She either didn't look at the bag when setting up the pump or she was so used to doing this that she 'looked through' it not really paying attention to the name of the med. Pharmacy loaded the Morphine bag in the Demerol slot in the pyxis. Problem was fixed, no harm done since the pump was not attached to the patient. The nurse notified our manager, who promptly wrote her up and reprimanded her. Humans are only human!

vanburbian · Sep 10, 2011

Something I've experienced. In PACU another nurse pulled what she thought was a pre made Demerol bag for a PCA pump, set the pump up and asked me to check it with her (this is mandatory). While checking the pump, I noted that it was a Morphine bag, not Demerol. She either didn't look at the bag when setting up the pump or she was so used to doing this that she 'looked through' it not really paying attention to the name of the med. Pharmacy loaded the Morphine bag in the Demerol slot in the pyxis. Problem was fixed, no harm done since the pump was not attached to the patient. The nurse notified our manager, who promptly wrote her up and reprimanded her. Humans are only human!

System errors...can't be fixed when we're punished for bringing attention to them.

And I know that feeling of doing the same thing so many times you "see through" the label, etc.

But in an opiate naive pt., morphine at a demerol rate could have been scary. The 2 nurse policy is only one step in preventing errors of this type.

Why not different colored labels, or bag sizes, etc. There are creative ways to reduce error, we just have to recognize it first, and not be afraid of reporting it.

annister · Sep 10, 2011

The question of varying dose availabilities is not important from what I read of your situation. You should be asking yourself "why did I give a drug without checking the strength/ml on the vial?"

If that sounded "mean", I apologize because my intention was not to make you feel worse. I'll be the first to admit that it's easy to make mistakes in hospital settings, especially as a new nurse on your own.

That being said, the problem has nothing to do with how morphine may or may not be packaged. Likely, it is that you are overwhelmed, feeling rushed, nervous (or you should be as a new grad IMO), and still adjusting to your role as a nurse. The best possible advice I can give you is to SLOW DOWN!! It is far more important to be a good nurse than a fast nurse and the two are not mutually inclusive. It is way easier said than done, but it is the solution to the problem. Whenever you are preparing a med, STOP AND THINK, make sure you are clear about the order, make sure you know the amount of the solution needed from the vial that you are using (not based on the concentration written on the MAR) to execute the order, focus only on the task of properly preparing said drug until you have done so, and ALWAYS ALWAYS ALWAYS ask another coworker if you are unsure of ANYTHING you are doing. It's hard to take your time in such a fast-paced and demanding environment, and it sucks to feel like you're too slow, but if you practice safe habits from the beginning, those safe habits will become second nature and speed and efficiency will come with experience.

It is awesome that you picked up on a possible (and probably minor) discrepancy that occurred, and I hope that you use it to your advantage in future scenarios. Think smart and you will be a great nurse and your patients will be safely cared for. I think that I've babbled enough, so if you are still reading, good luck in nursing!!

BTW, I've never come across a 1mg/ml vial of morphine...

Guest296136 · Sep 10, 2011

We have both 1mg/ml and 2mg/ml for morphine in our hospital but when you scan you medication it prompts you if the dose ordered is different on the vial from what is ordered.

Horseshoe, BSN, RN · Sep 10, 2011

something i've experienced. in pacu another nurse pulled what she thought was a pre made demerol bag for a pca pump, set the pump up and asked me to check it with her (this is mandatory). while checking the pump, i noted that it was a morphine bag, not demerol. she either didn't look at the bag when setting up the pump or she was so used to doing this that she 'looked through' it not really paying attention to the name of the med. pharmacy loaded the morphine bag in the demerol slot in the pyxis. problem was fixed, no harm done since the pump was not attached to the patient. the nurse notified our manager, who promptly wrote her up and reprimanded her. humans are only human!

can you imagine the repercussions of this mistake had you not caught it? morphine at a demerol dose?! wow, just wow.

i hope the pharmacy tech received the same reprimand as the nurse since that is where the first step in this mistake chain was made!

PediNurse3 · Sep 10, 2011

Here's the story:
I see on the mar: morphine 2mg/ml, give 1mg. If this was the case, did I throw away the other 0.5 ml without realizing it??? Without a witness???
What made me question the dosage availability (1mg/ml) was that: I saw an order for on the mar: zofran 2mg/ml, give 4 mg. But when I pulled the med from the Pyxis, the availability was a 4mg/2ml vial instead of the said "2mg/ml" in the mare.
What I'm HOPING is that there was also a discrepancy with the dosage availability and what was written on the mar. Makes sense? I'm HOPING that what I pulled was indeed a 1mg/ml syringe, and not a 2mg/ml syringe. Otherwise, without a witness, it will seem like I took the other 0.5 for what ever reason.
quote]
I have never seen 1mg/ml morphine.
The pyxis does usually prompt you to waste if you're pulling out more than the ordered dosage but it's possible if you weren't paying attention that it was bypassed. You should be able to go through your history and see what you took out.
Regardless, either you gave the patient twice the ordered dose because you weren't paying attention, or tossed the other 0.5 ml without paying attention. Chalk it up as a lesson learned- and please pay closer attention when you're injecting something into someone's bloodstream!

Esme12, ASN, BSN, RN · Sep 10, 2011

The question of varying dose availabilities is not important from what I read of your situation. You should be asking yourself "why did I give a drug without checking the strength/ml on the vial?"
If that sounded "mean", I apologize because my intention was not to make you feel worse. I'll be the first to admit that it's easy to make mistakes in hospital settings, especially as a new nurse on your own.
That being said, the problem has nothing to do with how morphine may or may not be packaged. Likely, it is that you are overwhelmed, feeling rushed, nervous (or you should be as a new grad IMO), and still adjusting to your role as a nurse. The best possible advice I can give you is to SLOW DOWN!! It is far more important to be a good nurse than a fast nurse and the two are not mutually inclusive. It is way easier said than done, but it is the solution to the problem. Whenever you are preparing a med, STOP AND THINK, make sure you are clear about the order, make sure you know the amount of the solution needed from the vial that you are using (not based on the concentration written on the MAR) to execute the order, focus only on the task of properly preparing said drug until you have done so, and ALWAYS ALWAYS ALWAYS ask another coworker if you are unsure of ANYTHING you are doing. It's hard to take your time in such a fast-paced and demanding environment, and it sucks to feel like you're too slow, but if you practice safe habits from the beginning, those safe habits will become second nature and speed and efficiency will come with experience.
It is awesome that you picked up on a possible (and probably minor) discrepancy that occurred, and I hope that you use it to your advantage in future scenarios. Think smart and you will be a great nurse and your patients will be safely cared for. I think that I've babbled enough, so if you are still reading, good luck in nursing!!
BTW, I've never come across a 1mg/ml vial of morphine...

You took the words right outta my mouth....... :yeah: BTW, I have seen 1mg/ml Morphine in 1cc vials. Uncommon but available......You need to chck the pyxsis to see what it has available.

tyvin, BSN, RN · Sep 10, 2011

Whether they were 1mg/1ml carpujects is no longer the question. You admitted that you were afraid they would think you were diverting because you didn't have a witness to waste half the syringe ... either you wasted it yourself or you gave the whole thing to the patient.

Either way you need to talk with your DON. At this point you don't know what you did but making up stories to cover never works. If you thought it was 1mg/1ml and you gave the whole thing what has all this fuss been about? It's clear you only gave half and either way you look at it there was a med error.

Everyone makes med errors; everyone. It's what you do when you realize that an error has occurred that shows people what you're made of and what type of person you really are.