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

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Is there such thing as Morphine 1mg/ml in the carpuject syringe?? HELP!!

" 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 mar."

umm, 4mg/2ml is 2mg/ml. you are going to give 4mg, so i fail to see your confusion. besides, it really doesn't matter what the concentration is in this or any other vial-- what matters is that you know what volume of the medication to give that delivers the correct dose. oh yeah, and of course this assumes that you don't ever take the pyxis's or anybody else's word for what is in the vial in your hand. you have to read it and figure this out.

or is this related to the idea that was brought home to me during the recent inclement weather when the power was out at the pharmacy, and the gal at the counter was completely unable to make change for me because her register was off? do they not teach basic algebra anymore? or am i missing something?

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Algebra? How about arithmetic?

They don't take coins at one credit union, and the coin counter is always broken.

They don't want the tellers to have to mess with coins.

Well, I know the real reason, have actually seen it.

The tellers can't count! Not even one dollars worth of change.

They can't count!!!!!

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Specializes in Developmental Disabilities; Gerontology.

Thanks for everyone's input

Some of your responses made it look like I wasn't paying attention to what I was giving. I am 100% sure I gave the correct amount to the patient. I triple checked my mar...once while pulling the med from Pyxis, once at the med counter while gathering my supplies, and once again while drawing the med at the bedside. I even diluted it in NS because I remember thinking "0.5ml is such a small amount to push over one minute".

(btw, when I pulled the med from the Pyxis, it asked "are you going to administer full dose"? I answered "yes", and it didn't prompt me for a witness! Of course, assuming that it was asking me "are you going to give the full amount of the ordered dose"?

My main concern is not having the witness for med waste. I know for a fact that I gave my pt the RIGHT dose. Its just trying to determine if the vial I dropped in the sharps had extra meds in it.

But anyway, I contacted the NOC charge this AM and told her about the incident. She said not to worry about it and to just email our manager . Worse thing that would happen is bad remarks on my eval. Email was sent soon after, so we'll see what happens on Monday.

I also forgot to mention: my preceptor was over my shoulder watching me the whole time, if she didn't catch anything, then I must have done something right...right?

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Specializes in Developmental Disabilities; Gerontology.
" 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 mar."

umm, 4mg/2ml is 2mg/ml. you are going to give 4mg, so i fail to see your confusion. besides, it really doesn't matter what the concentration is in this or any other vial-- what matters is that you know what volume of the medication to give that delivers the correct dose. oh yeah, and of course this assumes that you don't ever take the pyxis's or anybody else's word for what is in the vial in your hand. you have to read it and figure this out.

or is this related to the idea that was brought home to me during the recent inclement weather when the power was out at the pharmacy, and the gal at the counter was completely unable to make change for me because her register was off? do they not teach basic algebra anymore? or am i missing something?

what i meant was...the mar is telling me: each zofran vial/availability is 2mg/ml, i'm expecting to pull out s 2mg/ml vial ...but when pulling the med from the pyxis, the actual vial is 4mg/2ml. yes, i know it's equivalent...it's the same thing!! i was just trying to point out the discrepancy on the information provided on the mar to what is actually in the pyxis.

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Specializes in Developmental Disabilities; Gerontology.
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.

I'm trying to point out that the mar is telling me to expect a 2mg vial, when really a 4mg pops out instead.

Listen everyone, I know my math. I know we ALL know our math. And in know to check my labels. (did I NOT graduate nursing school...)

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I'm trying to point out that the mar is telling me to expect a 2mg vial, when really a 4mg pops out instead.

Listen everyone, I know my math. I know we ALL know our math. And in know to check my labels. (did I NOT graduate nursing school...)

That is the CONCENTRATION ORDERED. Similar to versed...you can get order versed 1mg/ml or versed 5mg/ml.

Standard concentration of zofran is 2mg/ml. It comes in a 2ml vial. There are not 1ml vials of zofran.

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I am 100% sure I gave the correct amount to the patient. I triple checked my mar...once while pulling the med from Pyxis, once at the med counter while gathering my supplies, and once again while drawing the med at the bedside. I even diluted it in NS because I remember thinking "0.5ml is such a small amount to push over one minute".

How can you be 100% sure if you don't even know the concentration of what you were giving? That was the original question, right? If you thought that you were giving morphine from a 1mg/ml carpuject syringe, why would you only draw up 0.5ml? It doesn't make any sense.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
what i meant was...the mar is telling me: each zofran vial/availability is 2mg/ml, i'm expecting to pull out s 2mg/ml vial ...but when pulling the med from the pyxis, the actual vial is 4mg/2ml. yes, i know it's equivalent...it's the same thing!! i was just trying to point out the discrepancy on the information provided on the mar to what is actually in the pyxis.

what it sounds like to me is that you were in a hurry or nervous and didn't pay meticulous attention to what med you were giving and how much to give. you are responsible to give what the order says to give. that is your responsibility. the amount of drug available will vary, in amount and in concentration. it is your responsibility to figure what the correct amount of medicine is to be given with whatever med you have on hand.

zofran 2mg/ml is the same mg/ml concentration as 4mg/2ml. there is no descrepancy. you just need to pay attention to how much to give. i am unfamiliar with mars that give the "vial/availability" instead of the dosage to be give. every mar i have encountered has the amount of drug to be given to the patient, not how much is on hand to be given. hospitals will provide the cheaper forms of the drugs. sometimes it 2mg/ml and sometimes it's 4mg/ml......if it's labeled correctly and you dose it wrong it's your fault not theirs....you gave it. you should have paid attention to the dose at hand.

see in the old days we always had "dose on hand" because we drew out of multidose vials. it was constantly going through our minds.....i have to give this much and i have this much....now how much will i give to mr. copd...":smokin:. so we were used to it.....i think single dose vials and carpujets have made us lazy.....:cool: and spoiled. small fractions of a decimal point will kill someone, especially a baby or a child....:eek:. i have a friend that is doing her phd on the loss of nursing skills with the onset of technology......i teased her at first.....now i don't so much.

i know the pyxis very well.....so when the pyxis prompted you....."when i pulled the med from the pyxis, it asked "are you going to administer full dose"? i answered "yes", and it didn't prompt me for a witness! of course, assuming that it was asking me "are you going to give the full amount of the ordered dose"?"end quote. why would you say you were giving a full dose when you were giving 0.5cc instead of 1cc? the pyxis will not prompt for a waste when you told it you were giving the "whole thing". if you give the "whole thing" there is no waste....right?

i know you assumed......you know what assume spells....an a$$ of u and me......i am curious, how long have you been using the pyxis? the pyxis only knows to ask if you are giving what you took out......not how much the md ordered for the patient to be given. when you enter how much the md has ordered and you are going to give is what caused the "discrepancy" to make the computer prompt for a waste because you aren't giving it all.

every action we take has ramifications that we need to be aware of and that each and everything we do can hurt someone. we as nurses need to be hyper vigilant so we don't make mistakes.....our mistakes can take someones life......slow down and take a deep breath, it gets easier overtime....;):heartbeat

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Specializes in Med/Surg.
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!

Not that it's entirely relevant to the OP, and not that I'm excusing an error of any sort, but...

If they were hooking up a PCA, let's say the morphine is a concentration of 1mg/ml. The Demerol is 10mg/ml. If the ordered dose of Demerol is 10mg, it would deliver 1ml with each push. That would equate to 1mg of morphine...so the patient would not receive a huge dose of morphine. It would even out.

Again, not saying it's ok...just saying. :)

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