nurses put on paid leave for carrying out orders for potentially fatal doses of fentanyl

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Unfortunately too few details to figure out what the heck was going on there...

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Okay...so reports are talking about hundreds-of-mcg doses of fentanyl, even 1000 mcg in one case...

Statements mentioning specific doses are from the lawsuits/lawyers/families

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I have always wondered about this myself. As a hospice nurse we often give a LOT more doses of comfort meds than is typical for non-hospice patients. I used to be very uncomfortable with this, and this is where it's *very* important to document what state the patient was in as far as pain/discomfort before and after the intervention. . . and back off the meds as soon as the patient is comfortable.

It's difficult to say what that safe or unsafe dose is for each patient-- some have been on pain meds so long they are given huge amounts that would kill an opioid naive patient immediately. I have patients on 200mcg/hour Fentanyl patches who are also getting breakthrough morphine, and they are still able to talk to me!

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Reserving judgement.

we have all had patient who, through tolerance, are on very high doses of opioids. What constitutes as a “potentially fatal” dose for one person may be routine for another.

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Specializes in Fall prevention.

I usually don’t post much but.. I read the enditment papers for 2 of the cases and the dosages listed for patient one was 1000mcg fentanyl and 10 mg hydromorphone and patient 2 was 1000 mcg fentanyl and 6 mg versed. Now I have to believe that any pharmacist or nurse would know that these would be fatal doses.

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.
On 1/26/2019 at 3:57 PM, BrandonLPN said:

Reserving judgement.

we have all had patient who, through tolerance, are on very high doses of opioids. What constitutes as a “potentially fatal” dose for one person may be routine for another.

I've given elephant-killing doses of pain meds to people with an extraordinarily high tolerance. You cross your fingers, say a Hail Mary and stay in the room for a while and check back often. And be amazed when they're still alert and talking to you.

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On 2/28/2019 at 12:27 PM, registerednutrn said:

I usually don’t post much but.. I read the enditment papers for 2 of the cases and the dosages listed for patient one was 1000mcg fentanyl and 10 mg hydromorphone and patient 2 was 1000 mcg fentanyl and 6 mg versed. Now I have to believe that any pharmacist or nurse would know that these would be fatal doses.

That would be true.

I'll play the devil's advocate and say..

a pharmacist and a nurse with a huge case load however..

Too much stress can lead to staff members overlooking the most obvious situations.

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Specializes in Critical Care.

As aggressive, death prolonging care becomes more and more common, this debate will continue to grow. There are prominent medical ethicists, not just those on the fringes, who propose just skipping to larger 'death-hastening' doses of palliative medications in end-of-life patients transitioning from aggressive care to comfort measures only. Ideally, patients only require doses of symptom management medications such as opiates that allow them to be comfortable but don't significantly affect the timeline of their death. In many patients however, such as terminal weans, there is no amount of respiratory effort that isn't agonizing and tortuous for the patient, so it may make more sense just to completely knock out that respiratory drive from the get-go. There are certainly times where prolonging death is far worse than the inevitable death. Per reports, these cases of large fentanyl doses were in end-of-life patients with at least one being during a terminal wean. It very well could be that the doses weren't actually inappropriate, the problem is that it forces us to recognize the realities end-of-life care following aggressive care.

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Specializes in Travel, Home Health, Med-Surg.
35 minutes ago, MunoRN said:

As aggressive, death prolonging care becomes more and more common, this debate will continue to grow. There are prominent medical ethicists, not just those on the fringes, who propose just skipping to larger 'death-hastening' doses of palliative medications in end-of-life patients transitioning from aggressive care to comfort measures only. Ideally, patients only require doses of symptom management medications such as opiates that allow them to be comfortable but don't significantly affect the timeline of their death. In many patients however, such as terminal weans, there is no amount of respiratory effort that isn't agonizing and tortuous for the patient, so it may make more sense just to completely knock out that respiratory drive from the get-go. There are certainly times where prolonging death is far worse than the inevitable death. Per reports, these cases of large fentanyl doses were in end-of-life patients with at least one being during a terminal wean. It very well could be that the doses weren't actually inappropriate, the problem is that it forces us to recognize the realities end-of-life care following aggressive care.

Yes, this is so true. Having worked in Oncology/Palliative/Hospice and been witness and caregiver to patients at end-of life I can tell you there are many ethics questions with no easy answers. I am not sure that blaming MD and nurses is the answer here (assuming these were end-of-life patients). We really had no written P/P etc for this so I now can see how bad this could have been at that time. We need common sense and some sort of back up if we are to care for these patients with dignity and respect. If healthcare professionals are worried about what can happen to them (license, lawsuit, termination etc) patients who need good end-of-life care may not be treated appropriately with comfort measures including medications.

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I gave a patient in out patient surgery 1 milligram of fentanyl over, I don't remember exactly, but I'm betting over 1/2 hour.

Yes he was a chronic pain patient, yes it was per anesthesia orders, he remained awake, alert, and ambulated prior to discharge.

But gee whiz, this was the first and last time anything like this was done. And my charge nurse did question me about it the next day. She was a okay with it when I explained the situation.

For it to happen to 27 patients, seems like someone, a charg nurse, a pharmacist, would have questioned the high dose?

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