right med, right dose, wrong route... ouchhhh

Nurses General Nursing

Published

What would you do if you an RN, go to an emergency room with anaphylaxis. ED doc orders epic 0.3 mg IM, and the ED RN gives you the same amount of epic 0.3 mg IV......

of course your BP goes from 170/110 to 70/30... now you need fluids (5-7 bags), Troponin goes to 4.6, chest pain is severe, EKG shows lots and lots of PVCs, HR is 120-137 sustained for the next 7-8 hours. Cardiologist is called, now you have an echo, a stress test, a CT of chest, D-dimer is a bit elevated 518... Of course you are now admitted into this hospital for 3 days until luckily your heart is cleared.... When you finally feel more alert 4 hours later after the incident you ask, the nurse at this observation unit, Who gave the order for IV epi?

the attending NP comes in an says: you deserve to know there was a medication error...

You knew it all long but wondered why no one said a thing.... now you feel quite traumatized after feeling that Gigant Mule of EPI that kicked your chest. Your heart felt as if was going to explode together with your brain and head. You were stucked in a treadmill exercising for hours while you were lying in ahopsital bed sweating profusely and asking for ice packs and fans trough your stay....

Any ideas?

By the way, they say because you aren't death there is no case, and because you are young and sustain "no physical damage" there is no case...; but what about the emotional distress and having to be off work for 10 days after while your heart rate went back to normal... and the nightmares, feelings you were going to code....

anybody?

Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.

Pixie,

So wise and empathetic. You are an inspiration for many reasons. (Having a baby later in life, one of many.) How is your husband doing in medical school?

Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
2 hours ago, Boomer MS, RN said:

Pixie,

So wise and empathetic. You are an inspiration for many reasons. (Having a baby later in life, one of many.) How is your husband doing in medical school?

Haha, and I am crazy enough to want another baby at my age, but my cardiologist might kill me. ? The husband is doing well, in 4th year and declared Emergency Medicine (yay!). Great to "see" you!

1 Votes
Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.

Yea! Love those ER docs, my favorite, for sure. And he's made it almost through the four years!! On to residency and new adventures. :-))

I am retired and miss nursing but am resigned to it. Our home burned to the ground in the 2017 CA Tubbs fire, along with 5000 others' homes in my immediate area. We are rebuilding, which is a nightmare, and we'll never be "whole" again. In spite of that, we have good support.

I admire you and wish you well in your new job. Having a 2-year-old is a challenge in itself. I follow your posts.

Best wishes,

Boomer

2 Votes
Specializes in Critical Care; Cardiac; Professional Development.

I am glad you are okay.

I would lodge a complaint with the hospital and ask to see the action plan going forward to re-educate and prevent these kinds of errors. Then I would let it go. We are human beings taking care of human beings. Errors are going to happen. What is done about it matters FAR more than a payout.

2 Votes

If there are any hospital bills associated with this, you should not have to pay them (nor your insurance company). Take it up the ladder for that concession at least. They need to cover all medical expenses for their error.

5 Votes
1 minute ago, Nurse SMS said:

I am glad you are okay.

I would lodge a complaint with the hospital and ask to see the action plan going forward to re-educate and prevent these kinds of errors. Then I would let it go. We are human beings taking care of human beings. Errors are going to happen. What is done about it matters FAR more than a payout.

It isn't necessarily about a payout, though. It is about it not being taken for granted that someone has an obligation to bear economic damages caused by someone else's mistake, and also about just literally not having to bear those costs.

There are two good questions to ponder: Should I be gracious? Sure. And, from the other side, do I have a right to expect that someone else will bear economic damages related to my error? Not really.

Disclosure: I have experienced something similar (on the receiving end of error), and I addressed both of those two questions. According to what I consider important in life, the injury was kind of small potatoes in the long term. But it was also completely gruesome and involved the "outrageous" factor because it was related to a gross misuse of medical equipment; it would have impressed any judge or jury. I made no mention of lawsuits and in subsequent days even advocated heavily against someone's termination from employment related to the error (successfully). I call that gracious. But I also immediately negotiated that neither myself nor my insurance company should be bothered with any bills related to the care required to fix the issue to my satisfaction (which involved the ED and then ongoing tx). The responsible party (employer) complied and followed through with out any additional demands or reminders or nagging from me. I'm good with that; I'm good with my actions, too.

There is a big difference in being gracious and expecting that someone else must be gracious to you when you have caused them real damages. We see this over much lesser issues, even in everyday life: If I come to your house and accidentally break your vase, you very well may tell me that people are more important than things and not to worry about it (gracious). But you can be sure that before you have even had a chance to say that, I will have already apologized and insisted on trying to compensate you as best I can, and then I would follow through.

8 Votes
Specializes in Nursing Professional Development.

I believe the OP should seek compensation. I have a family member involved in a lawsuit with a similar type of issue. Because everything ended up "OK" in the end, the assumption is that there was "no harm" and therefore, there is "no case." I call B.S. on that and had a long talk with his attorney making the case that having to have 3 surgeries (when he might not have needed any) and having to take off 4 months of work is "harm" regardless of the final outcome.

In my family member's case, we hope not to go to court -- we would just like a little, quiet settlement to recoup the money my brother had to pay out of his pocket for things that shouldn't have been needed and maybe some compensation for the lost income while he had to take off work. But we do feel entitled to that money and I don't feel bad about encouraging the lawsuit at all.

Yes, I have made mistakes -- and I am usually pretty gracious when I am the injured party. But when I mess up, I apologize and try to find a way to make up for any problems I caused.

3 Votes
Specializes in Critical Care; Cardiac; Professional Development.

Absolutely the patient should be made whole. If three surgeries resulted, that is without argument the definition of "harm". The patient has a right to be made as close to back to their baseline as possible and to be compensated for time lost from normal function. The OP, however, didn't mention that there are any residuals that require surgery, treatment or even psychological analysis. In that scenario I think it worthwhile to squeak to the tune of wanting to make sure it will not happen again.

20 hours ago, winkiebob said:

Ummmm? Could it be part of the patient going into cardiogenic shock? Maybe trying to compensate for the rush of adrenaline????

you tell me....

Thanks for your response. I will read up on cardiogenic shock.

1 Votes
Specializes in SCRN.

I bet you that nurse is quadruple checking her 5 rights now.

The hospital should pay for your numerous extra tests and hospital room fee, MD fees, etc. Make them pay, and thank God you are ok.

I've heard of this happening. Aside from all the legal stuff...what would be really beneficial to actually prevent this from happening in the future is to go speak to each group of new to practice RN's at the hospital during their orientation program and share your story. A face to face personal story on the importance of double checking meds during an emergent situation is way more impactful than another online module on medication safety.

5 Votes
Specializes in Emergency Nursing.

In my ER all of our IM epi comes in a small anaphylactic kit that contains the vial of epi, dosages by weight chart (although almost always 0.3), syringe, and an IM needle in a prepared kit. You literally pull it out under anaphylaxis kit in the Pyxis. I feel like this is a nice setup for this reason.

2 Votes
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