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

Nurses General Nursing

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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?

22 hours ago, Nurse SMS said:

The OP, however, didn't mention that there are any residuals that require surgery, treatment or even psychological analysis.

@Nurse SMS - I don't want to assume; is it your position that there is no degree of financial consequence/impact in a scenario that requires resuscitative measures, hospital admission and a cardiac rule-out?

I had to call emt's for my aunt who had a BS of 24. One of them accidently pushed Bicarb instead of glucose when she unresponsive. They immediately fixed the issue but still.....My mom had to tell the ER about it as they were not aware. Luckily she didn't have any more damage to her kidneys....It happens more than we think and I try to remember that we are human lol...until there is an injury that is.

Specializes in Critical Care; Cardiac; Professional Development.
1 hour ago, JKL33 said:

@Nurse SMS - I don't want to assume; is it your position that there is no degree of financial consequence/impact in a scenario that requires resuscitative measures, hospital admission and a cardiac rule-out?

She stated she was hospitalized and out of work for a week, so of course there is financial consequence. She should be made whole.

Specializes in tele, stepdown/PCU, med/surg.

wouldn't epi raise your BP? I guess peripherally it would lower it...but centrally raise it?

As an RN I would probably try to find some compassion for the fact that another RN made a mistake. I realize you have had a traumatic experience but it is important to remember that it was a mistake and that the RN involved is probably also incredibly upset with herself.

Obviously I would not be paying for the hospital bill. I would be calling the patient advocate to make that very clear.

Hell no dont pay the hospital bill

Contact whatever hospital safety/patient safety/quality improvement etc etc teams or boards exist for the hospital and tell them, to make this right, you guys have a safety gap, you need to make sure this doesnt happen again to someone else(change the pyxis or something so it only spits out IM syringes of Epi or something)

If the hospital dont want to do some process improvement/quality/safety review/etc, you can always say, fine I will write a nice article for local news agencies about how This Hospital Almost Killed Me Because They Are Too Cheap to Pay For Epi Auto Injectors

I would ask to speak with the ER director to ensure this is a teaching opportunity for those involved, and I absolutely would not pay the hospital bill for the sequelae of events this caused.

Specializes in CTICU.

I wonder the hoops you'll have to jump through as far as payment. I wonder how assertive the hospital or your insurance will be that you pay any extra for the med error/ sequelae of events.

ER's are the best place to go for anaphylaxis, how did this nurse not know that epi is always IM for anaphylaxis? That definitely needs to be a teaching point for the unit.

Very sorry for all the hell you must have gone through because of that, I can't imagine how frustrating that must have been.

Specializes in Transitional Nursing.

for anyone to take your case you have to prove permanent harm came to you and that another nurse in the same situation wouldn't have made that mistake. Also, attorneys turn down winnable cases all the time because there isn't enough money in it for them. After fees, etc. a case like this wouldn't leave you with anything left.

Specializes in Surgical, quality,management.

Contact quality/ complaints. Ask for a deidentifed copy of the in depth case review. If one hasn't been done ask as part of your complaint.

11 hours ago, Glycerine82 said:

for anyone to take your case you have to prove permanent harm came to you and that another nurse in the same situation wouldn't have made that mistake. Also, attorneys turn down winnable cases all the time because there isn't enough money in it for them. After fees, etc. a case like this wouldn't leave you with anything left.

Not true, at all. You are thinking of something along the lines of a medical negligence case, not every form of legal recompense requires negligence. Was there harm (physical, emotional, or fiscal) done by one party to another? If yes, recompense can be sought. If I walked up to you, grabbed your phone, and chucked it into a lake are you telling me that you cannot seek compensation because I did not perform medical negligence?

You are under the assumption that everything has to go to trial. Again, 99.98% of the time a smartly worded letter explaining the rights of the client to the other party will resolve the issue. No need for trials. No need for lengthy investigations. Hospital knows it messed up and so will it's insurance.

Specializes in Family, primary care.
On 9/10/2019 at 7:55 AM, 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.

I have just done that! and I just got news yesterday that a plan is going on in the entire department and re-education of the nurse involved.

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