We have a particular md who orders prn pain meds every 15 min. One of our nurses ended up giving 12 mg Dilaudid over 1.5 hr period to 20 yr old girl for flank and abdominal pain. Pt was not hooked up to any monitoring device such as bp or pulse ox, even though both are readily available at bedside on all of our beds. The pt's mom happened to be in room, came out and said she thought her daughter was breathing funny. Turns out, pt resp arrested, had to be bagged and narcaned. Pt was admitted to critical care unit for observation. Wouldn't you question giving that much pain med? Seems unreal to me to give that much pain med and not talk to the md about it. Even worse, pain meds were verbal order, nurse taking verbal order did not write it as verbal order (just wrote pain med order, not v.o. dr so and so/jennifer, rn.) and the md did not sign chart. So, no md documented on order sheet. I always thought I was overly anal about charting, monitoring and documenting, now, I am grateful for being overly cautious.
Thank God the parent was in the room and caught the change in resp status!!!!
The nurse here made several serious mistakes that violate the standard of care. I hope the hospital will give this RN some remidial medication administration saftey classes before he/she kills someone.
I work 2 jobs right now. ER and PACU - In the ER most docs I have met are always hesitant to give much more than 50-100 of Demerol much less anything else.
I can tell you that, one patient will passout after 4mg of MSO4 IV, and the next may take 8MG of IV dilauded, or even (seen it) 235mg of IV MSO4 over 1 1/2 hours.
Everybody is different.
However, I would give much more than 75 mg demerol, 1mg Dilauded, 8 mg MSO4 (roughly) without a monitor. Ecspecially when it is right there to be used. :)
In todays world, where pain relief is everything now. Is there really such a thing as too much pain medicine. It seems we are giving larger and larger doses and within shorter time frames.
Had a pt with Sickle that we gave dilaudid 10 IV to, then she asked for a cup of coffee and a sandwich,repeated the same shot within an hour.
Just give them all what they want nowadays anymore.
We semi-routinely give Dilaudid 4mg IV (especially to the sickle cell patients). And may have a repeat order X1. But MOST of us know that doesn't mean to run in at 15 minutes and give the second dose. (It means that in an hour you don't have to bother the MD for a repeat dose.)
I don't think I have ever given Dilaudid 4mg IV in one dose...Not that it can't be done but I guess I just haven't had those circumstances yet. Now Morphine yes 4mg IVP is usually the starting dose unless elderly or young. I think all the Dilaudid I have given was either 1mg or 2mg IV.
As mentioned before these "titrate to effect" type px med orders are routine in our dept and often just a verbal...we are very close with our docs, they trust us and we trust them.
I work 2 jobs right now. ER and PACU - In the ER most docs I have met are always hesitant to give much more than 50-100 of Demerol much less anything else.
I can tell you that, one patient will passout after 4mg of MSO4 IV, and the next may take 8MG of IV dilauded, or even (seen it) 235mg of IV MSO4 over 1 1/2 hours.
Everybody is different.
However, I would give much more than 75 mg demerol, 1mg Dilauded, 8 mg MSO4 (roughly) without a monitor. Ecspecially when it is right there to be used. :)
Just double checking on this: You did mean 235mg of Morphine? And not Demerol? That would be TWENTY FOUR vials of Morphine 10 mg!! That would normally wipe out my entire floor stock of Morphine in the ER. But I have given that much Demerol IV to a sickle cell patient over the course of a couple of hours.
12mg of Dilaudid! I think a lot of people don't even bat an eyelash at giving 1mg of Dilaudid, but may think twice if given an order for 10mg of Morphine. 12mg of Dilaudid is the equivilant of 96-120mg of Morphine! That's insane!
Ive seen people get severe Resp depression with Dilaudid 0.5 mg, even with Demerol 25 mg. But on the other hand Ive seen people get 10 mg of dilaudid IV and they ask you for coffee and a sandwich. And ask if they can go outside for a smoke. Why not.
lyceeboo
105 Posts
Thank God the parent was in the room and caught the change in resp status!!!!
The nurse here made several serious mistakes that violate the standard of care. I hope the hospital will give this RN some remidial medication administration saftey classes before he/she kills someone.