underdosage!-chemo

[GODwillhelpmepass]

hi, i need ur advice. i have a friend who's working in a tertiary hospital. he was a volunteer nurse who just graduated from college. he was asked to hang a chemo. the pt. went so good and didnt have any reactions to the chemo. when the infusion was done. he stopped it. when the doctor came after a day. the doctor noticed that there was still about 400cc left of the fluids - he forgot to throw it out or a nurse had noticed it ( i dnt know!) but anyway, my friend didn't notice coz it was all wrapped with a black cloth. he was called by the nurse supervisor and made an incident report about what happened.

the main concerned of my friend was that he was worried about his patient, he doesn't care if he got reprimanded or scolded because it was his mistake after all. but he was so worried with the patient. he has been crying for days now, and i can't help him out about it because i just have few knowledge about chemo drugs..

our questions are:

1, since the doctor knew that the patient was underdosed, will the doctor can still able to do something about it?

2, will it harm the patient and make his/her cancer worst?

3, does my friend did a very tremendous mistake?

4, how can i comfort my friend?he has been crying for days now. he's very devastated with what he has done. (her grandparents died from CA, that's why he is very concerned about his patients)

thanks for your help. GOD BLESS...

[mom4josh]

I have several problems with this whole situation:

1 - Was this "volunteer" nurse instructed in chemo administration? If not, then she should not have been asked to hang it.

2 - Why was there 400 cc left in the bag? Why did it not all infuse? Why was it covered with a black cloth? (Never heard of that!)

Yes, an underdose of chemo can be a very serious problem. Chemo is supposed to be given on a strict schedule, i.e., every 2 weeks. Probably cannot get the additional dose now.

Hopefully this will not cause any ill effects to the patient. However, my advice to this nurse is just to pick herself up and go on... you can't change what is already done. She should learn a very valuable lesson from this though. And, if she is not trained in chemo administration, she should NOT give it again unless and until she is certified!

[Silverdragon102, BSN]

I think we need to establish in which country this is happening, US do things differently than the UK and OP profile indicates they are in the UK although not where her friend is. I have, as a nurse in the UK, hung chemo treatment and have had no training.

[bigsyis]

I think we need to establish in which country this is happening, US do things differently than the UK and OP profile indicates they are in the UK although not where her friend is. I have, as a nurse in the UK, hung chemo treatment and have had no training.

:uhoh21: Oh, wow! I would be scared to death to do that. There aren't many things that I wouldn't try at least once, but that is something that I just couldn't do without at least some kind of basic training. Those meds, in the hands of the inexperienced, can do some unusual things. I don't want ANY of them on my conscience.

[caroladybelle, BSN, RN]

This should have probably been specifically posted in the UK forum, as the standards are obviously very different.

1) A "volunteer" nurse - there really is not such a thing in the USA ....and if there was, they certainly would not be giving meds, much less chemo.

2) In responsible facilities, new nurses would not be permitted to hang chemo at all. And in most places, unless you have been specifically trained in giving chemo and been "checked off" by the facility, you do not hang chemo. Many places require new grads to work for 6 monthes on onco before even starting to train for chemo.

3. Some chemo does come up in a "brown bag" - a wrap that keeps light out for some sensative drugs. But no nurse would take it down partially infused, unless the MD ordered it stopped. In 14 years, that has only happened only twice and I've given a lot of chemo. Why did they take the drug down without making sure it had adequately infused?

4. Most bags (unless 24 hour infusions) do not hold 400mL - if that much was left, there will be undertreatment. As to the the damage done, this would vary greatly from pt to pt. and be dependant on the chemo involved, the type and extent of the cancer, and the purpose of the chemo. Some chemos get repeated at 3 week intervals, others (like those used for AML leukemia) may be given w/one big massive dose cycle, and then a group of smaller infusions. Sometimes the drug is to shrink the tumor prior to surgery, sometimes to "cleanup" after surgery, and some just used for met. control, pain control, etc.

But I would say leaving 400cc not infused would be a sentinel event in the USA (a serious enough error to require JCAHO - who regulates USA hospitals - to do some investigation). ANY Chemo error would be reported to JCAHO, but that one would be quite serious.

This is why US facilities are VERY careful with who administers chemo. There are ALWAYS significant dangers in chemo administration, and no room for error.

My advice is, there is no way to change what has happened - chemo given improperly cannot generally be fixed easily. (This is the USA is super strict) The nurse in question must go on, learn from this - what will occur will occur, and worrying will not change that. As long as the MD is aware, they can anticipate in changes in the regimen.

[Silverdragon102, BSN]

We don't really have volunteer nurses in the UK. I am aware that this did not take place in the UK and we can also say not the US but does go to show how different countries work regarding things nurses do and as correctly pointed out it is the nurse's responsibility to ensure that all care is taken and I do believe that most nurses will follow this path unfortunately mistakes do happen

[TazziRN, RN]

No matter where it happened, the bottom line is that this nurse made a pretty big mistake and must learn from it and move on. It's very noble that s/he (can't figure out the gender of the nurse!) is upset about the pt and not him/herself, but there's nothing to be done about it now. This will be a mistake never forgotten, and probably never repeated.