::vent::

akulahawkRN, ADN, RN, EMT-P · Feb 19, 2015

It sounds to me like the dose that was drawn up was appropriate for it being given via the ET route. Your instincts and recollection for subcutaneous route doses is correct. I'm guessing that the ped in question is about 17 kg, knowing standard pedi doses for epi. It's a good thing that you spoke up because the anesthesia doc might not have caught the issue either.

Nice catch.

LJ85, ADN, BSN, CNA, LPN · Feb 19, 2015

Thanks...this near miss still makes me feel like it was too close a call. I guess I just have to be thankful and move on. This is how experience is gained I guess. I think I'll be studying up on the cpen after I'm done with the CEN. I do not like not knowing things when it comes to keeping my patients safe.

ATLIEN · Feb 20, 2015

Good call. You did a great job!

RNCEN · Feb 21, 2015

Never, EVER give a med that you did not draw up yourself. That's MY personal rule. If the person that drew it up is present, THEY can administer the med.

LJ85, ADN, BSN, CNA, LPN · Feb 21, 2015

Never, EVER give a med that you did not draw up yourself. That's MY personal rule. If the person that drew it up is present, THEY can administer the med.

In critical or code situations in my ED it seems that is protocol. One RN draws it up, one gives...when I have worked anywhere else I never gave a med that I didn't draw up..I feel much more comfortable giving meds I draw up vs someone else.

foragreatergood · Feb 21, 2015

I understand you're rattled because of what almost happened. But for the rest of your nursing career, this experience will effect your decisions in a positive way.

The next time someone hands you a syringe you should feel confident in simply stating that it is not YOUR practice to give med drawn by someone else. You might actually be surprised at the response, because other nurses will respect you for it.

Keep following your gut too :)

ColoradoED_RN · Feb 22, 2015

Do you have a full time pharmacist in your ED? Whenever an emergent comes in, or trauma/code/STEMI, pharmacy always responds to bedside and draws up medication for us.

Guest219794 · Feb 22, 2015

It sounds to me like the dose that was drawn up was appropriate for it being given via the ET route. Your instincts and recollection for subcutaneous route doses is correct. I'm guessing that the ped in question is about 17 kg, knowing standard pedi doses for epi. It's a good thing that you spoke up because the anesthesia doc might not have caught the issue either.
Nice catch.

Looks like this was the correct cardiac arrest dose, if given ET.

But, this was not an arrest.

It can be hard to focus in an emergency, but this had 2 huge red flags-

Somebody cracked 2 ampules for a little baby. Why would a little baby need 2 ampules of anything? Sure, it could be, but it is still a huge red flag.
1.7 ml sub q for a baby.

Bottom line is you caught it.

And, you will never give the wrong concentration epi.

Whenever humanely possible critical drugs are double checked. Human error is unpreventable, but we can mitigate it. It sounds like this drug was only double checked by luck.

BTW- not all docs should be double checking med doses, particularly concentrations. Had a baby with Menningitis, and the Pediatrician was pushing me to start the ABX RIGHT NOW. All other nurses were busy, so I asked her to double check with me, and she refused, correctly stating that it wasn't her field of expertise. I told her I would give the med as soon as it was safe, and got it double checked as soon as I could. The 2 minute delay was worth it.

Nice catch- great this happened early in your journey. If you weren't there, the baby might have died. Pat yourself on the back and stay sharp.

LJ85, ADN, BSN, CNA, LPN · Feb 24, 2015

Thanks for the feedback...I guess I tend to be too hard on myself sometimes but I feel its for good reason. I take my job very seriously. If I dont know an answer to a question, I look it up. And you can bet I will never make an error with epi. Ive memorized the dosages now. You guys really help build confidence in a new nurse :sneaky: . I spoke to a few of my colleagues about it since the incident and Ive had to come to terms with the fact that not every nurse is equal. Not everyone seems to take things to heart like I do. Some people I spoke to about it agreed with me when I suggested we get critical care training on pedi even tho we do not have a pedi unit, we still treat pedi in the ER and we get critical care training for adults so..I know the ER is fast paced but I will be sure that safety is not compromised. As far as not giving a med another nurse draws up, I'll have to put my own worries aside about offending another nurse and just stick to my instincts and my comfort level of giving only what I draw. I am learning every day, thanks again guys!

allnurses Guide · Feb 25, 2015

Your questioning the dose alerted the room that something might not be right and got the wheels of thought turning. It took a moment for someone's head to catch up with what was happening, but your verbalization of your concern ultimately saved this little one's life from what would be a huge tragedy. I am sure you are not the only one in that room who was sobered by the near miss. The doc and the nurse drawing up the med are likely having nightmares. Every single person in that room is going to be a better care provider due to this. You did well and I think being rattled is a very natural reaction. You don't know if you would or would not have given it anyway, but here's the thing. You hesitated. You verbalized. And you hesitated again. You did what you should have done. I take my hat off to you. My pulse picks up just reading about the situation.

Anna Flaxis, BSN, RN · Feb 28, 2015

Did you write an incident report? A near miss certainly qualifies. Perhaps in doing so, it will help you to process your feelings about it and help to prevent similar incidents.