What should I do?

[squee-gee]

'Kay, here's the situation...I am a new grad RN, and I just finished my first full week on the floor with my preceptor. I had one patient all week who had one problem after another, poor thing. Today she developed an attack of acute gout, and was in severe pain. I phoned the MD to get orders, and read them back (4mg decadron and 50mg toradol both IV push). He has a very heavy accent and I had to ask him to repeat and spell everything and he was getting upset with me. I looked up the toradol in the IV book and noted the toradol dose was higher than normal, then showed my preceptor, who called pharmacy and they ok'd it. At first I was secretly hoping he hadn't said 15mg instead of 50. I heard 50, and I read 50 back to him. So I gave the meds, the pt tolerated them well, pain level went down. And I forgot about it. At the end of the shift I went to write my progress note and read what the MD had written about the patient's many issues including the gout, and it said 15mg toradol. I thought I was going to throw up. My preceptor had already left, I won't see her again until Wed. next week (I'll be with someone else Mon & Tues.). Pt. is probably being d/c this weekend. First of all, I feel like an idiot. I know I should have called him back, but truth be told I am terrified to talk to these MD's I can't understand over the phone. I feel sick that I gave this woman the wrong dose. I feel sick that I left today without saying anything. Secondly, what should I do about it???

[locolorenzo22, BSN, RN]

A) Was the patient's pain under control after the dose?

B) You read it back and verified it...and checked the book, and checked with pharmacy, and made sure it didn't harm the patient.

C) Why didn't you say anything if you were concerned?

D) Is it possible that the doc wrote for 15mg toradol to be given regularly as a new order once he came around?

E) You made a mistake. Own up to it. That's why nursing is a 24 hour job...if it's serious it will be caught. But Now you know that "hey, that toradol dose is kinda high....maybe I heard that wrong." Worst case, you call a doc back and say "I know we discussed this but 50mg is very high above a usual dose. Did I hear this wrong or did you want that 50mg of toradol...."

for example, on my post ops the docs usually order 15mgIM for ortho/neuro pain control...for a example.

The docs are there to care for the patients...if he were to come up and yell at you, I would simply say "I'm sorry about that, but I wanted to make sure that we were giving the right dose of medication for the patient....You can be mad if you want, but I pride myself on giving safe, effective care."

and you learned. Stop beating yourself up now.

[PICURN74, ASN, RN]

I agree, mistakes are just that until you try and cover them up then they become choices be honest. It sounds like you did try and varify the dose after reading it back to the doc and checking with pharm. In my world I sometimes give crazy doses of drugs but I still double check with my neighbors/docs. It could have been the doc forgot what they ordered when they went to read it in the chart. When we take a verbal order we have a big yellow sticker we place in the chart where we write what the doctor says and that we wrote, repeated and varified the order and sign it and the doctor then comes and cosigns the order. Most importantly the patient sounds like they were not harmed and pain was treated.

[mama_d, BSN, RN]

I've made it a routine with all of the docs, regardless of accent or not, to repeat back the number to them when it's possible for this kind of mistake..."That was fifty, five zero, not fifteen, one five, correct?" I've caught a few possible errors that way. Likewise if it's a drug I'm not familiar with the dosing of off the top of my head if they say something like "1-25"..."Was that one point two five or one hundred twenty five? I'm not familiar with this drug's dosing without referencing it."

[Eirene, ASN, RN]

I give 50 mg IVP toradol all of the time.

Don't worry. Just write up an incident report and describe the actions leading up to the accident. Med errors should never, ever be punitive. It's how we all learn.

:redbeathe

[suanna]

50mg is a generous dose depending on the patients other medical conditions but I can't imagine a one time dose causing any sentinal problems. What I am amazed at is the pharmacy OKing that dose without clairying the dose with the doctor themselves or insisting you call him back to reaffirm the dose. Usualy we give 30mg IV for the first dose followed by 15mg every 6hrs IVP for postoperative pain. 50mg isn't too much of a stretch from 30mg as a loading dose but our vials come in 30mg or 15mg doses. It would be a red flag if I had to use two vials to give a dose of medication. That said- you repeated back the order, questioned the dose with you preceptor and the pharmacy and looked it up. What more you could have done, short of driving to the doctor's house with order sheet and pen in hand I don't know. You did everything right. The doctor must know he dosen't have the best grasp of the english language and needs to take extra precautions before he ends up ordering 50mg of morphine when he intended 15mg. His problem shouldn't become yours.