What would you do???

[sweetyjen]

ok...scenario....

a patient of yours comes to the floor after surgery with a pca pump. policy is that the pacu nurses hook it up prior to leaving recovery room then once to the floor, pacu nurse and floor nurse check it together. ok...so your pt has a pca pump...you check it with the other nurse, everything's fine and you go about your business. 2 hrs later the pacu calls and says to check your pump b/c they think it may have been programmed with the wrong concentration. ok so you go check and it is programmed for 1 mg morphine/1 ml. You look at the syringe and it is morphine 5mg/ml. The pt has used 8mg. remember that is what the pump "thinks" is 8 mg...in reality it is 40 mg!!

ok so tell me what you would do first, etc... what is your policy with everything going on here.... i want to know everything you would actually do in a situation like this.

i'll tell you a story after i hear some responses!!

[SunnyAZRN]

Well, granted, I haven't had experience with this type of situation (I'm a fairly new nurse and have worked with PCA's some) but I would assess the patient immediately and look for signs/sx of resp depression. If resp depression then give narcan and report it to physician for any further orders. At 40mg I can't imagine the pt NOT having resp depression Also, this would need to be written up as a med error.

[steelcityrn, RN]

Stop pump.....Assess pt....notify charge, physician and pharmacy.....Follow physician orders.....fill out incident report on medication error....looks like 4 incident reports....one pharmacist, 2 nurses in pacu, and yourself.

[Tweety, BSN, RN]

We quit using anything but 1:1 concentration.

First and foremost check the patient, check vitals and oxygen sats and have narcan ready. Depends on how long the patient infused this much weather the patient is going to be overly symptomatic or not.

Then change the concentration to the correct dose. Notify the chain of command, notify the doctor and fill out an incident report. At my facility this would only be one incident report.

Lastly, what lessons could I have learned. Ultimately as you accepted the patient you're as responsible as the one who hung the wrong dose. No need for heads to roll.

[meownsmile, BSN, RN]

I agree,, we havent ever used the 5mg/ml concentration for a PCA either.

But,, yes,, stop pump, assess patient, call dr and follow any further orders by dr. Call supervisors or per protocol and make reports.

[Antikigirl, ASN, RN]

I agree with the others, but ya know what...we had that policy in a hosptial I worked for and the PACU nurse did everything right except actually hook it up to the patient!

When the patient came to me, he had three different IV's and the PCA tube was under his 300 lb body...so I didn't catch it. OOPS! Talk about a med error and horrid for the poor patient trying to get pain relief.

So now I check lines like crazy, and I double check the rate and med carefully when they come to my unit...and I do it with the PACU nurse as they are reporting off (they come up to the floor in person). I can't say that it wouldn't happen to me one day...but I try to catch these things since I really got chewed out badly for that one incident (oh brother...worse chew out I have ever gotten in my life from my charge nurse, doc, and patient family! OUCH!).

A good reminder to always check your 5 rights with any medication you administer (even if started somewhere else)...I leave nothing to chance anymore after that boo boo....

[General E. Speaking, RN, RN]

We quit using anything but 1:1 concentration.

anything but is just asking for trouble IMO:nono: