I’m sooooo beat up: An overworked nurse's medication error

I've been an LPN for a month. I made a med error this week...Gave .50 mg of Ativan instead of .25 mg. Devastating.

On top of that, I was called into the ADON's office to see how they could help me from having so much overtime on my charting.

I'm soooo beat up. I have 40 residents to care for, and I had CNA's that were gone during the 6am med pass to leave me alone with my residents taking them to the bathroom, etc...They didn't ask to break, and if they had, I would have asked them to wait until my meds were passed.

I try hard to allow as many breaks as possible. I try to help them, because I know what it was like being a CNA...needing help and not getting it...

Here I am...

Med Error, Overtime...

I feel I already take too many "short-cuts" for a new LPN to be taking, and some of the things that go on on 3rd shift...that we are "taught" to do...I won't do anymore. It's not worth it to lose my license.

I hope it is not too late for me.

Advice to people needing to go into the hospital in July or August: Bring a patient advocate, as the new crop of residents has just begun work.

Read another story of an overworked nurse.

Thanks to LookingBeyond [no name given] for the source blogpost today at allnurses.com/forums.

The physician ordered the methotrexate as listed: A wrong dose near-miss

An 85-year-old man who'd been getting treatment for severe psoriasis was admitted to the hospital with a three-week history of confusion, forgetfulness, and weakness. Home medications listed on his medication reconcilation sheet included oral methotrexate, 25 milligrams every Saturday at breakfast and lunchtime. The hospital used patients' medication reconciliation sheets as order sheets, and a physician ordered the methotrexate as listed.

A typical dose of methotrexate for psoriasis is 2.5 milligrams at 12-hour intervals for three doses once a week. Doses may be gradually adjusted but generally should not exceed 30 milligrams/week. The pharmacist recognized that a 50 milligram weekly dose was high, so he asked the nurse to confirm it. The patient verified that he was taking 25 milligram doses.

Before dispensing any methotrexate, a second pharmacist questioned the order. The pharmacist called the patient's family and asked them to read the prescription container. It indicated that each dose was supposed to be 2.5 milligrams. The order was changed because of the pharmacy intercept, and the patient received the correct dose.

Advice: Bring your medication containers and a list of your medications when you go to the hospital.

Read another near-miss of a drug error story.

Thanks to Michael Cohen for the source story in the June issue of Nursing2008.

Pimp C's death from an overdose of cough syrup

Influential Southern rapper Pimp C died of an accidental overdose of a combination of drugs he had named in his lyrics - codeine and promethazine, the county coroner's office ruled Monday.

The drugs are key ingredients in "syrup," a narcotic of choice in Southern rap circles that was most famously celebrated by Three 6 Mafia and Pimp C's group Underground Kingz in the 2000 single "Sippin' on some Syrup."

The coroner's office said Pimp C had sleep apnea, which causes people to stop breathing for up to 30 seconds at a time while sleeping. That illness combined with large amounts of prescription-strength cough syrup is what killed the rapper, the coroner's Capt. Ed Winter said.

DJ Screw, another influential figure in the Texas hip-hop scene, died of a heart attack in 2000 after a reported overdose of codeine-laced cough syrup.
Pimp C, born Chad Butler, was 33 when he was found in his bed Dec. 4 at the upscale Mondrian hotel in West Hollywood. The coroner's office said his body was decomposing when it was found.

With partner-in-rhyme Bun B, Pimp C was half of the pioneering Port Arthur, Texas-based rap duo UGK. The group's self-titled CD topped the Billboard charts last year. Pimp C had been working on a solo effort before he died.


Advice for those who need to use recreational drugs: Use safe, legal ones in moderation.

Browse for related stories in the index at the very bottom of this page, or read a self-administered prescription drug overdose story.

Thanks to the Associated Press for the source story today.

He was found dead at his computer: A Fentanyl overdose

Adam Hendelson had been in a car accident as a teenager. For years, on his right arm he had worn a Duragesic patch, containing Fentanyl gel, to manage his chronic hip pain. In December 2003, at age 28, he was found dead at his computer. The cause was traced to a leak in the patch that had given him a fatal overdose. In June 2007, a Florida jury awarded his family $5.5 million.

Last week, noticing that hundreds of people had died from similar accidents, the Food and Drug Administration issued a warning about the use of Fentanyl. The FDA warned doctors against prescribing Fentanyl patches to anyone new to opioids, the family of painkillers that includes morphine. The drug is only to be used for chronic pain in people who are used to using narcotics, such as cancer patients. Fentanyl can cause other people to have trouble breathing.

Advice to those with family members using Fentanyl patches: Read the FDA warning.

Browse for related stories in the index at the very bottom of this page, or read a less harmful story about conscious sedation.

Thanks to Lauran Neergaard of the Associated Press and Kenneth Reid for the source stories in the Dec. 22 issue of the Boston Globe and the June 18 issue of Adverse Event Reporting News, respectively.

He stopped strangers in the mall: Overdose lawsuits from misdiagnosis

Steven Ridley, a 45-year old husband and father of three in Napavine, Ohio, was suffering from back pain, so he saw his doctor. The doctor said his pain was due to a complication of rheumatic fever, and prescribed methadone, in a dose more than five times higher than recommended. Steven took the medicine, and died three days later.

His doctor believed there was an “epidemic” of undiagnosed patients in the county. Other doctors and state officials discounted this controversial theory. But the doctor persisted in believing it, and he even sometimes stopped strangers in the mall who had the red face he included in his diagnosis. His treatment was to prescribe strong narcotics, often methadone.

The state suspended his license to practice medicine. This was his sixteenth and final lawsuit, for up to 16 deaths of patients in his care.

Advice: If diagnosed with a rare disease, learn all you can about it, so you can ask intelligent skeptical questions.

Read another misdiagnosis story, or read Barbara LeBoe’s source story.