Question

A 13-year-old is admitted to the hospital for influenza. The patient has a history of epilepsy and takes carbamazepine. The physician orders carbamazepine 200mg QID by mouth. The nurse interprets verifies the order as 200mg QD which results in the patient receiving 200mg daily. Starting on day two, the nurse documents the patient seems to be preoccupied, as he is found to staring into space and not responding to questions. After a short period of time, the patient responds to the nurse. On day five, the patient is discharged. As the nurse is reviewing the discharge instructions with the patient’s father, the patient has a tonic-clonic seizure. The nurse ensures patient safety by removing all nearby objects. After one minute of seizure activity, the nurse initiates a rapid response. Despite the administration of multiple doses of lorazepam, the seizure lasts for over ten minutes. Once the seizure ends, the patient continues to be in respiratory distress. The patient is intubated and transported to the Intensive Care Unit for supportive therapy. As a result of the prolonged seizure, significant anoxia occurs. The anoxia results in a catastrophic stroke; the patient is determined to have suffered brain death. Ten days after admission, the parents decide to withdraw care and the patient dies.

1. Describe the medication error. Include possible reasons the medication error occurred, and which medication administration right was violated.
2. Identify the changes in patient condition the nurse should have acted upon and what interventions should have been performed by the nurse that could have prevented the patient outcome.

Answer 1

Here the medical error occured due to medical abbreviation. The nurse could have prevent it by knowing more about the dose of carbmazepine for that particular patient. She should know what will happen if she misses the dose and how long the dose will take to give appropriate response by the patient.

Medical Administration right that was violated : Nurse should verify the schedule of medication ordered with respect to date, time and frequency of medication given to the patient.

The Nurse should have acted upon when starting from day two the patient was staring into space and was not responding to the questions.

Before planning discharge of the patient nurse should have identify all the risk factors and triggers for patient's seizures. As he was the previous patient of epilepsy he should not be left alone without observation. Obervation could help identify that patient can develop seizure and could be manged more efficiently.