Question

A patient diagnosed with multiple sclerosis is admitted to the hospital for an acute exacerbation. The patient’s baclofen dose has been increased to 60mg daily by mouth divided into three doses. The order is entered on the medication administration record as 60mg three times a day. On the third day, the patient is noted to confused and complaining of paresthesia. No follow up action is documented by the nurse.   On the fourth day at 8 AM, the nurse finds the patient to be more confused and hypotensive with a blood pressure of 90/50 mm Hg. The nurse informs the physician about the hypotension and the patient is given a liter of normal saline per MD order.   At 3 pm, the UAP is performing hourly rounding and finds the patient unconscious, with a respiratory rate of 6, pulse of 120 bpm and a blood pressure of 60/40 mm Hg. A rapid response is initiated, the patient is intubated and transported to the Intensive Care Unit for supportive therapy. Due to the patient's overall compromised condition, he is unable to be weaned from the ventilator and will require long term ventilator support.   He requires placement in a long-term care facility.

After reading the article, craft a response to your assigned patient scenario as indicated below. Your initial response should include:

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

Multiple sclerosis is a disabling disease affecting the immune system.It affect the communication between brain and spinal cord.

Baclofen is a muscle relaxant.It reduce muscle stiffness and spasms.

It usually taken as a tablet,but some people have no effect and give intrathecal via spinal cord.Small doses may be given, higher doses affect the absorption and reduces the effect.It usually given at bed time because it act about 3to 4 hours.

The usual dose is 20 mg 3 times a day.The maximum dose is 100 mg daily.Here the prescription is 60mg daily in divided dose.But the nurse violate the medication administration right.One of the medication right is right dose.The nurse make this error.Nurse didn't check the dose correctly.Then over dosage occurred.The medication titration should be followed.5mg thrive for first 3days,10mg next 3days,20mg next.

The nurse should check the condition of the patient if given any medication.Here nurse didn't take any follow up. Low dose of baclofen reduce BP.High doses may increase BP It may cause cardiac problems.Higher doses affect the haemodianamic system of heart.So we should check the vital hypotension is the most serious problem.If we find any changes , should immediately report to doctor.Here the nurse didn't report to doctor immediately.

The interventions include

give correct medication

check the patient

check the condition of the patient

check the vital signs

report to doctor immediately if any variation occurred

provide psychological support