The nurse, Karen, is caring for a critically ill client in the
surgical intensive care unit (ICU) after radical neck surgery. The
client is connected to a ventilator and is on a sedation protocol with
continuous IV infusion of midazolam (Versed), a powerful sedative that
requires constant monitoring and titration to maintain the required
level of sedation. During the night shift, the nurse discovers that the
medication bag is almost empty, and the pharmacy, which is closed, did
not send up another bag. Karen looks the medication up in a drug guide
and proceeds to mix the drip herself. The night charge nurse is busy
supervising a cardiac arrest situation out of the ICU and is unavailable
to double-check how the medication was mixed.
Inadvertently, the
nurse mixes a double-strength dose of the medication. Thirty minutes
after she hangs the new drip, the client’s blood pressure is 44/20 mm
Hg. The client requires a saline bolus and a dopamine drip to stabilize
the blood pressure. The family is notified that the client has “taken a
turn for the worse” and that they should come to the hospital
immediately. In backtracking for the cause of the hypotension, the nurse
realizes that she has mixed the sedative double strength and reduces
the rate by half.
When the family arrives, the client’s blood
pressure has started to return to normal. They ask the nurse what
happened and why their mother was on the new IV medication.
Questions to Discuss:
1. Should the family be told about the error?
2. Who should tell them? The nurse? The physician?
3. What approach should be used?
4. What ethical principles are involved in resolving this dilemma?
