Critical Care Nursing Expert Discusses Dosing Mistake Leading to Amputation

Case Overview

This case involves a female patient in her mid-thirties who presented to the emergency room with persistent abdominal pain and gastric distress. A CT scan was ordered and several possible causes were suggested – the patient was discharged with a referral to a GI specialist but no diagnosis was made. For an extended period of time following this initial evaluation she was seen by a number of doctors, and was eventually diagnosed with severe sepsis and Crohn disease. Several drugs were prescribed including vasopressors. It was determined that a member of the hospital’s nursing staff gave the patient an exceptionally large dose of one of these medications, resulting in the amputation of both legs.

Questions to the Nursing expert and their responses

How often do you care for patients with sepsis?

I have been caring for sepsis patients for over 40 years, working in the ICU and ED - I have treated over 500 patients with sepsis and administered these types of medications routinely in the ICU and the ED. I have also participated in hospital committees developing sepsis protocols.

If a change in the patient's cardiovascular status is noted, what kind of measures should a critical nurse take?

When there is a change in the cardiovascular status the RN has the responsibility to notify the physician for further orders.

Can a nurse change the dosage of the medication prescribed without the approval of the attending?

If the medication is ordered as a titrated drug the nurse is permitted to adjust the dose per the physician order. But when the dose administered reaches the higher limits ordered, the RN must contact the MD for further orders or changes in medications.

About the expert

This expert has over 40 years of experience in nursing and is certified in emergency nursing, critical care nursing, and gerontology. She earned her diploma in nursing at Altoona Hospital School of Nursing and her BSN and MSN at Pennsylvania State University. Additionally, she earned her Ph.D. from Drexel University. She is active in her field as a member of numerous medical societies including the American Association of Critical Care Nurses and the National Gerontological Nursing Association. She has worked at several major clinics as an attending nurse and administrator. Currently, she serves as a staff nurse and a nursing supervisor at a PA hospital. She is also an associate professor and clinical professor of critical care nursing at a major PA medical university.