Norco 759/24/2023 When the nurse was asked why she administered 25 tablets, she said that no alert was issued when scanning the bottle. So, scanning the label will likely not cause an alert that the quantity in the bottle does not match the amount to be administered. For charging purposes, order entry systems require a dispense quantity of 25 tablets even though the dose is just 1 tablet at a time. Unexpectedly, a very small vial or bottle of medication is dispensed that contains more than 1 dose and an assumption is made that it contains a single patient dose.īecause of stability issues, pharmacies must dispense nitroglycerin tablets in their original 25-count amber glass bottle. The error usually occurs when a nurse consistently receives unit dose packages, or blister packs, holding a single dose for administration. The ISMP has received reports of this error happening in both hospitals and long-term care (LTC) facilities. During orientation, an inexperienced nurse administered the entire bottle of nitroglycerin to a patient, which was witnessed by another nurse, who removed the tablets from the patient’s mouth and prevented harm. It is a new report of administering an entire bottle (25 tablets) of sublingual nitroglycerin. No, this is not a case from our old files. 4Īlso, those who think that their pets may have ingested a potentially poisonous substance can visit the American Society for the Prevention of Cruelty to Animals Poison Control webpage 5 or call (888) 426-4435 or the animal’s veterinarian. For more information on veterinary medication error prevention and analysis, see the FDA Center for Veterinary Medicine webpage. Pharmacies that dispense human drugs for veterinary patients should contact the prescribing veterinarian if there are questions about a prescription, without making assumptions regarding what the veterinarian intended if the prescription does not make sense or is not available (eg, hydrocodone 5 mg). Cats are 7 to 10 times more susceptible to acetaminophen toxicity than dogs 3 acetaminophen should never be given to cats, even at low doses. Dogs are not the only pets affected by acetaminophen. 2 Symptoms of acetaminophen toxicity in dogs include brownish-gray colored gums hypothermia jaundice labored breathing swollen face, neck, or limbs vomiting and coma. However, acetaminophen is often avoided in dogs because of the increased risk of toxicity.ĭogs typically experience acetaminophen toxicity when doses exceed 75 mg/kg of body weight, which can lead to serious adverse outcomes, such as permanent liver damage. Thus, the pharmacist assumed that the prescriber was using a shortened name for the combination product with acetaminophen. Hydrocodone as a singular product is available in an extended-release formulation (Zohydro ER and Hyslingla ER) at higher-strength capsules or tablets starting at 10 mg, which cannot be cut or opened. The veterinarian had prescribed hydrocodone 5 mg without realizing that the medication is available only in this strength in combination with other products, such as acetaminophen, homatropine methylbromide, or ibuprofen. Under the Animal Medicinal Drug Use Clarification Act of 1994, 1 the FDA recognizes the professional judgment of veterinarians and permits extra-label drug use, or the use of an approved drug that is not in accordance with the approved labeling, including use in another species at a different dose, frequency, or route or for a different indication.Ī recent report described an error in which hydrocodone and acetaminophen 5 mg/325 mg was dispensed for a dog. Community pharmacies are increasingly making veterinary medicine a specialty, dispensing both human and veterinary products. The Institute for Safe Medication Practices (ISMP) occasionally receives reports of veterinary medication errors.
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