Digoxin Error How should it be handled? Worried for a Pt.

In short, I was orienting for a week as a new LPN at a LTC home. On day one, a certain pt's AHR was only 50 so I held his Dig.

On day two, I noticed that the MAR and the doctors order called for 0.125 of Dig, but the pharmacy had sent a box of only half that dose, which is what? 0.6

No one had caught this for the past 20 some days and the RN who was orienting me, did nothing about it. She didn't even tell it in report, but I waited until she finished report and reminded her. The nurse coming on was irked that the RN didn't do anything about it.

So, I'm wondering what really should have been done...

how urgent was this, considering that even on the half dose his heart rate was only 50...

and also considering that going one day without the Dig, his heart was too erratic to count, shouldn't something have been done?

I'm feeling very worried about this patient, but don't know if I'm being a newbie or if I'm right in thinking that this was an urgent situation.
Pharmacy should have been contacted to get the correct dose. And a med error occurrence report should have been filled out.

The physician needs to know what dose the patient has been getting and for how long, and what is happening to his heart rate. He probably needs and EKG and dig level as well. Kudo's to you for catching the dosage error and trying to follow up. Good job!

Half of .125 is .0625.....not .6What form was it in? Any chance the order was for a partial package? I've never seen Dig come in anything other than .125, .5, .05, etc.

Yes, it was 0.06. The pharmacy had split the 0.125 pills and then they are put in individual packets with the name and containing dose. The 0.06 is printed on the package as well and it's clear that the pill is halved. I can't believe I typed that wrong in my original post, but I DEFINITELY meant that the order and MAR calls for 0.125 but he was only getting half of that. Thank you for pointing that out, I write better than I type

Gotcha. It's tough to say what the other RN's and shifts might have done, unless there's a VERY clear trail....like a computer override or something. It the patient didn't receive the incorrect med on your shift (YAY, you!), then it's at least a pharmacy error, and you should follow your facility's policy on how to document that. I would have to write it up, cc: my NM, HO and send it to QA.

Quote from wvstarfishin short, i was orienting for a week as a new lpn at a ltc home. on day one, a certain pt's ahr was only 50 so i held his dig. on day two, i noticed that the mar and the doctors order called for 0.125 of dig, but the pharmacy had sent a box of only half that dose, which is what? 0.6

I know that he was getting a very very low dose, and his heart rate was only 50 when he was getting it. What worried me most was that, after one day of not getting that little dose, his HR was so fast and erratic. And nothing was said, nothing was done. The nurse never even checked on him that day, much less contact the doctor.I just didn't know how urgent this would normally be, what to do or how to handle something like this. Considering that I was being "oriented" as a brand new nurse, you would think I would have been told what to do in that instance.

Quote from wvstarfishi know that he was getting a very very low dose, and his heart rate was only 50 when he was getting it. what worried me most was that, after one day of not getting that little dose, his hr was so fast and erratic. and nothing was said, nothing was done. the nurse never even checked on him that day, much less contact the doctor.i just didn't know how urgent this would normally be, what to do or how to handle something like this. considering that i was being "oriented" as a brand new nurse, you would think i would have been told what to do in that instance.

Quote from Cathlabnurse46YOU HAVE A NURSING LICENSE.... it is your responsibility, if he is your patient, to notify the physician.

Quote from SuesquatchIn her position, her responsibility as an LPN is to report to the RN, who was charge.An LPN "gathers data" and reports it to the RN, who then "assesses" what the LPN already has. However, it is not within our scope to assess, but to report to the RN under whom, by law, we work.Were she to go above her charge's head there would be hell to pay.

I don't remember if I clarified in my original post that this was my second day orienting, and as a new graduate. I was "shadowing" an RN, and all I knew to do was report to her, and bring it to another nurses attention at shift change.

Quote from WVStarFishI don't remember if I clarified in my original post that this was my second day orienting, and as a new graduate. I was "shadowing" an RN, and all I knew to do was report to her, and bring it to another nurses attention at shift change.