alt Hacker NewsI wouldn't trust that a nurse or doctor that is bedside to flag that either, though. Hospitals are woefully understaffed, and while they will do there best, we are all just humans.
My wife's grandmother was killed by a second dose of metformin (well kidney failure after a second dose) because the attending that administered the first dose left the room, planning on coming back a moment later, when the next round nurse came in, they noticed the does hadn't been administered (wasn't in the chart), ordered another dose, and injected it.
There were multiple layers that should have prevented that. The prescription shouldn't have been filled for a second time without someone noticing. The first doctor should have filled in the chart before leaving. And the pharmacist should have noticed that it had already been requested.
Too many patients, too few doctors, and with Epic, too many button clicks.
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Oh absolutely, especially in an emergency. I mentioned the other scenario because when I've told this story before people have been skeptical that a bedside provider could make that kind of error.
Damn, sorry to hear that a nurse killed your grandma :(
I am very sad to hear that your grandmother died as a result of a medical error, but the details of the story as you remember them aren’t quite plausible.
1) Metformin is not available in an IV formulation 2) Metformin itself is not nephrotoxic
It certainly is believable that a medical error caused kidney failure but it is very unlikely to have been caused by an incorrect second IV dose of Metformin.