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Administration of IV promethazine (14HDC00958)

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(14HDC00958, 25 May 2015)

Registered nurse ~ Accident and medical clinic ~ Allergy ~ Administration of IV medication ~ Thrombophlebitis ~ Right 4(1)

A woman complained about the care she received at an accident and medical clinic. She had disturbed a wasp nest and was stung approximately 10‒15 times on her face, neck, and right arm. The woman had experienced a delayed skin reaction to wasp stings in the past.

Within 15 minutes of her arrival at the clinic, the woman was attended to by a physician. The physician recorded: "[N]o hypotension, asthma or throat swelling." He prescribed intravenous (IV) promethazine 25mg and hydrocortisone 200mg. He also wrote: "[M]onitor vital signs."

A registered nurse (RN) then administered 25mg of promethazine. Promethazine must be diluted before IV administration, to reduce the risk of vein irritation. However, the RN injected an undiluted form of promethazine into the cannulation site on the woman's hand.

The woman became drowsy and, 10 minutes after the administration of promethazine, she was unable to be roused. She was monitored closely by the RN for one hour, with stable vital signs noted. As there had not been a significant improvement in the woman's ability to be roused, the physician contacted the registrar at a public hospital.

The woman was transferred to the public hospital by ambulance, and was discharged the next day. The woman's discharge summary recorded her primary diagnosis as: "Allergy to wasp stings." Her secondary diagnosis was recorded as "a reduction in consciousness secondary to promethazine". It was also noted that the woman was not allergic to promethazine.

The woman was subsequently diagnosed with thrombophlebitis (vein inflammation).

It was held that the RN did not provide the woman with services with reasonable care and skill, and breached Right 4(1) by failing to comply with the clinic's IV Manual, in that she did not double check the IV medications with another qualified person prior to administering them, and by administering an undiluted form of promethazine to the woman. It was held that this was a significant departure from the accepted standards of safe medication administration.

The clinic was not found in breach of the Code.

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