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The nurse, Karen, is caring for a critically ill client in the surgical intensive care unit (ICU) after radical neck surgery. The client is connected to a ventilator and is on a sedation protocol with continuous IV infusion of midazolam (Versed), a powerful sedative that requires constant monitoring and titration to maintain the required level of sedation. During the night shift, the nurse discovers that the medication bag is almost empty, and the pharmacy, which is closed, did not send up another bag. Karen looks the medication up in a drug guide and proceeds to mix the drip herself. The night charge nurse is busy supervising a cardiac arrest situation out of the ICU and is unavailable to double-check how the medication was mixed. Inadvertently, the nurse mixes a double- strength dose of the medication. Thirty minutes after she hangs the new drip, the client’s blood pressure is 44/20 mm Hg. The client requires a saline bolus and a dopamine drip to stabilize the blood pressure. The family is notified that the client has “taken a turn for the worse” and that they should come to the hospital immediately. In backtracking for the cause of the hypotension, the nurse realizes that she has mixed the sedative double strength and reduces the rate by half. When the family arrives, the client’s blood pressure has started to return to normal. They ask the nurse what happened and why their mother was on the new IV medication. Questions for Thought Questions for Thought 1. Should the family be told about the error? 2. Who should tell them? The nurse? The physician? 3. What approach should be used? 4. What ethical principles are involved in resolving this dilemma?
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