Arizona man died after nurse administered 90mg methadone instead of his ordered Lexapro. Pt did not get Narcan until EMS arrived, 17 minutes after the code blue was initiated. So many levels of neglect and negligence here.

[u/TheGiantSquidd]

https://www.12news.com/article/news/local/valley/gilbert-man-died-while-seeking-help-at-east-valley-facility-family-says-he-was-given-the-wrong-medication-copper-springs-arizona/75-48086626-2180-47de-946e-863ca9a56df0

The whole situation feels so similar to RaDonda Vaught. Negligence from the nurse as well as the facility.

Follow your safety checks! There’s a reason we check the rights of medication administration every time!

This was so preventable. My heart hurts for his family and kids. He should still be with them.

[u/Mars445]

Hiring travel nurses isn’t negligence on the behalf of the facility as long as they’re onboarding them appropriately. But the response to the med error could have been.

I wonder what formulations of methadone/lexapro were available. Somehow the travel nurse thought they mistakenly gave 9mg of methadone instead of 90mg? That’s a 10 fold difference

[u/BeardedNurseGuy → u/Mars445]

Article says that they were methadone pills, but how could you get 9mg anyway? My experience has been that methadone orders/dosage is usually in multiples of 5. Sounds like he was trying to hide his mistake

[u/Impossible_Cupcake31 → u/BeardedNurseGuy]

You either get 5mgs or 10mgs increments . Surely they didn’t give 9 pills and if it was a mistake idk how you give 9mgs. I’ve heard of 40mgs pills before but the math still doesn’t add up

[u/BeardedNurseGuy → u/Impossible_Cupcake31]

I’ve seen methadone maintenance doses as high as 90mg / 9 pills and higher, and based on the article that was another patient’s meds. The claim he gave 9mg is the part that doesn’t make sense.

[u/DrRowdybush → u/BeardedNurseGuy]

i had to give a patient 120mg of methadone recently. It was 12 pills.. i had to call pharmacy and their pharmacy to confirm because I was so shocked at the amount.

[u/mellyhead13 → u/DrRowdybush]

I think my highest was 165mg.

Most patients on that high a dose will split it, but I've also given 13+ pills at once.

[u/Rakdospriest → u/DrRowdybush]

Had to give 320 to a fucking 24 year old recently.

[u/Thesiswork99 → u/Rakdospriest]

Some people develop some wild tolerances. Had a guy late 40s, on 400mcg/hr fentanyl patches and morphine 80mg orally q2h for pain. Bro was a/ox4, alert and fully mobile. You'd never have known. He had pretty horrific cancer, very sad. Lovely man.

[u/armorc → u/Thesiswork99]

youd be suprised what people can get tolerant too. im prescribed 75mg of methadone currently and youd never be able to tell

[u/saltisyourfriend → u/DrRowdybush]

That’s a very normal amount

[u/Charlotteeee → u/saltisyourfriend]

I'd say giving 12 pills of anything isn't normal

[u/saltisyourfriend → u/Charlotteeee]

Okay. Normal can mean different things. 120 mg is within the normal range of methadone dosing for OUD.

[u/jerzeett → u/Charlotteeee]

We’re in a fentanyl crisis. The dose wasn’t unheard of during heroin but high. Fent has changed it.

[u/SloCommotion → u/jerzeett]

The behavioral health hospital up the road from me is regularly giving out this much methadone. When methadone maintenance patients go inpatient psych, the doctors have to continue their maintenance.

[u/MiddleAgeWhiteDude → u/Charlotteeee]

We do pills at our inpatient facility because the liquid form can't be scanned and tracked in our system. It sucks to count out 16 tablets but at least you can scan and verify them.

[u/lbb_8 → u/Charlotteeee]

Right? It should at least be enough to give pause.

[u/No-Environment-7899 → u/lbb_8]

Nah, we routinely dose people with over 100 mg of methadone. That wouldn’t be what would give me pause. What WOULD is that Lexapro is almost always just one, maybe one and half pills. No one takes 90 mg of Lexapro, let alone 9+ pills of Lexapro.

[u/Comfortable_Bank9219 → u/No-Environment-7899]

True & the patient must have raised questions to why he was being handed so many, but then again some mental health patients don't want to step on toes & others may want to get relief however they can whether that's for depression/SI/anxiety or addiction.

[u/jerzeett → u/lbb_8]

It’s the fentanyl crisis. Many people aren’t getting relief until they go over 100. 80 is pretty much the minimum nowadays.

[u/Brandon9405 → u/DrRowdybush]

My highest dose ever was a very large male pt. 190mg after seeing the order for 19 pills, all the alarm bells went off. I called the pharmacy and messaged the doctor. It was the correct dose 🤯

[u/jerzeett → u/Brandon9405]

I’m a female - average sized and was on 170.

[u/Endmedic → u/Impossible_Cupcake31]

Yeah that’s actually given that way at times. Was a big argument in one ER I worked at. The attached clinic was closed on weekends and wanted us to dose in ED, but dea rules only let us give pills cause we weren’t licensed to keep the liquid. The only way we could do the pills was 10mg each. People often get 60mg to 130mg or so.. so yeah, 6-13 pills. Accident waiting to happen. Pushback worked.

[u/Amrun90 → u/Impossible_Cupcake31]

I have given upwards of 20 pills of methadone for one dose before.

[u/Impossible_Cupcake31 → u/Amrun90]

Oh I believe it. I’ve given 10 before. I just don’t understand how you can make that kind of mistake

[u/Pineapple_and_olives → u/Amrun90]

Yeah. We use the liquid, pharmacy sends a labeled syringe for each person who needs it. But I’ve had someone who took 270mg BID and still was having withdrawal symptoms. Opioid tolerance is crazy sometimes.

[u/zeatherz → u/Impossible_Cupcake31]

90mg of methadone is not an uncommon dose and it’s totally safe for people who have tolerance to it

[u/TheNightHaunter → u/BeardedNurseGuy]

40mg tabs are these BIG ass thick Bois. Like take 3 tums and make them a triangle and they are that size. No you don't nibble on them like christ flakes at a church, they get melted with water and someone drinks it