The Manyhia Hospital Brouhaha!

So, this doctor, doing her housemanship at Manyahia Hospital prescribed IV Diazepam 120mg tds x 24 hours for 2 year-old child. The nurse upon realising the “murder” in her prescription drew her attention to correct it. This lady went and told her father and her father went to the hospital to assault the nurse. (see video in the comment area). Jesus Christ of Nazareth! (This is the dose that has been reported widely. It may not be true).

Diazepam is anticonvulsant with very powerful effect on the heart. It can stop the heart like the way Messi controls a moving ball. The maximum dose allowed at any given point but psychiatric conditions is 10mg and may be repeated when necessary. The 10mg is even adult dose. I have worked with good doctors who have refused to exceed the 10mg threshold for kids aged 6 and above. This was 2 year-old kid and even the limit of 10mg would’ve been too much for her body talk less 160mg (that’s 10mg x 12). Jeez!

The current protocol we used at the hospital is 0.2mg per body weight not exceeding 10mg. Clearly, 160mg tds (repeated every 8 hours) would’ve killed the child against even the wish of God! The nurse did well because there are instances where nurses have ODed patients using doctor’s prescription. By the way, if a nurse administers an overdose, she is as guilty as the doctor who prescribes it.

One doctor once told me some wise words that never left my mind. He, said, “The medications we give our patients are poison in controlled quantities. And one thing about medication is that once you put it in the body system, you cannot remove it, literally”. If doctors and nurses work as a unit, a lot of needless medication murders would be defeated.

So, it a shame that a timely aversion of medication murder finds its way into social media spaces. The house officer should’ve accepted the correction in good faith and not involve her caring father. In the hospital, no one is a superman. No one is beyond correction. Even old experienced orderlies are documented to have corrected surgeons in the theatre. Even students correct their teachers!

In my practice, I have learnt a great deal of clinical knowledge from doctors and nurse practitioners. Nonetheless, I have drawn their attention to few errors in their prescription or second-guessed their opinion. My RN friend, Abass in US told me that a doctor can thank you a whole day for correcting or bringing their attention to an error.

There is this prescriber at our hospital that all nurses fear. I was working with him and he wrote a prescription, “Tab P’mol 1000g tds”. I asked one of the nurses to send it back for correction. The nurse looked at me with shock and said, “He will finish me with insults”. I took it to him and he corrected it.

You see, an adult dose for Paracetamol is 1g but he wrote 1000g. May be he wanted to write 1000mg (which will be corrected on conversion). Although no nurse would be stupid enough to give 2000 tablets (1 tab = 500mg) to a patient to swallow, you can never trust a Kumbungu nurse on that. Bottomline is, all corrections, small or big, must be corrected in healthcare delivery because you are dealing with human life. There is no second chance. You can’t think for others!

Another time, I was vetting my ward’s folders, and then came across a prescription of “Injection Insulin 10 units then 5 mL every 1 hour”. I flagged it, referred to the doctor’s note. The doctor actually wrote “then 5 units every 1 hour” but the nurse wrote “5mL every 1 hour”. The difference is the “units” and the “mL”. And that’s also the difference from “Earth” to “Hell”.

This one was not a correction but a suggestion. This prescriber writes his prescription ending with decimal. For instance, he will write IV Diazepam 1.0mg stat or IV Artesunate 25.0mg. I approached him and told him that American Paediatric Association (APA) frowns on ending prescriptions in decimal 0. Because 1.0mg could be administered as 10mg and 25.0mg as 250mg. The zero (0) is unnecessary and potentially dangerous. So, if a prescription is 1mg, write 1mg. Simplicita. The APA handbook also warns that necessary decimals should not be rounded. For instance, if a prescription is 2.85mg, don’t write 2.9mg to one decimal place or 3mg to the nearest whole number. A 0.1 in paediatric dosing is no appendix. It is physiologically important and should not be deemed as discountable percentage error. He thanked me and that was all. I learnt this when I volunteered with Operation Smile International.

I was unhappy. I spoke with the nurse who copied the medications. He told me that that was what he saw, claiming the doctor’s writing was not legible. Another problem is that some nurses don’t want question or seek clarification from doctor’s prescription because they don’t want to be insulted or risk being stupid. The risk of being stupid is not more important than human life. If there is anything you are not fully clea with, consult with your colleagues. If they can’t help you, involve the doctor.

Look, we are human. We go through varying degrees of stress and struggles every day. Our lives can never be error-free. However, the most important story is how quickly these errors are addressed when they occur without needless conflict and altercation.

Feeling big to be corrected or not wanting to risk of sounding stupid has led to many preventable deaths in the healthcare setting. But as Ghanaians, who always give everything to God, we often get away with it. Health Professionals ought to get their act right before Ghanaians stop leaving everything in the hands of God.

Ego issues between doctors and nurses, doctors and PAs, RNs and ENs, white uniform and green uniform etc is the single most dangerous outcomes for patient care. This silly rivalry is especially common with ladies. It is about time these needless dramas are resolved.

The value of human life is above all considerations.

My last words: No matter your certificates, never try to look down on experience. You can have PhD in Oncology but you need to listen to the nurse who has worked in the oncology department for 20 years. Such a nurse has oversatisfied Malcolm Gladwell’s 10,000-hour work rule of expertise.

Gladwell’s 10,000-hour rule is a real deal. Look, when Umar Pharuk Francis reported as a new nurse, he learnt suturing on our guidance. Today, he is far better than some of us because he refused to work anywhere else apart from the dressing room for 5 years. Today, I can’t be angry at his suggestions on suturing. I respect him for that.

When I first reported to work, I learnt most of the things I know today in the hands of enrolled nurses. Today, I plan their duty roster (rota). That’s the beauty of the job. You need to humble yourself to learn, grow and rise.

This young doctor has started dangerously. She can’t involve her father in work matters all the time. She has to humble herself, learn, know her stuff, before she can become the boss she badly needs. An incompetent boss commands no respect.

(Note: an update say the dose was potentially dangerous but not 120mg)

By Hanan-Confidence Abdul