To think adult DD was given overdose of pain meds

[IVbumble]

Following an operation DD came back to the ward with a syringe driver with Fentanyl for pain relief. She also states she was given 2 additional doses whilst in recovery and was kept there for about 6hrs.

The next morning her oxygen sats were at 82% and she was having problems breathing. She was itchy & had a rash. They said she was having an allergic reaction but instead of ceasing the syringe driver they just gave regular antihistamine. A nurse from the intensive care unit who knew DD dropped in to see her and said they needed to discontinue the syringe driver. DD mentioned this to the nurses on the ward.

The next day the nurse from intensive care dropped in again and was concerned to see the syringe driver still in place - although DD had stopped using the button for additional doses to help with the pain.
Following this second visit the syringe driver was removed.

After being discharged DD requested a copy of her drug chart. The person she spoke to about this said they weren't sure that type of record was kept.

DD has contacted PALS and again requested a copy of the medication chart. Is there anywhere else she can go/ask to find out more?

The nurse from the intensive care unit is over reaching. Decisions on fentanyl need to be made by a doctor. I think it’s very reasonable to ask for a copy of medical records from PAL’s however I would suggest that they made the decision to continue the syringe driver to give good background pain relief and the low SPO2 reading is a normal post op complication which can be managed with o2 supplementation.

Every area has an advocacy service that helps people make complaints about the NHS to the NHS. Seek this service out they will assist with this.

I mean this gently, but, to what end?

I have been given massive doses of morphone and it made me itch and scratch like hell. They gave it to me to control the pain and I was glad for that.

Heroin addicts scratch because opiates can cause scratching.

How is your daughter now?

I don't see any good reason to pursue this, what is the point, she clearly didn't overdose in any meaningful way or have any poor outcomes.

I always itch on morphine, and I have been given too much in the past due to rapid weigh loss while in hospital and using my admission weight to calculate the dose (8st versus 6st). It was not a big deal, they just corrected it and moved on - the safety margins are so wide that I was never in danger.

I don't think your DD was either, just stuck between two minor judgement calls. I can see that leaving it in, just in case, is easier for your DD than removing it, when she might be in pain. It's really not a big deal.

I'm not really seeing where the overdose was? In fact the PCAS is designed to only allow X amount of medicine after X amount of time has past specifically to not allow an overdose. And how much she used won't be written on her drug chart in the same way regular drugs are.

It's reassuring to hear other people have also had potential allergic reactions. Thank you for sharing.

We wondered if the two extra doses in the recovery room meant that over a 24hr period she had been given too much but perhaps not.

They did offer to switch to morphine instead however she declined that and found that the IV paracetamol worked better.

She is fine now although still recovering from the operation and no purpose for obtaining the medication chart/notes but to find out if too much was given and/or if it was the Fentanyl itself that led to the lower oxygen levels and the breathlessness.

You can have an allergic reaction to any amount of a drug even in low doses. However having too much fantanyl can cause respiratory depression. If this is what caused the low Sat's they would have needed to stop the infusion and give a reversal agent. It doesn't sounds like this was the cause.

I'm not sure seeing the drug chart would help but if you still want to see it then you have to apply in writing to the hospitals caldicott guardian, the staff on the ward aren't allowed to give you a copy due to the data protection act.

I would be wary of relying on her account alone post op when obviously on strong painkillers. Her notes will show what was given when but given she has recovered is it worth pursuing?

DD had a spinal operation last year and she was on ketamine and oxycodone via syringe drivers, for the 1st 3 days post op her SATs kept dropping to the mid to high 80s and she was on supplemental O2.
Opioids are a respiratory depressant but she obviously needed the painkillers and they had to manage the breathing with oxygen.

In general, morphine produces more itch than fentanyl.

It won’t necessarily mean anything to know how much fentanyl your daughter had as it is hard to predict exactly how each patient will react.
I would be concerned by an oxygen reading of 82% though. Was that reading confirmed by the nursing staff or was that the initial reading on the machine when the probe was placed on your daughters finger and then it increased quickly? Where I work some of the oximeters will show a low reading for a few seconds before it reads properly. Presumably this period of low O2 ended quickly or your DD wouldn’t have been discharged.

I understand your concerns, but could I also, very gently, suggest that nothing terrible has occurred here, and your daughter is recovering well after what sounds like a pretty big op.

Itch from opioids is not an allergy. It is a very common side-effect, like constipation, for which a simple antihistamine is prescribed to help. It is uncomfortable, but not in anyway dangerous. It was managed appropriately.

The low sats are a common issue post operatively too. A combination of the anaesthetic wearing off (and depending on the length of surgery, this can take hours to short days), analgesia and pain on deep breathing can cause this and it is why supplemental oxygen is frequently given in the immediate post op period. Taking down the fentanyl pump could actually make things worse as patients in pain breath less deeply and move less, putting them at risk of pneumonia and blood clots, as well as delaying their healing.

Now I know I don’t have all the facts, and I was not there, but nothing in your post raises a red flag except for the conduct to the intensive care nurse who undermined your daughter’s confidence in the team looking after her. It was nice of her to visit, but if she really felt your daughter was receiving sub-standard care then it should have been beholden on her to raise it herself with the ward team, not expected your daughter to do her own advocacy when so unwell. My feeling, from what you posted, is that there was nothing actually wrong in your daughter’s care, but the nurse felt “she would have done it differently”. Well that is a judgement call, not medical negligence.

Anyway, I hope your daughter recovers fully and quickly.

Here we go again. Another ambulance chaser after a quick buck.
We need to privatise the NHS asap