Making Errors

Digoxin Side Effect 
Excessive/ppt by hypokalaemia: anorexia, nausea, vomiting, diarrhoea, abdominal pain, visual disturbances, headache, fatigue, drowsiness, confusion, dizziness, delirium, hallucinations, depression, arrhythmias, heart block
Tx: Potassium-sparing diuretics, potassium supplements, digoxin-specific antibody fragments

Mx: blood levels, cardiac monitoring

Methotrexate 

Toxicity: anorexia, diarrhoea, toxic megacolon, hepatotoxicity, pulmonary oedema, dizziness, blood disorders (sore throat, bruising, mouth ulcers), liver toxicity (nausea, vomiting, abdominal discomfort, dark urine), respiratory effects (shortness of breath)

Mx: FBCs, LFTs, Obs

Insulin 
OD: hypoglycaemia

Tx: 50% dextrose, IM glucagon, sugary drink

Mx: Blood glucose

Warfarin 
OD: haemorrhage

Mx: INR, withhold warfarin, Vitamin K

Penicillin Allergy 
Anaphylactic Reaction: urticaria, angiooedemam, fever, inflammation

Mx: Stop antibiotic, adrenaline, chlorphenamine, steroids, fluid

Communications:
- Apologise 

- ?Admit responsibility- Explain carefully what has happened
- Short-term effects
- Long-term effects
- "This shouldn't have happened and we will do everything we can to make sure it does not happen again
- There are many checks and balances"- Notify senior
- Will make an inquiry/Fill in incident form
- Direct to PALS (Patient Advice and Liaison Services)

- Independent Complaints Advocacy Service (ICAS)
- Complaints can be made to Trust Complaints Manager 

- Can talk to consultant

- Write to ward manager
- Give name and bleep number