nurse made mistake ..chemo dose

SweetSue

I found out today...my 3rd A/C out of 4..that nurse has been giving me 10% less of my prescribed dose. They said it didn't matter, since I have been having very low white cell counts which would mean they would want to decrease dosage anyway.
I'm getting disgusted...I hardly ever see the big shot onchologist..just his physician's assistant whom I do like. However, one time she sent me on to chemo, not noticing the low count...I asked about it , and she apologized and said I would have ended up in the hospital.
Maybe I should change centers. Anyone happy with Karmonos ? Thanks.

rizzo15

How strange, Sweet-onion. My oncologist works the problem the other way around. He always made sure the white blood count was good or brought it up to an acceptable level with Neupogen first, then gave me a set dosage of A/C...even if the chemo had to be delayed 1 week to do it. He said chemo could be every 3 or 4 weeks, but never reduced the dose. I would get the oncologist to say something about what has been going on with you. If nothing else, you and your insurance company are paying a lot of money for this treatment and it seems to me you deserve an explanation. Also, I don't understand how they can give you your next A/C treatment without the doctor looking you over real well to make sure you are ready--such as checking your eyes, neck, hands, breathing, liver, etc. Maybe a 10% difference isn't significant. But I would like the doctor to tell me that just for piece of mind.

hummingbyrd

Had opposite problem, my doc overdosed me, by second treatment I almost died. White count dropped to .5 when I finally did go back it was only because they dropped my dose 10-15%.
I'm a Physician Assistant, and I'll be the first to say nurse, PA or hot shot MD you better be watching the treatment for yourself. Unfortunately, they all can and do, make mistakes. As patients we all need 'crash courses' in oncology to survive, personal opinion only. In your case it sounds like you were blessed the nurse 'made a mistake'. IF she had given you the full dose it may have been too much!
God watches over us in mysterious ways! Sounds like you've been blessed. hummingbyrd

SweetSue

hummingbyrd said:

Had opposite problem, my doc overdosed me, by second treatment I almost died. White count dropped to .5 when I finally did go back it was only because they dropped my dose 10-15%.
I'm a Physician Assistant, and I'll be the first to say nurse, PA or hot shot MD you better be watching the treatment for yourself. Unfortunately, they all can and do, make mistakes. As patients we all need 'crash courses' in oncology to survive, personal opinion only. In your case it sounds like you were blessed the nurse 'made a mistake'. IF she had given you the full dose it may have been too much!
God watches over us in mysterious ways! Sounds like you've been blessed. hummingbyrd

Dear Hummingbyrd,
You seemed a little angry with me. I am really trying to be responsible in regards to my care. I can't even begin to imagine how much dosage a person is to receive.
Thanks for your reply.

maggs

I DID end up in the hospital after only ONE chemo treatment and I almost died about five times. I was semi-conscious or unconscious most of the three weeks in the FIRST hospital AND no one ever discussed with me what might have gone wrong. Then the insurance company eventually dropped me as well as others and left the individual market! What kind of medicine is this? I think there should be an investigation of the things that go on in oncology! Too many mistakes and too little concern for the patient! I STILL have a deep-seated fear of chemo as a result and even though I have changed oncologists, the fear is still as real as what happened to me! At least your team TALKS to you--and I have a Master's Degree in Education, so there's no excuse for these people.

inkblot

Hi:

It's indeed very scary whether we're over-dosed or under-dosed. Neither is acceptable.

If you speak with your doctor, he/she should be able to tell you precisely the dosge you will be receiving of each drug. Assuming that you are receiving standard dosing, (as opposed to high dosing) the formula is calculated per your body mass index, I believe. PLEASE ASK YOUR DOCTOR ABOUT THIS. This way, you will know exactly what you should be receiving at each infusion. No questions, no nonsense. The dosage is clearly printed on the syringe and/or IV bags.

When I was having treatment, the infusion nurses ALWAYS reviewed every line of info on the meds with me and always asked if the info was correct, before proceeding. I just assumed that this procedure was standard protocol for infusion nurses.

About that onc. doc or yours: Not the best example of a conscientious medical professional. Based upon the incidences you've related here, I'd say YES, you should consider a change. It is essential that you feel that you are in capable,
competent hands. Anything less than confidence in our docs and medical staff is frightening. These kinds of dangerous mistakes, coupled with such ridiculous excuses, after the fact, reeks of poor medical practice. Particularly when the offending doctor is completely unwilling to apologize, and fails to take strong positive action to see that it doesn't happen again. That posture seems awfully cavalier. It may be worthwhile to have a word with the facility director/administrator about
your experience. This is very serious and shouldn't be ignored, even if you do change facilities and/or doctors.

Good Luck,
Ink

hummingbyrd

Dear Sweet-onion, I am so sorry if I sounded angry at you, that was certainly not what I meant. I admit when I read my post I sounded angry to myself, but it's not at you. What makes me angry is that you had to suffer this substandard treatment. Granted you were fortunate in that the 'mistake' was in your favor. I feel the 'overdose' was in my favor also. If you had gotten the prescribed dosage you may have died. My tumor type is very aggressive so my 'overdose' may have saved my life. I praise God for these things! The part that makes me mad is the mistake to begin with, and I know I sound terribly contradictory, but as a health professional I find mistakes in health care unacceptable. I know how to figure medication doses, but was to sick at the time to care. Plus it never really crossed my mind that I needed to double check my MD. None of us should have to, but I find in dealing with cancer its almost as if patients, to a degree, are on their own, and that is what makes me mad. It's just not right that as physically and emotionally ill as cancer patients are that they should also be responsible for their treatment. I don't blame you for being disgusted, I feel disgusted too, but the disgust is for substandard care that so many recieve, not for you. I do apologize for sounding angry.
Hope you forgive me. hummb

SweetSue

maggs said:

I DID end up in the hospital after only ONE chemo treatment and I almost died about five times. I was semi-conscious or unconscious most of the three weeks in the FIRST hospital AND no one ever discussed with me what might have gone wrong. Then the insurance company eventually dropped me as well as others and left the individual market! What kind of medicine is this? I think there should be an investigation of the things that go on in oncology! Too many mistakes and too little concern for the patient! I STILL have a deep-seated fear of chemo as a result and even though I have changed oncologists, the fear is still as real as what happened to me! At least your team TALKS to you--and I have a Master's Degree in Education, so there's no excuse for these people.

Dear Maggs,
How do u survive without medical insurance?
Just terrible that your insurance company dropped you.
sweet-onion

SweetSue

inkblot said:

Hi:

It's indeed very scary whether we're over-dosed or under-dosed. Neither is acceptable.

If you speak with your doctor, he/she should be able to tell you precisely the dosge you will be receiving of each drug. Assuming that you are receiving standard dosing, (as opposed to high dosing) the formula is calculated per your body mass index, I believe. PLEASE ASK YOUR DOCTOR ABOUT THIS. This way, you will know exactly what you should be receiving at each infusion. No questions, no nonsense. The dosage is clearly printed on the syringe and/or IV bags.

When I was having treatment, the infusion nurses ALWAYS reviewed every line of info on the meds with me and always asked if the info was correct, before proceeding. I just assumed that this procedure was standard protocol for infusion nurses.

About that onc. doc or yours: Not the best example of a conscientious medical professional. Based upon the incidences you've related here, I'd say YES, you should consider a change. It is essential that you feel that you are in capable,
competent hands. Anything less than confidence in our docs and medical staff is frightening. These kinds of dangerous mistakes, coupled with such ridiculous excuses, after the fact, reeks of poor medical practice. Particularly when the offending doctor is completely unwilling to apologize, and fails to take strong positive action to see that it doesn't happen again. That posture seems awfully cavalier. It may be worthwhile to have a word with the facility director/administrator about
your experience. This is very serious and shouldn't be ignored, even if you do change facilities and/or doctors.

Good Luck,
Ink

Ink,
Thanks for your reply.
There was almost another error in my 2nd treatment, but I caught that one. The PA was sending me to chemo , until I questioned my blood count. SHe said,"You can't have chemo today , or you'd end up in the hospital."
I'm just wondering if I should just try changing onchologists within the center.
Thanks.
sweet_onion

SweetSue

hummingbyrd said:

Dear Sweet-onion, I am so sorry if I sounded angry at you, that was certainly not what I meant. I admit when I read my post I sounded angry to myself, but it's not at you. What makes me angry is that you had to suffer this substandard treatment. Granted you were fortunate in that the 'mistake' was in your favor. I feel the 'overdose' was in my favor also. If you had gotten the prescribed dosage you may have died. My tumor type is very aggressive so my 'overdose' may have saved my life. I praise God for these things! The part that makes me mad is the mistake to begin with, and I know I sound terribly contradictory, but as a health professional I find mistakes in health care unacceptable. I know how to figure medication doses, but was to sick at the time to care. Plus it never really crossed my mind that I needed to double check my MD. None of us should have to, but I find in dealing with cancer its almost as if patients, to a degree, are on their own, and that is what makes me mad. It's just not right that as physically and emotionally ill as cancer patients are that they should also be responsible for their treatment. I don't blame you for being disgusted, I feel disgusted too, but the disgust is for substandard care that so many recieve, not for you. I do apologize for sounding angry.
Hope you forgive me. hummb

Dear Hummingbyrd,
I definitely forgive you....we're in this together.
Take care,
sweet-onion

inkblot

SweetSue said:

Ink,
Thanks for your reply.
There was almost another error in my 2nd treatment, but I caught that one. The PA was sending me to chemo , until I questioned my blood count. SHe said,"You can't have chemo today , or you'd end up in the hospital."
I'm just wondering if I should just try changing onchologists within the center.
Thanks.
sweet_onion

Hi Sweet-O:

I'm thinking that you need to talk with those closest to you and maybe another doctor (for his/her opinion about your experiences) and then decide.

Several critical and dangerous errors were made. The nurses were unplugged or out to lunch it seems. The doctor didn't seem upset by it, once he was aware of it. It would naturally be difficult to maintain trust and confidence in that facility due to your negative experiences there.

I cannot tell you what's going to be the right thing to do. Only you can make that decision. However, if that happened to someone I loved, it would be important to me to have a meeting with the facility director and voice my concerns and fears about it. You didn't suffer extreme physical injury from the mistakes but you easily could have and obviously you've suffered emotionally and now lack trust in your doctor and the staff. I would ask you to think about this: If you do not report the incidents, someone else may well lose their lives if such tragic errors and/or miscommunications continue there, unaddressed.

It is my opinion that your doctor deserves reprimand and the nurses as well. Someone needs to investigate the incidents and determine what went awry and everyone involved must account for their actions (and/or lack of action), which contributed. The bottom line, however, is that YOU must feel confident with the doctor treating you. Bc can tax all our resources some days and if we're afraid/worried that our doctor's and nurses are incompetent, then we are in the worst position imaginable.

There may well be very good physician's and very conscientious nurses at this facility and you can probably gauge this by talking with the doctor's available, BEFORE, you consider a relationship with them, if you want to continue being treated there.

Your care and treatment must continue, uninterrupted. That's essential. It's not an easy position you're in but here's to hoping that you get it resolved as SOON as you possibly can.
Better days will come and the intense stress you must be feeling from all this will pass too. I think what happened to you is deplorable to be honest and I feel so badly that you're having to deal with such an issue just now.

Love, light and laughter,
Ink

maggs

Dear Sweet,
After the insurance HMO dropped us, we were offered a PPO at a higher rate. Now the state is offering something for the uninsurable that offers prescription coverage. Also, I have Medicare. But it's all getting too expensive!
Maggs

zimbo

Sweet-Onion:
I just wanted to let you know that my partner just finished eight months of chemo and 30 radiation treatments for salivary gland cancer through Karmanos and the doctor's nurses and staff have been wonderful. His original surgery was at one of the large suburban hospitals and half the tumor was left behind requiring additional surgery. We're both thankfull that he went to Karmanos for a second opinion.

Another close friend had a modified mastectomy at another major suburban hospital. Her doctor there told her that her "margins were not as close as they would like, but radiation and chemo would take care of it" She went to Karmanos for a second opinion and decided to do her radiation and chemo there. She has finished chemo and has started radiation. She has nothing but good things to say about Karmanos.

Dr. Flaherty is an excellent oncologist there that speicalizes in breast cancer. Even though Karmanos is in downtown detroit, I beleive that the care is top notch and the docs and staff are very approachable.

Also, thank you for the info for my 93 year old mother--she's opted for the lumpectomy and feels that she can handle radiation and tamoxofin (sp?). The docotors at Karmanos are confident that this will add 3-5 years of quality life for her. Her surgery is this friday and she plans on taking the radiation through Karmanos, even though it is an two hour round trip for her.

Good luck to you!

jake10

inkblot said:

Hi:

It's indeed very scary whether we're over-dosed or under-dosed. Neither is acceptable.

If you speak with your doctor, he/she should be able to tell you precisely the dosge you will be receiving of each drug. Assuming that you are receiving standard dosing, (as opposed to high dosing) the formula is calculated per your body mass index, I believe. PLEASE ASK YOUR DOCTOR ABOUT THIS. This way, you will know exactly what you should be receiving at each infusion. No questions, no nonsense. The dosage is clearly printed on the syringe and/or IV bags.

When I was having treatment, the infusion nurses ALWAYS reviewed every line of info on the meds with me and always asked if the info was correct, before proceeding. I just assumed that this procedure was standard protocol for infusion nurses.

About that onc. doc or yours: Not the best example of a conscientious medical professional. Based upon the incidences you've related here, I'd say YES, you should consider a change. It is essential that you feel that you are in capable,
competent hands. Anything less than confidence in our docs and medical staff is frightening. These kinds of dangerous mistakes, coupled with such ridiculous excuses, after the fact, reeks of poor medical practice. Particularly when the offending doctor is completely unwilling to apologize, and fails to take strong positive action to see that it doesn't happen again. That posture seems awfully cavalier. It may be worthwhile to have a word with the facility director/administrator about
your experience. This is very serious and shouldn't be ignored, even if you do change facilities and/or doctors.

Good Luck,
Ink

I agree. We each have to be resonsible for our care and we need to have the information about every med we are given and taking. I am a nurse and even with all my experience and knowledge I sometimes find this task overwelming. The nurse should review the dose and information on the lable before giving it. The PA should of course check you white count before a treatment and your oncologist should have discussed the error with you. It problably did not injure you but if an error is not taken seriously it leaves you worrying about the next error. Beth