Posted by: LD | 2020/05/18


Need help with complex situation

Hi I am looking for some advice from medical professionals. I will keep this as short as I can. My girlfriend is a nurse. A few years ago while she was working in a care home as a newly qualified nurse she was doing medication rounds. One evening she thinks she have mixed up and elderly 86 year old woman’s medication by mistake. From memory she is pretty certain the lady was due to receive some kind of blood pressure/ blood thinning tablets. Then next morning the lady was admitted to hospital and died 1 week later. My girlfriend has since for years blamed herself and is convinced this one missed medication may have triggered her death. It has really affected her mental health and can no longer cope to the point that I am really worried about her. She has long since suffered depression, spoke to numerous councillors but has had ill effect. I requested the death certificate for the old lady and it came back with the cause of death as mensentric ischemia. I have done numerous research online and it all points to the fact that one skipped medication would not have this impact but can I get advice or an opinion from a medical expert on this? Please and thank you very much

Expert's Reply


Depression expert
- 2020/05/21

Hello LD
I entirely agree with you : it is not in the least likely that missing one dose of any medicine would cause death : remember, most drugs remain in the body for various amounts of time after we take the : we take the next dose when the blood levels of the drug would be beginning to reduce, so as to boost the level back to the level we prefer : the levels do not drop precipitously but gradually.  
A blood pressure med sounds most likely to have been what the lady was taking, and a single missed dose of such meds is rarely important. A blood thinning agent is less likely, but also not likely to cause disaster after a single missed dose. It would be common nursing practice to have a pair of nurses doing meds, so they can check each other, too ; and others would glance at the charts later, or on the next medicine round, and notice an error. Also she wouldn't be handling the drugs for that and other patients, without having the drug charts and prescriptions in front of her and not only checking what was needed, but signing to show that it had been given : so there would have been a number of things she'd have had to forget, not just one, to result in a missed dose.
The cause of death given is a complex one, which they would not have put on the death certificate without a good reason, and which would not result from an under dose of those drugs, nor arise a week after one skipped dose.
Finally, it's quite common for young doctors and nurses to WORRY that they MIGHT have forgotten something important, when they have not done so.
From your description, she may have been developing depression, and her concern reflects an obsessive-compulsive personality or even a mild obsessive compulsive disorder, causing this distress and reluctance to move on from this event. Antidepressant drugs are good for OCD as well as depression.
It sounds like it would be a good idea for her to see a psychiatrist for assessment, and perhaps treatment of depression , if that's what he concludes.

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