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Overdose can be accidental or intentional. An overdose occurs when a person or a patient takes more than the medically prescribed dose. In nursing care, it is the duty of the assigned nurse to see to it that the administered medication correctly coincides with the physician’s order of dosage. But if an RN neglected such duty or made a mistake during her or his shift, a patient’s life will be at risk. And if an RN is accused and being summoned by the Board, a nurse attorney will be such a great help on the case.

At the time of the incident, she was employed as an RN at a hospital in Fort Hood, Texas, and had been in that position for one (1) year and four (4) months.

On or about June 6, 2019, while employed as an RN at a hospital in Fort Hood, Texas, RN administered Ultram to a patient in excess frequency and/or dosage of the physician’s order in that RN inadvertently administered Ultram 50mg to the patient as opposed to Ultram 25 mg. Afterward, RN obtained a physician’s order for a one-time dose of Ultram 50mg. RN admitted to the Director that she administered Ultram 50mg prior to obtaining a physician’s order for Ultram 50mg. RN’s conduct was likely to injure the patient in that the administration of Ultram in excess frequency and/ or dosage of the physician’s order could result in the patient suffering from adverse reactions. Additionally, RN’s conduct placed the hospital in violation of Chapter 481 (Controlled Substances Act) of the Texas Health and Safety Code.

In response, RN states that the patient received pain medication postoperatively in the form of Ultram 25 mg by mouth as ordered. The patient’s pain was not relieved by the 25mg dose on June 6, 2019, so the RN states she spoke with the doctor, asking if she could give a 50mg dose. RN states the patient was discharged on June 7, 2019, in stable condition. RN states she was assigned to the above-mentioned patient on June 6, 2019, and the order for Ultram states “Ultram (Tramadol Hydrochloride 50mg tab) 25mg PO every 6 hours as needed/for mild-moderate pain per protocol”. RN states her documentation shows “the patient had constant throbbing pain relieved by opioid and gave the one-time dose as ordered. Before the order was in, I scanned the 25mg order and gave the 50mg dose on accident.” This means that RN scanned the 50mg pill onto the 25mg order and gave the 50mg dose. Prior to giving the medication, the RN states she spoke to the doctor to give an order of 50mg because the patient was not relieved of pain from the 25mg dose. RN states therefore she had it in her mind to give the whole 50mg tablet.

The above action constitutes grounds for disciplinary action in accordance with Section 301.452(b)(10)&(13), Texas Occupations Code, and is a violation of 22 TEX. ADMIN. CODE §217.11(1)(A),(1)(B)&(1)(C) and 22 TEX. ADMIN. CODE §217.12(1)(A),(1)(B),(4),&(11)(B).

As a result, the Texas Board of Nursing decided to place her RN license under disciplinary action. It’s too bad that she failed to hire a nurse attorney for assistance, knowing that she had every reason to defend herself in the first place. Her defense would have gotten better if she sought legal consultation from a Texas nurse attorney as well.

So, if you’re facing a complaint from the Board, it’s best to seek legal advice first. Texas Nurse Attorney Yong J. An is willing to assist every nurse in need of immediate help for nurse licensing cases. He is an experienced nurse attorney for various licensing cases for 16 years and represented over 150 nurses before the Texas BON. To contact him, please dial (832)-428-5679 for a confidential consultation or for more inquiries.