Tuesday, February 26, 2013

Questionable urgent care & the response

Last Wednesday, Zadie's fever just wouldn't quit, even with regular doses of alternating Tylenol and Motrin.  I called her pediatrician and the soonest appointment was 6:45 that night.  I didn't want to wait for her to be seen, and since there was a good chance that her ped was going to want her to get an xray, I decided just to take her to the new urgent care place that I had been to twice recently, once for Zadie and once for Jonathan.  It's a really nice place, and they can do xrays there, so we can avoid trips to the ER.  I really liked the place the other two times we'd been there.

However, I'm not so sure about the care Zadie received there this time.  I pointed out Zadie's gunky eyes to the doctor, but she didn't say anything about them, and didn't prescribe anything for them.  I figured that meant they were junky just from her congestion.  That night, after the bloody eye incident, her pediatrician immediately diagnosed her with conjunctivitis and prescribed drops.  And, two days later, the eye doctor confirmed the infection.

Then, later on Wednesday night, Zadie's nurse questioned the prescribed dose for the oral steroid.  The doctor at urgent care had prescribed 15ml every day for five days.  It seemed like a lot.  When we looked back at the same medicine she was prescribed about a month earlier, the dose at that time was 3.5ml every day for five days.  Very big difference!

On Thursday, I called both the pediatrician's office and Zadie's pulmonologist's office to ask them about the dosing, since the urgent care wasn't open yet.  The pediatrician said 15 ml was way too high a dose for her, and said it should be 4 ml.  The pulmonologist said she could have a dose of 7.5 ml, but she also said the 15 ml was way too high.  Later on, I spoke to the doctor at urgent care who saw Zadie.  I asked her about the dose and she said, oh, that's way too high.  She apologized profusely and said that the correct dose should be 3.5 ml.  Pretty concerning that such a big mistake was made.  I then asked her about the conjunctivitis and she said she did look at her eyes, and didn't feel that it was conjunctivitis.  She continued to profusely apologize for the mistake in dosing.

Yesterday (Monday), the medical director of the urgent care called me.  He asked how Zadie was feeling, and then he told me he was made aware of the dosing mixup and he apologized profusely.  He said because of this mistake, a new policy was in effect at the office to avoid this happening again.  Apparently, they generally go by kilograms for weight, but someone wrote down Zadie's weight in pounds, and that's where it went wrong.  Zadie's only 10 kg, but that's 22 lbs.  So someone read her chart as if she weighed 22 kg.  Their new policy is to only record weights in kg so there are no more mixups.

What's scary about this is that there's no real way to know, as a lay person, whether a dose you've been prescribed is correct.  I'm not sure if the pharmacist should have picked up on the mistake, but it wasn't picked up there.  If Zadie's nurse wasn't the one giving the med, I'm not sure it would have been picked up at all.

Good news is, Zadie is feeling much better!

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