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Should I advise anyone about wrong medication?


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#1 WannabeMasterchef

Posted 14 September 2019 - 10:50 AM

**sorry meant triage nurse, not ward clerk

DS started coughing mildly on the weekend. He was otherwise fine so had his 4 month vaccination on Monday. By Wednesday he was laboured a little with his breathing so I took him to the doctor, who diagnosed a chest infection and prescribed antibiotics and Ventolin.

The next day he was worse so I took to childrens hospital. He has bronchiolitis. The ward clerk said that its easy for doctors to miss this as it comes on suddenly, however a baby under the age of 12 months should not have been prescribed Ventolin as it wont do anything but make his heart race, which is unhelpful for him when fighting the viral infection. It does actually say that in the leaflet not for under 12 months. I saw that but figured the pharmacist would know better about it.  

Any way, my question is, would you ring the doctor / pharmacist and tell them what happened? Do I need to report it anywhere?  Im not wanting to get the doctor in trouble or anything but obviously they need to know if that situation comes up again.

Edited by WannabeMasterchef, 14 September 2019 - 12:31 PM.


#2 Jamelex

Posted 14 September 2019 - 11:03 AM

It’s not unusual to trial ventolin under 12 months, but generally only if they are getting close, eg 10 or 11 months.
Without going into a lot more detail, frankly I would chalk it up to a crappy doctor and strongly consider a new GP.

#3 WannabeMasterchef

Posted 14 September 2019 - 11:09 AM

View PostJamelex, on 14 September 2019 - 11:03 AM, said:

It’s not unusual to trial ventolin under 12 months, but generally only if they are getting close, eg 10 or 11 months.
Without going into a lot more detail, frankly I would chalk it up to a crappy doctor and strongly consider a new GP.

Thanks. Thats a tricky one, we go to one of those big clinics with lots of doctors as its near my house and we usually can get in quickly, which you need with small kids. Most times the doctors there have been really good.

#4 Jamelex

Posted 14 September 2019 - 11:18 AM

It’s not like it was going to be dangerous for him, but would have absolutely no effect on his breathing while still being stuck with side effects such as increased heart rate.
Also, bronch is viral so the antibiotics are also useless.
Keep up short, frequent feeds, keep an eye on his breathing (watching for things like faster than normal, sucking in at the throat and/or under/in between his ribs, using abdominal muscles more for breathing, abnormal breathing sounds. Any concerns with breathing, or significant decrease in feeding/wet nappies please get him reviewed. Days 4-5 of bronch tend to be the worst then they start getting better again.
https://www.rch.org..../Bronchiolitis/
https://www.schn.hea...hiolitis-en.pdf

Hope that helps and that he feels better soon.

#5 overlytired

Posted 14 September 2019 - 11:22 AM

I'd speak with the pharmacist (for my own education) and trust their answer as they have the most knowledge regarding medications, their use, and side effects.

#6 Mands09

Posted 14 September 2019 - 11:32 AM

Ward clerks have no medical training so I wouldn’t be taking their word as gospel.

#7 Caitlin Happymeal

Posted 14 September 2019 - 11:48 AM

Yeah I'm not sure why a ward clerk is giving medical advice...

#8 Mumsyto2

Posted 14 September 2019 - 12:00 PM

View PostWannabeMasterchef, on 14 September 2019 - 10:50 AM, said:

The ward clerk said that its easy for doctors to miss this as it comes on suddenly, however a baby under the age of 12 months should not have been prescribed Ventolin as it wont do anything but make his heart race, which is unhelpful for him when fighting the viral infection.

The main complaint would be against the Ward Clerk. It is completely inappropriate for them to provide any medical advice or commentary as they have done. They need to be counselled so they don’t do this again.

Pharmacists are often in a tight spot, particularly when things are prescribed off indication or when the prescriber has taken potential benefit into account over certain precautions as part of prescribing assessment, used current clinically accepted doses rather than those in prescribing information etc.

Ultimately, this wasn’t really a great call by the prescriber. They may take that on board or they may just shrug their shoulders.

#9 panda eyes

Posted 14 September 2019 - 12:07 PM

Ventolin isn't going to hurt a small baby but it won't make any difference because the receptors on which it works don't fully develop until closer to 12 months. I have a baby with respiratory issues and he had a trial of Ventolin in an immunology appointment at 11 months and he showed improvement then. They said they really only start trialling at the 10-11 month mark because prior to that it doesn't help and correctly administering it to a wriggling, screaming baby is too upsetting for everyone involved.

The pharmacist's job is to dispense and provide advice on correct administration, unless they think that the script is incorrectly prescribed or there's been a serious error made.

Personally, I'd go back to the pharmacist, explain what happened and ask them to phone the prescribing doctor and let them know that Ventolin isn't recommended for the under 1s. That's probably the only way the feedback will realistically get to the doctor.

#10 purplekitty

Posted 14 September 2019 - 12:14 PM

My first thought was why the ward clerk was commenting on medical treatment.

Neither the GP or the pharmacist will be that impressed to hear you say 'the ward clerk said'.

#11 WannabeMasterchef

Posted 14 September 2019 - 12:17 PM

View PostMands09, on 14 September 2019 - 11:32 AM, said:

Ward clerks have no medical training so I wouldn’t be taking their word as gospel.

I might have used the wrong term - it was the person who first triaged us. They definately had a badge on to say they were an RN.  She was quite annoyed that a baby that young had been given ventolin so that made me wonder if it needed to be followed up.  

- ETA DS was actually admitted to hospital for a few hours. He was checked over by a paed who also said Ventolin wont work.

Hes been visited by a nurse today and getting a lot better.

Edited by WannabeMasterchef, 14 September 2019 - 12:22 PM.


#12 IamtheMumma

Posted 14 September 2019 - 12:22 PM

The doctor and pharmacist haven't done anything wrong. The pharmacist won't have dispensed the medication if it was unsafe.

However the ward clerk definitely needs to be reported. The distress this person has caused you is unacceptable. They're admin, not medical or nursing staff. Very unprofessional to undermine other health professionals.

If you go to the hospital website, use their search function and type in feedback or complaint, you should get a link to a form that allows you to give feedback. The time and date of admission will be used to track who the ward clerk is if you don't remember the name, or didn't see it.

Edit - ahh ok not a ward clerk but triage nurse. The hospital will follow it up. They will send a discharge letter to your GP. You can talk to your GP about it next visit if you want.

Edited by IamtheMumma, 14 September 2019 - 12:26 PM.


#13 Expelliarmus

Posted 14 September 2019 - 12:28 PM

The triage person isn’t a ward clerk. They are a registered nurse.

#14 WannabeMasterchef

Posted 14 September 2019 - 12:30 PM

View PostExpelliarmus, on 14 September 2019 - 12:28 PM, said:

The triage person isn’t a ward clerk. They are a registered nurse.

Sorry I should have used the word triage nurse. I didnt realise there was a difference in training.  Its the main kids hospital in SA so I would assume they see a lot of similar cases and know their stuff.

Edited by WannabeMasterchef, 14 September 2019 - 12:35 PM.


#15 purplekitty

Posted 14 September 2019 - 12:34 PM

I'm glad he is better,bronchiolitis can be scary.

It is tricky because it wasn't medical staff (even though it was a RN) who spoke to you and it is a clinical decision.

#16 Caitlin Happymeal

Posted 14 September 2019 - 12:55 PM

That's slightly more ok ish, there's a decent chance that triage nurse has the guidelines in front of them and that sounds plausible. It is part of a nurse's role to educate, but possibly would have been better worded to something like "latest evidence suggests ventolin is not recommended for under 12 months because of xyz". I don't really see that as any different to the 1300health nurses or state equivalent giving advice based on current evidence based practices.

Worth mentioning to the pharmacist as pp mentioned because they can then raise it with the prescriber.

#17 purplekitty

Posted 14 September 2019 - 01:07 PM

You could speak to the practice manager and tell them what was said by the triage nurse.
You could return the Ventolin to the pharmacist (ask to speak to them) and update them.

#18 PrincessPeach

Posted 14 September 2019 - 01:31 PM

Its not totally wrong as it can work in some situations, but the way it was discussed is certainly not right.

That aside Id actually be more cranky about being prescribed antibiotics for bronchiolitis, its a virus.

#19 Ivy Ivy

Posted 14 September 2019 - 06:35 PM

I think feeding back what happened, and was said, by other specialist paediatric clinicians, to the GP, is useful for the GP.  A handwritten letter addressed to the GP would be fine if you didn't want to make a phone call.   A letter also allows you to consider your wording and what info you wish to impart.  I wouldn't send it to the practise manager unless you want it to become a whole practise complaint type thing.

I suspect the GP will then call you to discuss (and give reasons why Ventolin was trialled) if he/she is a good GP.

Virus versus bacterial infection very hard to call and in a young sick baby not a surprise all bases were covered.

I think it is very hard for GPs to keep up-to-date across all ?15-20+ specialties that now exist (e.g. this is specialised paediatric emergency respiratory and pharmacological knowledge).  There are just too many medical advances for a generalist to always keep up with the nuances.  If I were the GP I'd love this feedback.  And just think - it may make them pause before doing it again for another young baby.

#20 PizzaPlease

Posted 14 September 2019 - 06:56 PM

When my youngest daughter was 11 months old she was admitted to hospital overnight because she had bronchiolitis and it had triggered an asthma attack. She was given ventolin at spaced intervals over the next 24 hours and she began to improve within minutes of the first dose.

I suspect the clinical decision making here is more nuanced than you have been led to believe and I do not think it is at all clear that the GP's decision was not the right one. It is never a bad idea to provide feed-back to any healthcare provider but I  think you should also be prepared for the possibility that the triage nurse's assessment may be questionable or at least oversimplified.

#21 Prancer is coming

Posted 14 September 2019 - 06:59 PM

I think I would want to know it was definitely the wrong medication first.  Nurses generally cannot prescribe medication, whereas doctors can, so I would not necessarily take the nurse’s word over the GPs.  It may be the nurse was correct and the GP had no idea what he was doing was wrong.  It may be that the GP had a decent reason for doing what he did.  It may be that what the GP did was not ideal, but not a mistake neither.  If it was a bad call from the GP, I would expect the pharmacist would have stepped in.



#22 RabbitHash

Posted 14 September 2019 - 07:00 PM

There is a health complaints commissioner or Ombudsman in every state. However they will probably ask you if you've brought it up with the practitioner before they'll take action - unless there is immediate and serious risk to the public.
If you complained about the GP, what outcome would you want?

#23 WannabeMasterchef

Posted 15 September 2019 - 09:20 AM

View PostRabbitHash, on 14 September 2019 - 07:00 PM, said:

There is a health complaints commissioner or Ombudsman in every state. However they will probably ask you if you've brought it up with the practitioner before they'll take action - unless there is immediate and serious risk to the public.
If you complained about the GP, what outcome would you want?

Im not wanting to complain about the GP as such. But I wondered if they needed to know that ventolin doesnt work in such a young baby for future reference if a similar case presents.  I was concerned at the time of writing the thread because as I said the triage nurse seemed very annoyed it had been prescribed.

The hospital did say bronchiolitis is hard to call as it comes on quickly, and that was complicated by baby having had his 4 month needles, so like like Ivy Ivy said above the antibiotics would cover the bases if it had been a bacterial infection.

I do have a discharge letter and I was planning to go back to GP in a couple of days to get DS checked over so I will probably just show them so they know what happened.  

DS is looking heaps better today, still coughing but back to playing with his sisters and batting toys around  :)

Edited by WannabeMasterchef, 15 September 2019 - 09:45 AM.


#24 lucky 2

Posted 15 September 2019 - 10:12 AM

View Postpurplekitty, on 14 September 2019 - 12:34 PM, said:

I'm glad he is better,bronchiolitis can be scary.

It is tricky because it wasn't medical staff (even though it was a RN) who spoke to you and it is a clinical decision.
I'd suggest the triage nurse was acting within her scope of practice and job description as triage nurse in a major children's hospital . She'd be highly clinically experienced  specialist ED RN who made an initial clinical assessment and provided information and support to the mother sitting in front of her.

Eta, op the basic information will be in that discharge letter and I understand your interest in wanting the gp to have some feedback to improve practice.
I wish there was a really easy way to do this because this is a common scenario.
You could ask to talk to the gp practice manager about you sons illness and care, with a view to improving the care of the next baby who presents to that Dr in a similar situation. I've done this, it takes effort but I was listened to. ?

#25 MandaMama

Posted 15 September 2019 - 11:22 AM

View Postlucky 2, on 15 September 2019 - 10:12 AM, said:

I'd suggest the triage nurse was acting within her scope of practice and job description as triage nurse in a major children's hospital . She'd be highly clinically experienced  specialist ED RN who made an initial clinical assessment and provided information and support to the mother sitting in front of her.

Eta, op the basic information will be in that discharge letter and I understand your interest in wanting the gp to have some feedback to improve practice.
I wish there was a really easy way to do this because this is a common scenario.
You could ask to talk to the gp practice manager about you sons illness and care, with a view to improving the care of the next baby who presents to that Dr in a similar situation. I've done this, it takes effort but I was listened to. ?

This! (my bold) Registered nurses are health professionals who make clinical decisions every day. It is also within their scope to be able to question a decision - including appropriateness of medication, dosage etc - by a doctor. Doctors are not gods and they do make mistakes. The triage nurse was advocating for the OP's baby by pointing out the error.

Glad your son is feeling better OP.




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