Magnesium Sulfate
References: American Heart Association. (2006). Handbook of Emergency Cardiac Care (p. 57). Salem, MA: AHA. Dirks, J.L. (2010) Cardiovascular therapeutic management. In L.D. Urden, K.M. Stacy, & M.E. Lough's (Eds.) Critical care nursing: Diagnosis and management (6th ed., p. 550). St. Louis: Mosby Elsevier. Lehne, R.A. (2010). Pharmacology for nursing care (7th ed., pp. 458-459). St. Louis: Saunders Elsevier. Wilson, B.A., Shannon, M.T., Shields, K.M., & Stang, C.L. (2007). Prentice Hall Nurse's Drug Guide 2007 (pp. 989-991). Upper Saddle River, NJ: Pearson Prentice Hall. Back to Cardiac Medications Front Page Back to Antidysrhythmic Medications Classifications Problem: Practitioners who work in obstetrical units may feel assured in administering intravenous (IV) magnesium sulfate for treating preterm labor and pre-eclampsia. Yet many errors, some fatal, have been reported with this medication. Most of these errors were a result of unfamiliarity with safe dosage ranges and signs of toxicity, inadequate patient monitoring, mistakes in programming the pump, and mix-ups between magnesium sulfate and oxytocin. A detailed account of errors with magnesium sulfate has been published.1 In the span of a few years, the authors, who have been involved in an ongoing review of obstetrical mishaps in the U.S., accumulated 52 reports of accidental overdoses of magnesium sulfate. Simpson and Knox described 12 cases in detail, revealing common precipitating events.1 Following are a few scenarios from their article:
Safe Practice Recommendations: In the article, Simpson and Knox noted that patient transfers to units with lower staffing levels, chaotic environments, and changeable nursing assignments were the most common factors among several errors that resulted in death. To reduce the risk of harm when giving magnesium sulfate to obstetrical patients, all health care professionals should consider the following:
The reports described in this column were received through the ISMP Medication Errors Reporting Program (MERP). Errors, close calls, or hazardous conditions may be reported on the ISMP Web site (www.ismp.org) or communicated directly to ISMP by calling 1-800-FAIL-SAFE or via e-mail at gro.pmsi@ofnipmsi. 1. Simpson KR, Knox GE. Obstetrical accidents involving IV magnesium sulfate. Am J Maternal Child Nurs. 2004;29:161–171. [PubMed] [Google Scholar] |