The healthcare provider decreased the ordered dose of fentanyl to 25 mcg/hr transdermal patch. The pharmacy delivers a 50 mcg/hr patch to the nurse when the next dose is scheduled. What is the best action by the nurse?

To determine if the client's dose is safe and therapeutic, we need to calculate the appropriate dosing range based on the client's weight and compare it with the ordered dose.

Client's weight: 45 kg

Ordered dose: 500 mg every 8 hours, which equals 1500 mg/day (500 mg × 3 doses).

Calculate the therapeutic range:

The dosing range in the Davis Drug Guide is 20 to 40 mg/kg/day. So, for this client, based on their weight of 45 kg:

Minimum dose: 20 mg × 45 kg = 900 mg/day

Maximum dose: 40 mg × 45 kg = 1800 mg/day

The ordered dose of 1500 mg/day falls within this range (900 mg/day to 1800 mg/day), which means it is safe and therapeutic for the client.

A) Prepare and administer the prescribed antidote: Administering an antidote would only be appropriate if the medication error resulted in a harmful reaction that requires immediate reversal. Since the issue here is the timing of medication administration, it is more important to first assess the client for any immediate effects rather than administering an antidote, which might not be necessary at this stage.

B) Notify the charge nurse, the nurse manager, and the prescriber: While notifying the appropriate staff is crucial, the first action should be assessing the client for any safety concerns or complications resulting from the medication administration error. Immediate evaluation of the client's condition should take precedence over notification.

C) Assess and identify the presence of urgent safety issues: The first priority in this situation is to assess the client for any adverse effects or reactions due to the medication being administered too quickly. This could include monitoring for signs of toxicity, adverse reactions, or changes in vital signs that may indicate a potential risk to the client’s health. Once the client's status is assessed, further actions such as notifying other staff or completing an incident report can follow.

D) Complete an incident report detailing the error: While documenting the error in an incident report is necessary, this should not be the first step. The immediate priority is to ensure the client’s safety by assessing their condition, as an error in the timing of medication administration may result in unwanted side effects or complications that need to be addressed first.