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Anaesthetist prescribes too much morphine

NZ Newswire logoNZ Newswire 12/06/2017

© Getty Images An anaesthetist has escaped censure even though he gave a woman more than twice as much morphine she needed.

The identity of the private hospital, the patient and the anaesthetist have not been made public in Health and Disability Commissioner Anthony Hill's report, released on Monday.

On May 10 last year, Mrs A was admitted to the hospital to have decompression surgery on her back under general anaesthetic following diagnosis of spinal stenosis.

During the surgery, the anaesthetist, Dr B, administered an additional 6mg of morphine, on top of the already-prescribed 2.5mg, to Mrs A.

The syringe containing the 6mg of morphine had been prepared in advance for the next patient.

Dr B said that it was a "slip/lapse" by him in picking up the wrong syringe.

He said the record-keeping system at the hospital, which recorded what types of drugs were administered during an operation, could have alerted him to the error but it did not due to "certain limitations".

Mr Hill said although appropriate action was taken immediately to remedy the mistake, the administration of drugs in anaesthesia cannot be compromised due to potentially life-threatening consequences.

Mrs A made a complaint about the service she received at the hospital after being made aware of the incident.

Dr B had apologised in writing to Mrs A and Mr Hill felt that while more attention was needed to record-keeping at the hospital, Dr B had reviewed his own practices in terms of injecting drugs safely and no further recommendation was needed.

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