Negligence in usage of controlled drugs

We have all heard the name ‘Nishwa’ — the nine month old baby who lost her life to medical negligence on April 22.

It all started with a fateful injection of potassium chloride which was given to Nishwa. The injection has special therapeutic protocols. It is given to a patient when the blood potassium level decreases either as a side effect of certain medications, or due to severe and prolonged diarrhea or vomiting.

All forms of potassium chloride available in drug stores are in concentrated form and therefore need to be diluted and injected into a patient’s vein slowly. What happened in Nishwa’s case was that untrained nursing staff administered concentrated potassium chloride solution directly into Nishwa’s veins without diluting the formulation. Resultantly, potassium level in Nishwa’s body increased which caused abnormalities in her heart rhythm, weakness and paralysis which became the reason of her departing untimely from this world.

The lethality of intravenous potassium chloride injections can be gauged by the fact that it is used in suicidal attempts, termination of pregnancies and state sanctioned punishments.

'Lethal injection' is typically a combination of three drugs— one of which is a potassium solution— and is injected into a person to cause instant death. It is used for suicide, homicide and is also a legal method of execution in countries like China, Thailand and the Maldives.

One of the main causes of medical negligence in any healthcare system is fatigue. In our country especially, health workers have to work painfully long hours which exhausts them and increases the likelihood of human error and negligence. Many international researches conducted on this subject have all concluded that working hours of doctors and paramedical staff should be limited for the safety of patients.

Ethics has not been our forte and hence weak ethical practices are part of almost all professions in Pakistan. While the developed world invests greatly in teaching and practicing good ethics, unfortunately medical and nursing schools in Pakistan do not incorporate this subject in their curriculum. A strong accountability process, such as ones in the UK and the US, is a deterrent to acts of medical negligence.

Sindh administration has sealed the hospital where Nishwa was overdosed with potassium chloride. Our health sector is already deficient in specialised hospitals and closing a hospital which has cared for and saved countless lives should not be shut down altogether. Not to mention, Nishwa visited this hospital with her twin sister who had similar complaint of diarrhea and was optimally treated.

Blaming the medical profession as a whole is unjustified. The crime of a few should not taint the image of the whole medical fraternity.

Hiring untrained nursing staff, as in the case of the staff nurse who administered potassium chloride injection wrongly to Nishwa, is an act of crime. All public and private hospitals should allow only those nurses to work who are registered with the Pakistan Nursing Society.

Potassium chloride is a lethal drug and should be accessible only when a senior doctor prescribes its use. Protocols for using such controlled drugs should be printed and distributed to all nurses and doctors. Before breaking a potassium chloride ampule, it should be cross-checked by another nurse or a doctor. After using potassium chloride, the on-duty healthcare provider should make an entry in the register of controlled medications.

All doctors and nurses are humans prone to mistake, but when this mistake occurs in a healthcare setting it causes injury or death of a patient and such actions deserve stern legal action. The individuals involved in the criminal negligence shown towards Nishwa should meet justice.

While Nishwa has left us all grieving, let’s hope she becomes the face of medical reforms in Pakistan.

Published in The Express Tribune, May 5^th, 2019.

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