Mommy's Intuition

Well, it's been one heck of a day. My blood pressure has shot through the roof on numerous occasions and has since been controlled by a well-timed cocktail. Or two. However, many of you may have seen my post on FB regarding Quinn's scare today. This is the basic gyst and I'll try to keep it as short and sweet as possible. But then again, it's me writing it, and I typically don't do short and sweet. I like to think you appreciate all of the minute details. Which you probably don't, but oh well.

Quinn has been on a compounded type of Prevacid (liquid form) since a couple of weeks prior to her release from the hospital. Before we were discharged, we picked up her prescription for the Prevacid to give to her at home. Of course, in 4 weeks it was due to expire, so I worked with a case manager to get the prescription couriered out to our pedi's office so we wouldn't have to drive to TCH every time to pick it up (it has a very time sensitive expiration and you have to pick it up virtually within a couple of days it's compounded --- and with 2 11 week olds, that can be difficult to make that trek down there). (Oh and it should be duly noted that the compounding pharmacy for the new prescription was NOT Texas Children's, but a different compounding pharmacy that they use).

Friday the prescription was due to expire and conveniently we had a Q weight check scheduled that day so I was able to pick it up on time. When I got home, I opened the bag, threw it away, pitched the old bottle and put the new one in the fridge. When I went to give her the meds that night, I noticed that it looked different and had a different consistency. However, when I looked at the label, I saw that it had the genereric form of prevacid listed instead. So I assumed that was the difference. So I gave the child the med and proceeded to hear my child scream in pain and spit up volumes, exorcist-style that evening for 2 hours.

For most parents, I guess that would have been a red flag --- but Quinn is "predicatably unpredictable". She has good nights and bad nights. And she's always a little fussy. And she always spits up. This was just kind of taking it up a notch --- so in my naive mommy mind, I was thinking "great, now my child is colicky. Awesome.".

Anyway, my aunt and uncle were in town that weekend and somehow the morning feeds were thrown off and she never got her meds. So she didn't get her next dose until Saturday evening. Repeat of Friday evening, only worse. This time, my nerves were completely shot and I ended my night with tears just rolling down my face, feeling completely helpless to fix this little baby who obviously has just such severe reflux and a horrible case of colic.

But still in the back of my mind, something didn't sit well with the meds. We decided to again forgo the morning meds, see how she would do with the day and then try again that evening. If anything worse happened, Monday morning was right around the corner (and yes, we know there are 24 hour places you can take a child, but I really wanted to be able to speak to my dr. And I still wasn't 100% convinced that it was the meds. I thought I was just getting into the really difficult baby stage with her --- but the meds were just kinda nagging on me)

So Sunday was a total repeat. When we finally got in bed last night, I could hardly sleep because now I was 100% convinced that the meds were wrong.

Woke up the next morning and immediately called the case manager. I told her these meds were clear, sweet and sugary smelling --- and our old ones were of a white milky substance with no stickiness/sweetness to be found. She said she would look into it and figure out how to get a new bottle out to us soon.

In the meantime, I had already placed a call to my dr because I wanted to tell him the story personally and get his thoughts and to see what he wanted us to do in the interim while we weren't giving her the prevacid.

During this "waiting period", I decided to dig through Q's discharge paperwork and see if I could find the info sheet from the TCH pharmacy so I could at least compare labels. Score one for mom! I found the label and ran over to the fridge with it. Grabbed her medicine bottle out of the fridge and almost fainted ---- on it, it had the same medicine, but one was written for 3 mg and one label had 30 mg. Guess which one was the new one? Yup, the 30.

So TEN TIMES the dosage. When I furiously dialed the case manager back with this new information, she told me that label could have been referring to the 30 mg tablet that they used to compound the liquid. I am not 100% sure that I believed that one --- so I had her call them again and verify the prescription. Of course, everything they have there says "3". But I'm not there to look at it, so who knows. She also mentioned that it could have just been compounded differently --- different pharmacies use different ingredients. I personally think they should be pretty damn consistent when mixing infant medication.

But basically through this entire scenario, we can guess that one of three things happened....

1. She was given a dose that was 10 times what she was supposed to have in her system.

2. It was compounded with a different ingredient, one that made the mixture clear in appearance with a sweet stickiness to it (as opposed to the milky white we had previously)

3. OR It's not even infant prevacid at all. I'm kinda leaning towards this one for some reason.

All I know is that somewhere along the line balls were dropped - labels were misprinted and medications were not the same. My daughter suffered because of it. Thank God she didn't have an allergic reaction to it and she's doing just fine now.

But we will be sending it out for independent testing to see what the heck is in the bottle. In the meantime, Q is on the same type of tablet prevacid as R --- she's big enough now that she doesn't necessarily need the liquid kind.

Mommy's heart is now in recovery. I feel terrible that I didn't follow my instinct the first time but I guess I was just trusting that since so much special care had been taken to get her the meds, then they would be correct. I won't be taking that chance again. We will be checking and double-checking all of our meds from here on out. A good reminder for us all. People make mistakes. I just thank God that it's not something a load of laundry and Resolve carpet cleaner couldn't take care of. It could have been so much worse.

Stay tuned to find out what was in the bottle.... I know I can't wait to find out --- and then we'll see if we need to take any additional steps with some head-rolling.

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lifebytheday said...

SO scary! I'm so glad that Quinn is okay and that you survived as well...I fully support the head rolling, keep us posted!

Amy said...

Oh. My. Gosh. I'm having heart palpatations just reading this. I've always had a total fear of a pharmacist getting a prescription of Hogan's wrong... I've heard horror stories with much worse endings than this one. Thank GOD she's ok. And of all babies for this to happen to, one that's a teeny bit fragile as it is. Meg, not that you need to hear this from me, but EVERYONE up the line needs to hear about this. They all need to have the fear of God put in them over the massive ass lawsuit they could be facing, not to mention the precious little life that was at stake here. Let me know if you want me to start composing letters, I'm all over it. Bless your heart, I'm glad YOU'RE ok! That's so scary!

The L's said...

OMG. What an ordeal. I am so sorry that you both had to go through all that!!!

Leslie Stanga said...

Meagan,what a nightmare! I'm so glad Quinn is ok. Somebody needs to be held accountable and not just with a slap on the wrist. I have always regretted letting a mistake slide when a pharmacist gave me the wrong meds for Molly. She was about 15 and noticed right away that it was not the same, so she didn't actually take any of the wrong stuff. And, it probably wouldn't have hurt her much if she had. But,I should have made more of a fuss about it to force the pharmacists to be more conscientious about their jobs. Keep us updated.