ENS 53390

v t e ENS Event
05:00 May 4, 2018
Title	Agreement State Report - Misadministration of Incorrect Medication
Event Description	A lung scan was incorrectly performed at Wesley Medical Center in Wichita, Kansas last Friday, the 4th of May. It was reported [to the State] at approximately 1500 [CDT] on 5/7/2018. The DTPA [pentetic acid] dose was supposed to go through a nebulizer, and an MMA [methylmalonic acid] dose was supposed to be injected for perfusion, but they accidentally injected the DTPA instead. The patient was able to go through the scan as normal, but the end result is that 40 mCi of DTPA (what should have been the MMA dose, by [the State's] understanding) were injected instead of 4 mCi (what should have been the DTPA dose). The bladder dose was over 5 rads. A full report has been promised by the licensee tomorrow, which will be forwarded to [the NRC] and entered into NMED [Nuclear Material Events Database]. It is unknown if the patient and the prescribing physician have been notified at the time of this report. A Medical Event may indicate potential problems in a medical facility's use of radioactive materials. It does not necessarily result in harm to the patient.

ENS 53390 +/-
Where
Wesley Medical Center Llc Wichita, Kansas (NRC Region 4)
License number:	19-C041-01
Organization:	Kansas Dept Of Health & Environment
Reporting

Agreement State
Time - Person (Reporting Time:+85.33 h3.555 days <br />0.508 weeks <br />0.117 months <br />)
Opened:	James Uhlemeyer 18:20 May 7, 2018
NRC Officer:	Ossy Font
Last Updated:	May 7, 2018
53390 - NRC Website
v • d • e

v t e Emergency Notification System
Wesley Medical Center Llc with Agreement State
WEEKMONTHYEAR2018-05-04T05:00:00 [Table view]
[ENS list for Wesley Medical Center Llc]

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