Hello, I wanted to ask a couple of practice inquiries?
1) What is your definition of compounding medications and do your department nurses compound medications?
2) When you get an order to give IM Benadryl, Haldol, and Ativan at once, how do you administer them? Do you mix any of the medications (ie, Haldol & Ativan) in one syringe?
As nurses at my facility, we do not do any compounding. That is what pharmacy is for.
I also NEVER mix meds in a syringe. I cannot tell you the amount of times I have told people what I am giving them and they suddenly remember a bad reaction or they decide to refuse something they asked for 15 minutes ago. I also like to make sure some meds are pushed slower than others.
We use Micromedex for compatibility checks. If drugs are compatible, we use one syringe for an IM, for example, to save the patient from multiple sticks. If it's unavoidable, we stick them twice or thrice. Like i've given Haldol and Ativan in the same syringe to patients who were just off their proverbial rockers. Those are the ones where you have to have security restrain them and get it in one shot.
IM meds can be mixed in a syringe as long as they are compatible. You should be able to check compatibility in a drug book or via a computer app - I remember at my last ER, Lexicomp had a compatibility module where you could put in any number of meds and it would check compatibility. Pretty sure Haldol and Ativan can be mixed, not sure about the Benadryl (I think we gave that separately, if I recall; not sure). But we went away from the "B52" in favor of Geodon or Zyprexa some years back.
At my last ER we were not supposed to mix more than three meds - so things like banana bags/rally packs/whatever you call them were out because they had Folic Acid, MVI, thiamine, and the NS in the liter bag. We didn't have pharmacy 24x7, either. We ended up being the pharmacy for making drips (Cardizem, insulin, etc.) for our inpatient floors too. Plus all antibiotics that needed mixing.
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