[Lfransis]

On the floor the other day I recieved a N.O. for Cefoxitin 1gm IM. ( no IV access on pt.)

I work in a very small rural hospital;after the Pharm.Tech leaves we often access the pharmacy for our new order meds, etc..our Pharmacist is at our larger sister hospital. My charge nurse and I were unable to find this ordered med in IM form. She did however find Cefoxitin 1gm For I.V. use only. Hmmm, she read the packet insert that clearly said IV only. Then called our Pharmacist. He stated that it can be admin. IM and that the nurses there often admin this IM. We also called the DR. and he stated the same.
I was told to go ahead and admin the med IM, but to document what the Pharm. and the DR. said in my nurses notes so that " I would be covered"
I was very uncomfortable with this. I am in my first year of nursing. I told my charge in the long run it would be my signature that admin. this med wrongly and refused to give it. I then politely suggested she admin. the med. and sign.She phoned the DR back and 5 min. later the order was D/C'ed. Interesting.

So I talked with other nurses: Some said yes they would of given the med IM. Others clearly said No-way.

What would you have done?

[morte]

No No No No No No

[Boston-RN]

If the mfg says IV only then I would only admin IV....I may ask for an equivalent med that is acceptable by IM admin

There are many Cephalosporins (systemic) that can be given PO or IM

[Suesquatch]

I'd have checked my drug guide.

[lector]

OMG.even if im still a senior stud...That,s a no no for me.

[NursingAgainstdaOdds]

Nope.

I think the fact that it was D/C'ed after you asserted yourself is very telling. Good on you for doing so.

[castens]

This is from UpToDate Online:

DOSAGE FORMS

Infusion, as sodium [premixed iso-osmotic solution]: 1 g (50 mL); 2 g (50 mL) [contains sodium 53.8 mg/g (2.3 mEq/g)]
Injection, powder for reconstitution, as sodium: 1 g, 2 g, 10 g [contains sodium 53.8 mg/g (2.3 mEq/g)]

DOSAGE FORMS: CONCISE

Infusion [premixed iso-osmotic solution]:
Mefoxin®: 1 g (50 mL); 2 g (50 mL)
Injection, powder for reconstitution: 1 g, 2 g, 10 g
Mefoxin®: 1 g, 2 g, 10 g

GENERIC EQUIVALENT AVAILABLE — Yes: Powder for injection

ADMINISTRATION

I.M.: Inject deep I.M. into large muscle mass.
I.V.: Can be administered IVP over 3-5 minutes at a maximum concentration of 100 mg/mL or I.V. intermittent infusion over 10-60 minutes at a final concentration for I.V. administration not to exceed 40 mg/mL

Now... I don't know if the vials are specified IM only/IV only/IV or IM use so I can't comment specifically on your case, however it is documented that it can be used IM. There are accepted off-label administrations for medications if prescribed. For example, Haldol, which still says IM injection only, can be given IV and has been for decades. Frankly, I would have looked into the situation in more detail. If, like Haldol, the vials say one thing but there is established (key word is established... not just now and then, for convenience) practice for another, I would have administered IM. (Now, if the physician wrote IV, it would not be acceptable to change to IM without contacting him for a correction first.)

I'm curious how this is dealt with in your hospital. How does the medication get delivered to the nurses? Does pharmacy simply deliver the vials for the nurses to administer? If so, and if IM and IV doses come from the same vials, why hasn't anyone caught this yet? Surely SOMEONE would have seen "For IV Only" on the vials at some point, wouldn't you think?

[CritterLover]

That is a really intersting situation. Most drugs are safer given IM than IV. That is, there are some drugs that come in forms that can only be given IM, and other forms that can be given either IV or IM (haldol is a good example -- one form [I think the deconate form] can only be given IM, where the other form [I think the lactate] can be given IV or IM, though the IV form is off-label but well established).

I've never heard of an unmixed drug that can be given IV only, and not IM, when other forms of the drug can be given IM. (Of course, that doesn't mean that they don't exist )

I'm sure that is where the confusion of you doc and pharmacist came in -- that is a drug that can be given IM, and often is given IM.

I think I would have sided with you, and refused to give it; however, I would have wanted someone to check with the manufacturer to find out why that particular preparation said "IV only."