[peachey_mouse]

Hey i have a critical thinking question...

you are working with a critical care nurse who has been "floated" to your unit. You observe this nurse drawing up 0.25mg of digoxen into a 3ml syringe. The nurse does not dilute the medication and is preparing to give this medication by IV bolus. You tell her that neither you nor any other nurse has given digoxen by IV bolus. She tells you that she does so almost every day. Would you intervene in this situation? What rationale would you use to justify your position?

My answer would be..No because you don't have to dilute the medication and you can give it IV as long as it wouldn't harm the patient I wouldn't think it would be a problem. But it would also depend on the unit proticol.

So my question is what would you do?? Intervene or not??

[Daytonite]

Yes, you should intervene and stop this nurse. Although this is an ICU nurse, she's not working in the ICU at the moment. The protocols for the drugs that can be given by the nurses in ICU is different because the ICU is equipped with the equipment to monitor the patients. Digoxin shouldn't be given IV push to any patient who is not on an EKG monitor and whose heart rate is not being continuously monitored for the reason that IV digoxin entering the system quickly by IV push can cause arrhythmias. Just because this is an ICU nurse doesn't give her carte blanc to perform the same procedures she does in ICU when she is working on another unit. What if this patient experiences arrhythmias? How is it going to be known, other than taking a pulse? How will immediate treatment be given? Other units aren't stocked with the drugs that would be needed to be given to immediately treat an arrhythmia, not to mention there is no continuous EKG monitoring available. Most hospitals have very clear rules about what drugs nurses can give by IV push and there are usually a special list of drugs that the ICU nurses are allowed to give, but ONLY in the ICU, not when they are working on other units, or unless it is during a Code Blue situation where they are a member of a Code Blue team and following a doctor's verbal order.

[savedbutterfly]

Originally Posted by Daytonite

Yes, you should intervene and stop this nurse. Although this is an ICU nurse, she's not working in the ICU at the moment. The protocols for the drugs that can be given by the nurses in ICU is different because the ICU is equipped with the equipment to monitor the patients. Digoxin shouldn't be given IV push to any patient who is not on an EKG monitor and whose heart rate is not being continuously monitored for the reason that IV digoxin entering the system quickly by IV push can cause arrhythmias. Just because this is an ICU nurse doesn't give her carte blanc to perform the same procedures she does in ICU when she is working on another unit. What if this patient experiences arrhythmias? How is it going to be known, other than taking a pulse? How will immediate treatment be given? Other units aren't stocked with the drugs that would be needed to be given to immediately treat an arrhythmia, not to mention there is no continuous EKG monitoring available. Most hospitals have very clear rules about what drugs nurses can give by IV push and there are usually a special list of drugs that the ICU nurses are allowed to give, but ONLY in the ICU, not when they are working on other units, or unless it is during a Code Blue situation where they are a member of a Code Blue team and following a doctor's verbal order.

Just what i was thinking, also not as important my Hospital policy is we dilute all most all iv pushes so to make this less irratating.