Medication administration confusion??? - page 2

Hello everyone! I am a nurse who is newer to dialysis. I have only been working there for a short period of time, but I am concerned about their medication administration to patients. There is a... Read More

  1. by   Penelope_Pitstop
    When I worked in the ICU, we would prep Levophed bags for each other and I never thought twice about it...but we did have a huge, obnoxious sticker that we needed to fill out and place on the bag if the medication was prepared by a nurse vs. pharmacy staff. It included all details, including concentration, date, time and name of whomever prepared it. As far as MAR documentation, not sure how that would work as we used eCare for any drips.
  2. by   canoehead
    When pharmacy prepares the med, they are dispensing, and I know RNs are NOT able to dispense meds. I'd have to email the Board on this situation to see if it was legal.

    I know that pharmacy has two people to check their work, and education and environment to maximize safety. OP, your situation makes me very uncomfortable. If the RN draws up the med, and you give it, who signs it off? Who takes responsibility for the administration? Does your facility have a policy for med administration that includes one or two people? If you hunt, you might find the policy expressly forbids giving a med you didn't prepare.

    Check your policies, and email your professional group. They may have some clear answers for you. In the meantime, email your concerns to your supervisor, so they have been notified in writing that you are uncomfortable, and doing some research. If you have that proof, you'll be in a better position if something goes badly in the meantime.
  3. by   MunoRN
    Quote from canoehead
    When pharmacy prepares the med, they are dispensing, and I know RNs are NOT able to dispense meds. I'd have to email the Board on this situation to see if it was legal.

    I know that pharmacy has two people to check their work, and education and environment to maximize safety. OP, your situation makes me very uncomfortable. If the RN draws up the med, and you give it, who signs it off? Who takes responsibility for the administration? Does your facility have a policy for med administration that includes one or two people? If you hunt, you might find the policy expressly forbids giving a med you didn't prepare.

    Check your policies, and email your professional group. They may have some clear answers for you. In the meantime, email your concerns to your supervisor, so they have been notified in writing that you are uncomfortable, and doing some research. If you have that proof, you'll be in a better position if something goes badly in the meantime.
    "Dispensing" as a regulatory term is actually different from what the pharmacy does when they prepare a med for use by an RN. "Dispensing" refers to receiving and interpreting a prescription and preparing and labelling it for use by someone not licensed to "administer" a medication. As nurses, we are licensed to administer medications, which means we can legally skip the "dispense" step and instead directly interpret the physicians order and administer the medication without it being "dispensed".
  4. by   dudette10
    Quote from Double-Helix
    This is exactly what happens when the pharmacy sends a pre-filled medication syringe or bag to an inpatient unit. You didn't see the pharmacist draw up the medication either, but do you go to the nurse manager and refuse to give the medications sent from pharmacy? No. You check the label on the syringe with your order and give the med and sign it out. It's not a violation in practice to give a medication that another trained and licensed professional prepared.
    Technically, there were two people in the pharmacy who already did a check on it--the pharm tech and the pharmacist. In this scenario, there is no way to do a check. It's completely gone.

    Not to mention, NO ONE will let the administering RN off the hook if it was the wrong med. All the rationalizations in the world using a different role with different scope to compare it to will change that.
  5. by   dudette10
    Quote from chare

    ETA: I find it sad that some of you have so little trust and confidence in your coworkers that you would refuse to administer a medication prepared by one of them.
    It's got nothing to do with lack of trust; it has everything to do bypassing the rights of med administration in a system that just doesn't have to be that way.

    What is the point of doing it the way they do it? There isn't one!
  6. by   dudette10
    Quote from MunoRN
    I would agree that having another nurse draw up the med for you to give is adding an unnecessary extra step that is presents an opportunity for error, but I think some are also maybe being a bit irrational in what that risk is compared to other processes that occur prior to administering a med. We're also trusting that the pharmacy tech calculated, measured, and labelled the med correctly. As for charting who drew up the med, every MAR I've ever seen has some way for you to chart who drew up the med. It's certainly not an ideal way to do it, but the sky isn't falling either.
    The sky will fall with the first error. You're right about one thing though, it's not the ideal way to do it.

    Then why do it that way at all?

    Anyway, the "other processes" also have their safety checks.
  7. by   dudette10
    Quote from MunoRN
    "Dispensing" as a regulatory term is actually different from what the pharmacy does when they prepare a med for use by an RN. "Dispensing" refers to receiving and interpreting a prescription and preparing and labelling it for use by someone not licensed to "administer" a medication. As nurses, we are licensed to administer medications, which means we can legally skip the "dispense" step and instead directly interpret the physicians order and administer the medication without it being "dispensed".
    Can you provide a link to where you got this information? The way you have described the word "dispense" hinges on who (RN or patient) will actually be administering the medication, licensed or not and not all the checks that pharmacists do.

    I'm not a pharmacist, so I'm not sure if it would be appropriate for me to interpret a physician's order. I have not been trained in med interactions or all the lab values that need to be reviewed or all the indications for a med before being ok with a medication order.
  8. by   Alex Egan
    Ok so the reason this works is because of the setting, and the label system.

    On the dialysis unit I worked on the medication labels were printed the night before. They have the patents name, MRN, drug, dose, and then a spot for your initials and the time. A nurse draws them up completing the label. More often then not I would give them myself but if the RN was charging that day I would often pick up the drugs and give them. They are correctly labeled, you know what's in there as well as you do when you get meds from the pharmacy. Which is to say you really don't. You don't know what pill looks like what or what clear liquid in a syringe is REALLY, you trust the label.

    The administering nurse walks over to the patent, confirmes the correct patent, checks the order on the chair side charting against the label, administers and documents.

    The trick here is that it's dialysis. There are maybe five push drugs routinely given, and maybe the same number of IV infusions. There are no narcotics, so unless you want to divert iron that's not a concern. It's a leagal and well established practice that is done by the one of the big two I worked for in every clinic I worked at.

    As far as LPNs, they can practice right up the the limits of the nursing act. I think a lot of folks would be supprised what LPNs can leagaly do. My state is a my not state, so LPNs May do anything not specifically forbidden in the practice act. Facilities may restrict obviously, but unless the law says no, it's leagal.
  9. by   AnnieNP
    I have only given meds drawn up by someone else in an emergency situation. I'm curious to hear what "Bjwojcik" has to say.
  10. by   chare
    To those of you saying that you would only give medications drawn by another during an emergency situation, what makes this different? If your concern is that the medication wasn't properly prepared, don't you think that the increased stress and anxiety during an emergency is going to greatly increase the probability that an error will occur?
  11. by   Double-Helix
    Quote from dudette10
    Technically, there were two people in the pharmacy who already did a check on it--the pharm tech and the pharmacist. In this scenario, there is no way to do a check. It's completely gone.

    Not to mention, NO ONE will let the administering RN off the hook if it was the wrong med. All the rationalizations in the world using a different role with different scope to compare it to will change that.
    As was stated earlier in this post, the pharmacist is not directly observing the tech draw up the medication, print out the label, and label the syringe. The pharmacist is verifying the the information on the label and volume in the syringe match the order. The potential that the person preparing the med drew up the wrong drug exists in either scenario.
  12. by   JKL33
    I'm trying to think back a few years here...I don't think I've actually ever been taught not to administer a properly labeled medication prepared by another RN.

    What we were taught was not to take "a syringe" that someone else prepared and push it - the (usually stated but possibly unstated) implication of this instruction was that we don't know what's in such a syringe because we didn't prepare it ourselves and it has no label. Over time and with poor understanding, this has morphed into the instructions we are seeing on this thread, but the bottom line is that this has always been about the label. The label is the key - that's why, without one, pushing medications that we ourselves pre-drew can easily become dangerous, too.

    The more I think about this, it's nonsensical that students are being taught to not administer a properly-labeled medication for which the patient has an order simply because it was prepared by another RN. How does that make sense? That would also have to mean that the nurse can't administer a medication s/he pre-drew and properly labeled him/herself. Either it is in an RN's scope of practice to read an order, draw up a medication and label it, or it isn't. If you're going to say that pharmacy must prepare all medications that you don't prepare yourself, then you should be saying that pharmacy must prepare all medications because no RN (including yourself) should be doing so.

    There just isn't something magic about the way a pharmacy tech or pharmacist puts on a label compared to the way a nurse does it (as far as the basic duties that must be performed).

    This "never administer a medication prepared by another RN" sounds like something where, over time 1) The original admonition has been twisted and 2) the personal preferences of individual RNs have been passed on to the point where it is being taught as a rule.
    Last edit by JKL33 on Apr 15
  13. by   AnnieNP
    For me I was referring to code situations in the ER (and this goes back 10 years!!!!). I am now in private practice and hope to never need emergency drugs in my office...

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