Medication administration confusion???

  1. 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 charge nurse (RN) who is responsible for drawing up all of the medications for the clinic. If there is a LPN, or RN who is running a pod of 4 patients they are expected to administer the medication. I have a few concerns with this process. The charge nurse draws with a syringe from a vial, after drawing from the vial she labels the syringe, with the medication and initials. Once this is completed she drops them off for the other nurses to administer. This goes against my fundamental principles of what I have been taught and practice as a nurse, You don't give medications you do not draw up yourself, and then chart them off! How am I supposed to do my rights of medication administration? I didn't see what was drawn up into that syringe.... I have to rely on the charge nurse to draw the correct medication, and then label it correctly. I am looking for advice, because the manager doesn't care about my concerns. I mentioned it to the charge nurse as well and she agrees with me and about the nursing standard of practice, but she says this is how it works, we're in the real world not the ivory tower. How should I approach this? what should be done?
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    About Mike DBD

    Joined: Feb '14; Posts: 105; Likes: 72
    N/A; from US

    69 Comments

  3. by   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.
  4. by   smf0903
    I'm going to disagree with DH, I would not give meds drawn up by another nurse. Something coming from pharmacy has a name to it (which pharmacists mixed the antibiotic or what-have-you). Not to be dwelling on the bad side, but what's to say that nurse isn't diverting...how would you know if s/he pulled up an mL of saline and labeled it as dilaudid or whatever? How am I to know s/he wasn't careless and labeled Mr. Jones' syringe with Mrs. Smith's name?

    I'd administer a medication pulled up by another nurse if I witnessed the draw with my own two peepers, which I suspect is not the case here. Otherwise, it ain't happening.
  5. by   LilyRN99
    I agree with smf. I was taught never to give a med prepared by another nurse.
  6. by   brownbook
    Seems wrong to me. Is there any logical reason it is done this way? Something to do with LPN's?

    Can the LPN's even give the medications (I assume) I V push?

    All very confusing to me.
  7. by   chare
    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.
    Agree with this, so long as the medication is properly labelled.

    For those of you making the distinction between meds prepared by an RN, and meds prepared in the pharmacy. You are aware that most of these medications are prepared by a pharmacy technician, and the only time it is seen by a pharmacist is when he or she verifies the information on the label with the order.

    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.
    Last edit by chare on Apr 14
  8. by   smf0903
    Quote from chare
    Agree with this, so long as the medication is properly labelled.

    For those of you making the distinction between meds prepared by an RN, and meds prepared in the pharmacy. You are aware that most of these medications are prepared by a pharmacy technician, and the only time it is seen by a pharmacist is when he or she verifies the information on the label with the order.
    ...and it's documented as to who prepped it in pharmacy. You have somewhere to go with a pharmacy-prepped med. If the proverbial crap hits the fan with a med that another RN drew up, they could throw you under the bus faster than you can say root cause. I am not a trusting person when it comes to my license, and it would be my name on the MAR, not the nurse drawing up the med.

    Just my .02
  9. by   chare
    Quote from smf0903
    ...and it's documented as to who prepped it in pharmacy. You have somewhere to go with a pharmacy-prepped med. If the proverbial crap hits the fan with a med that another RN drew up, they could throw you under the bus faster than you can say root cause. I am not a trusting person when it comes to my license, and it would be my name on the MAR, not the nurse drawing up the med.

    Just my .02
    Did you not see my comment "properly labelled?"
  10. by   smf0903
    Quote from chare
    Did you not see my comment "properly labelled?"
    I did. My point is that there is a paper trail for pharmacy-prepped, whether it's a tech or the pharmacist preparing it. Where is there concrete documentation of the RN who draws up a syringe that they pass to you to administer? Initials on a label, on a used syringe, in a sharps container. Our sharps get changed every morning. Even if something went wrong during our shift (1900-0730) the sharps are already changed out, along with my proof of who drew up the med. That's all I'm getting at with that line of thinking.
  11. by   LilyRN99
    How do you know the nurse labeled it correctly? The pharmacy prints out a label and has computer checks to verify if it is an acceptable dose and such. The unnamed nurse would have no responsibility if something went wrong since it is your name on the MAR. Pharmacy prepared meds can be traced back to them.
  12. by   smf0903
    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.
    I don't consider it lack of trust or confidence in my co-workers, I consider it good practice. On the flip side, I would never ask another nurse to give a med I drew up (except in a code situation, but I'm talking about everyday practice).
  13. by   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.
  14. by   JKL33
    MAR note: "Dose prepared by ____________,RN, Charge Nurse."

    Both sides are valid, but it's true - there's really no reason to trust pharmacy staff more. Yes, they print out a label - they still have to put the right med in the syringe/put the right label on a syringe with medication in it.

    The label placed by the Charge Nurse must contain all of the elements necessary to verify med administration rights.

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