PO vs IV formulations

[elizabells, BSN, RN]

Last night I had a baby with a med ordered IV, that had always been ordered IV. In the med drawer, however, were a bunch of doses drawn up in those ExactaMed oral syringes that don't fit our IV tubing, but labeled [med name] Inj. We use different labels for PO and IV meds, and these had the PO labels, even though it said Inj. When I called pharmacy I was told that the PO and IV form were exactly the same, like literally they just draw from the same vial no matter whether it's ordered PO or IV. Obviously I made him send me new (correct) syringes, but I can't decide if he was telling the truth or just covering for the mistake. Maybe I'm being dim, but that seems weird to me. Can anyone speak to that? Are there really meds that can be PO or IV from the same vial with no changes in dose or additives/dilutents or anything?

[texas2007, BSN, RN]

Hmm I'm not sure on the answer to your question, but I agree this is highly suspicious. What was the med if you don't mind me asking? Maybe a neofax could give us the answer?

[TiffyRN, BSN, PhD]

I heard that about caffeine a few times. We never had our pharmacy try to cover sending the wrong form, but it has happened when the order was changed from IV to PO the pharmacy would let the nurse know it's the same medication drawn from the same vial and that if they wanted to use it PO they could, or they could wait for them to draw it up in the correct syringe.

Just on principal I insist like you did that it be put into the correct syringe. There is a reason so many insist on IV meds coming from IV syringes and PO meds coming from PO syringes.

[Jolie, BSN]

I believe Tiffy is correct about caffeine being the same formulation whether IV or po. I seem to remember giving po Vancomycin to one infant, and it was also the IV form.

I know that theophylline comes in different oral and IV forms, and I'm sure other drugs do as well.

I think you are wise to insist that your meds be provided in the proper syringe, regardless of the formulation.

[FlyingScot, RN]

Decadron. Injectable form can be given PO at same dosage. Mix with juice.

[elizabells, BSN, RN]

Good to know. The med was glycopyrrolate, which I didn't even bother looking up in Neofax, since it's not really a baby drug, but in our online Lexi-Comp formulary. Nothing about the same formulation for PO and IV.

My other concern is that if the pharmacist was in such a rush when they drew it up that it went in the wrong syringes, who's to say it was even the right med? Or that they didn't shortcut aseptic procedure because it was PO instead of IV?

[Mimi2RN, ASN, RN]

Our meds are usually drawn up by the pharmacy tech, and checked by the pharmacist. And yes, we find mistakes.

One night we had two bags of TPN made with incorrect formulations that had to be replaced. Expensive errors!

[Imafloat, BSN, RN]

I don't think caffeine is the same formulation for po/iv. I know the DOSE is the same. Our PO caffeine is a cloudy liquid, the IV version is a clear liquid.

[RainDreamer, BSN, RN]

A while back I had that same situation with caffeine. The kid had PO caffeine ordered but they had IV caffeine in the fridge for this kid. I called pharmacy to get the correct form (PO) sent up and they told me I could just give the IV form PO. I didn't feel comfortable doing so, so I just had them send me the correct form.

[ilstu99]

I don't think caffeine is the same formulation for po/iv. I know the DOSE is the same. Our PO caffeine is a cloudy liquid, the IV version is a clear liquid.

Here, too. The PO caffeine is cloudy/pink, and the IV is clear. Don't think I'd be up for pushing the pink one into my baby. It may just be some additive that sets them apart, but if I don't know what the additive is.....I'll pass.

I'd also request the right syringe, but I'd probably fill out an incident report as well.

[munkypants]

we give iv caffeine also as oral if we're out of oral suspension, but wouldnt give oral as iv

[BittyBabyGrower, MSN, RN]

There are drugs that are interchangable from IV to PO, but never the other way around! I'd have written an incident report because that could have been a sentinel event. If it is written for a specific route, then it should be in the appropriate syringe or else a serious med error could be made!