When I graduated from nursing school and worked at my first hospital, I was very diligent about pushing meds at the recommended rate; I remember taking up to 4 to 5 minutes just to push dilaudid, morphine, and demerol. Solumedrol was another one that was pushed slowly. In those days I remember actually holding my watch up to the syringe to make sure I wasn't pushing too much too quickly.
Since that time, I moved to a hospital where no one times themselves as they push meds and since transitioning to critical care, I was told by my colleagues that the "ICU way" is just to push everything fast. I'm not talking about critical situations such as codes either - I am talking about just routine doses of versed for conscious sedation, zofran for nausea, haldol for agitation, fentanyl and pretty much any narcotic too. Everyone just basically slam in the meds then leave the room then continues on their merry way.
Another thing that I see go on a lot is the running of incompatible meds together. We use micromedex which is an online IV compatibility library and what I've found is that a lot of meds that are supposedly incompatible actually do run together. I was always taught that incompatible meds form a precipitate due to acidity or alkalinity of the meds or fluids. However, I have watched nurses set up y-porting 3 or 4 meds that are supposed to be incompatible and they run just fine. Why is that? I even saw one nurse push dilaudid through a line that had TPN & lipids which I thought was incompatible with everything.
Does anyone else witness or participate in these "bad practices?" What do you think of them? I'm still confused on how the incompatible meds run together, personally. Nonetheless, I avoid it.
