Can't mix drugs??

  1. Our pharmacy recently decided that we can't mix drugs, meaning we can't mix pitocin, nubain, or any other "high risk" drug. This has caused a problem already where the physician orders a different concentration than we have stocked in our fridge.
    There is some confusion as to whether this is going to apply to all drugs including antibiotics, but we dont have pharmacy at night so I don't see how that's going to work. I know the pharmacist isnt going to come in the middle of the night to mix some antibiotics for a newborn or something.

    Anyone else experience this??
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  2. 14 Comments

  3. by   neneRN
    We mix a lot of our drugs, pharmacy actually gets a little testy if we need them to do it once in a while....and I'm in ER so we mix quite a few high risk meds; make our own amiodarone, levophed, vasopressin, cardizem, labetalol, cardene gtts and the list goes on and on.
  4. by   SmilingBluEyes
    I guess I don't get why or how they can arbitrarily decide to do this when there is no pharmacy support at night. Will the house sup do this then? What do you mean by mixing drugs? Are you talking about using saline, say, to give ampicillin or something?

    What does your manager say about this?
    Last edit by SmilingBluEyes on Feb 8, '07
  5. by   SmilingBluEyes
    And if there is confusion as to what drugs this will apply you will have to get confirmation from the pharmacy as to whether there are exceptions or not. If they draw a hard line, then I guess they better be prepared to come in at night and do it themselves then. I swear, JCAHO makes our jobs harder every year that goes by. It's enough to make you want to quit

    or scream

    or both.
    Last edit by SmilingBluEyes on Feb 8, '07
  6. by   meownsmile
    My hospital although small does have a staff pharmacist on call if needed in the night. They have to come in. I would think that would be a reason for someone to come in.
  7. by   taramayrn
    I suppose if they don't want you to mix drugs then there needs to be a pharmacist on call when the pharmacy is closed or have some policies in place for the use and mixing of night cupboard medications.

    - Tara
  8. by   snowfreeze
    Call the pharmicist on call, if they give you a hassle, report em..(a little grumpiness when we wake em up can be shrugged off) That is their job as our job is to respond to all call light requests and be a patient advocate. Oh yeh, patient advocate is why we call the pharmacist on call. Many studies have shown that nurses mixing IV drugs, antibiotics, paralytics etc has caused poor patient outcome.
  9. by   BittyBabyGrower
    We had to go to almost all commercially prepared bags at our hospital....the docs just had to get used to it and it is very rare that they are allowed to order something out of that stock. I'd ask if this is their intent.
  10. by   canoehead
    Isn't it amazing how nurses are dumber than rocks during the day, but smarter than the most accomplished administrator at night? It's a phenomenon that seems to cross all state and national lines, no matter what specialty, it just baffles me

    :smilecoffeecup:
  11. by   babyktchr
    Unfortunately, this is an abomination of JCAHO...apparently part of their patient safety mission. Going to nursing school really doesn't give you much clout any more, if you ask me. But you know, what did happen as a result....we got 24 hour pharmacy coverage. Now if we could only get in house anesthesia and OR....we may become a hospital.
  12. by   MemphisOBRNC
    We run into the same thing, too. When 6 gm of Mag. Sulfate is ordered, our premixed is 4 gm and the pharmacist will NOT send up 2 more gms to add to the bag. He has to mix it himself. At night, some nurses are taking 1/2 of another 4 gm bag and adding it. Some even bolus out of the 40 gm / 1000 ml bag. We are now using premixed Pit: 30 units in 500 ml which is 1 mu/min = 1 ml/hr.
  13. by   Mrs.S
    the only time we can mix drugs where I work is at delivery; we can add 20units of Pit to current IV solution per MD verbal order. It is kind of a pain not to be able to mix stuff in other instances though.
  14. by   LDRNMOMMY
    Quote from MemphisOBRNC
    We run into the same thing, too. When 6 gm of Mag. Sulfate is ordered, our premixed is 4 gm and the pharmacist will NOT send up 2 more gms to add to the bag. He has to mix it himself. At night, some nurses are taking 1/2 of another 4 gm bag and adding it. Some even bolus out of the 40 gm / 1000 ml bag. We are now using premixed Pit: 30 units in 500 ml which is 1 mu/min = 1 ml/hr.
    We have the same pre-mixed pit at our hospital too! We also have the same problem with the Mag. Sulfate! We do the same things, to get the 6 Gm load.

    We are also not supposed to mix meds except for add a vials. Our pharmacy takes forever to get meds to us though. Sometimes over an hour and then longer if the scanned order gets misplaced.

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