Am I wrong to think this is NOT okay?

[Peetz, BSN]

I work in a SNF, going on a bit over a year now. I shake my head often at things that I would never do yet are being done by other RN's and LPN's. I understand that things are different in the world of long term care but some things just seem not okay.

Maybe I am wrong but taking an antibiotic from one pt to give to another because you were to lazy to pull the dose from the pixis or look in the fridge for the patients meds seems wrong. A nurse "borrowed" two bottles of 1 gram antibiotic meant for IM from one pt to give to another who has an order for the same drug but IV at 2 grams. Now patient with IM AB is short two doses and IV pt has one extra we can 't use.

Not sure how I will feel if everyone tells me this is okay practice. I really don't know anymore, I feel very lost as a new nurse when things like this happen.

Any advice would be appreciated. Also, can someone tell me why IM Antibiotic is given BID X 10 days vs. IV ? This lady has no muscle mass, what would be some reasons for this being ordered this way?

Also what is the reason to give a pt 1000 ml of 0.9% ns over 2 hrs, times two days for dehydration. Should that be given over a longer period of time? When things like this happen, I feel so darn stupid for not knowing. One part of me says " it was ordered by a doctor it has to be okay" another part of me says, " question it if it feels wrong, that's how we learn."

Which is right? UGG, when does this get easier?

[NewPICURN]

I think it's wrong. It's ordered that way for a reason and one of the "Rights" of medication administration I learned was "right route." I don't think that that's ok and I would not do it. As far as the difference between IM and IV administration, I don't know about specifics about IM administration contraindications, but IV antibiotics can be vesicant. Also, IM meds are absorbed over a longer time than IV and so it could be to control the blood level of medication, which could have it's clearance from the body affected by another medication that the patient is on. There are many reasons, but the bottom line is, that it's ordered that way for a reason more than likely. (Of course, it could always come down to cost as well.)

Sorry I don't have the answers to some of your other questions, that's just my as your comrade new nurse.

Hang in there!

[Flo., BSN, RN]

I wonder if that order should have read 1L over 24hrs for two days. That would make more sense to me.

[ShantheRN, BSN, RN]

I wouldn't swap out pt meds like it's candy. That's just asking for a med error. Take the extra 5 minutes and do it the right way.

IM antibiotic.....um.....yeah I got nothing Was it an access issue? I'm interested in the answer to this one because the fastest I've ever run an abx is 30 minutes. So I googled....all I can find is some conditions respond better to IM vs IV. Most of the conditions I've been around - pneumonia, fungal/bacterial infection - respond to IV treatment the best.

As for the boluses....I can't think of an equation off the top of my head, but in the land of kiddos, we give boluses over 2 hours all the time. Faster if needed. I had a dehydrated 10 mo old a few weeks ago and he got two boluses. I think mine was around 250 mls, given over 2 hours. He got one on my shift and another overnight. In peds the amount is figured by weight. I'd imagine it's similiar in the adult world.

Hope this helps!

P.S. I hope someone can enlighten more on the IM vs IV question!