Drawing up meds

[Curious1alwys, BSN, RN]

OK, I need clarification on something. I've done some research on AN about how to draw up a med you intend to dilute.

Specifically, MS. Comes in pre-dosed vial of 2 mg/ml. Is it NOT OK to waste 8 ml out of a saline flush and then draw up the whole ml MS in that flush? I get it needs to be labeled or done at bedside but wondering about this. The vial max volume is 1 ml so why would I need to use small volume syringe first?

Then I saw in another post that it IS OK to draw up the MS in a 3 ml syringe and then inject that into a saline flush and/or pull NS from the flush to inject 2 ml into 3 ml syringe as diluent.

I just don't get how all this is different, really. I get if you are working with a small volume of med in a multiple dose vial that you need to pull up in small syringe for accuracy. But since a lot of our meds are pre-dosed now by pharmacy why is it wrong to just pull them up and dilute in a flush at bedside?

[LadyFree28, BSN, LPN, RN]

Is MS morphine?

Usually since it is a narcotic, another nurse needs to witness it and see the amount that is going to be administered; if the entire med is going to be administered, one still needs to witness that the pt is going to be given the full amount and co-sign; if not, one needs to waste the rest of the med and have a witness along with wasting the med; for example, someone can receive 3 mg; the 1 mg needs to be a witnessed waste.

When I witness and vice versa, if I need to dilute the med, I show the amount ordered to be administered, allow the witness to verify the order, then dilute, and then it can be co-signed; it's more of a fail safe to eyeball what is happening so that the pt can be mediated adequately-pt safety and all that.

[Penelope_Pitstop, BSN, RN]

if the entire med is going to be administered, one still needs to witness that the pt is going to be given the full amount and co-sign;

Really? I've never had to do this. I needed a witness to waste or return narcs, but not to give the full amount pulled from the Accudose.

...I see that one of your specialities is peds...maybe since I've only done adults I've never needed to do what you're describing here.

[Boomer MS, RN]

Really? I've never had to do this. I needed a witness to waste or return narcs, but not to give the full amount pulled from the Accudose.

...I see that one of your specialities is peds...maybe since I've only done adults I've never needed to do what you're describing here.

This is how I practiced too. I needed a witness only for a waste or return for peds and adults. The policy at your hospital may be different.

[LadyFree28, BSN, LPN, RN]

Really? I've never had to do this. I needed a witness to waste or return narcs, but not to give the full amount pulled from the Accudose.

...I see that one of your specialities is peds...maybe since I've only done adults I've never needed to do what you're describing here.

In the areas that I worked in acute care, the person witnessing the med, whether it was a wasted or full amount needs to co-sign the witness in the computer.