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drawing up small amounts of meds?

Nurses   (10,689 Views 22 Comments)
by LanaBanana LanaBanana (Member) Member

LanaBanana specializes in Level III cardiac/telemetry.

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I'm wondering how other people draw up small amounts off meds, like 2mg morphine. We can't store leftover narcotics so it all has to be drawn up and wasted. Seems like there should be a better way than drawing all 8 and wasting 3/4s of it? Besides that I always have patient's say "is that all I get?" THanks!

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queenjean has 9 years experience.

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Many of our meds come in smaller increments. Our morphine, for example, comes in 2mg and 4 mg containers. Many of the other meds are the same.

If I have someone who is getting small, frequent doses of a prn med, I will keep the vial in my pocket and waste it at the end of the shift. Why waste all that med throughout the noc if we don't have to. If I'm too busy or it if is a crazy night, I won't do it, though, for fear of forgetting to waste. Ialso dont' do itif I have more than one med to do this with--I dont' want a bunch of vials in my pocket.

I would discuss it with your pharmacy. Wasting most of a med every time you give it doesn't make sense. Surely they can order it in smaller doses.

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GingerSue has 20 years experience.

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I will keep the vial in my pocket and waste it at the end of the shift. Why waste all that med throughout the noc if we don't have to. If I'm too busy or it if is a crazy night, I won't do it, though, for fear of forgetting to waste. Ialso dont' do itif I have more than one med to do this with--I dont' want a bunch of vials in my pocket

- why should you have to keep any vials in your pocket? I mean, if you are going to reuse it, then why can't it be kept in the med cupboard with the person's name on it?

- I agree, that it is a shame to wast

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cheshirecat specializes in midwifery, gen surgical, community.

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Our smallest Morphine vials come in 10mg. If I gave 5mg, I must waste the other 5mg. We always check the drug with another RN. If I put a syringe of 5mg Morphine in my pocket for later use I would be struck off the NMC register and would no longer be able to practice as a nurse.

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Roy Fokker is a BSN, RN and specializes in ER/Trauma.

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Try drawing 0.625 mg of Droperidol (Inapsine) from a 5 mg/2 ml vial.... :selfbonk:

We bellyached for 2 months and finally pharmacy listened to us and stocked our suremed on the floor with 2mg/2ml vials. We rarely give any amount over 1.5 mg anyway...

Our Morphine syrettes come in 2mg, 4mg and 10mg forms. Easy to use with the Carpuject injector system. If Morphine comes up in bags/bottles on our floor - it's usually for epidural/drip use.

cheers,

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meownsmile is a BSN, RN and specializes in Med/Surg, Ortho.

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Reusing a single use vial isnt doing anything but costing your hospital. I know it seems wasteful, but the patient is charged by what is pulled from pyxis not by what is signed off on MARs as doses given. Do yourself a favor and adhere to your policy and discard and waste what isnt given. It not only keeps you from becoming suspect for diversion (keeps you out from under the light as far as accountability) but helps keep your facilities budget on target.

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I just had to give 0.625 mg of droperidol on Friday. I was happy to learn I got the math right but unhappy with having to draw up 0.25 ml. What a headache! I think we need to talk to pharmacy where I work too. As far as morphine goes, we do have the 2 mg, 4 mg, and 10 mg cartrigages, so that's not a problem.

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CarVsTree has 4 years experience and specializes in Trauma ICU, MICU/SICU.

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When I have to draw a very small volume of med, I also draw some saline in the same syringe and give that. This way the patients don't think their only getting a tiny amount.

I also agree, check to see if pharmacy can supply higher 2, 4, 10mg syringes.

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queenjean has 9 years experience.

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Reusing a single use vial isnt doing anything but costing your hospital. I know it seems wasteful, but the patient is charged by what is pulled from pyxis not by what is signed off on MARs as doses given. Do yourself a favor and adhere to your policy and discard and waste what isnt given. It not only keeps you from becoming suspect for diversion (keeps you out from under the light as far as accountability) but helps keep your facilities budget on target.

I don't see how it makes any difference. If I pull an 8mg vial, and use 8mg over the course of the noc, how is that costing the hospital money, as opposed to me pulling several 8mg vials and wasting most of it over the course of the noc? And isn't using patient resources wisely a part of our jobs? Further, a significant number of our patients have no or limited insurance. So, if they don't pay a portion (or all) of their bill, am I not ultimately saving the hospital money, by keeping their bill down?

Our charting is computerized, we use a bar code method for drug dispensing. If my scanned MAR matches my shift pulls per pt for the pyxis, there is no issue. Incidentally, we have brought this up with pharmacy and our CNS, and both agree that if the patient is using multiple doses, this is indeed an option of pulling the meds; but we have to maintain responsibility for wasting any at the end of the shift. I'm okay with that. I'm sure this will change if any of us screw this up.

That's why I don't put it in the pt drawer; I'm worried I would forget to waste any at the end of the night.

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Dolce is a RN and specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.

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I worked at a place that only stocked Morphine in 10mg/1ml cartridges and I rarely gave more than 2 mg and then had to waste the other 8. Unless its in the PACU we rarely give 10 mg Morphine all at once. I like it when pharmacy stocks smaller doses--2 mg and 4 mg cartridges. I've been guilty of carrying around the remaining med in a vial or syringe in my pocket but do not feel comfortable doing so. But, sometimes it is really hard to find an extra person to witness the waste during a busy morning. I always dilute IV push meds in 5-10 cc of saline so the patients see a nice big loaded syringe whenever I give them their meds.

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LanaBanana specializes in Level III cardiac/telemetry.

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Can somebody tell me the best way of diluting things like morphine with saline? I usually draw up the morphine, waste what is necessary and then draw up saline. I've seen others draw up all the morphine, mix it with saline in a certin ratio and then waste.

We are NOT allowed to keep morphine in the vials either in our pockets or in the patient's drawer. They can do this in the units, but not on regular floors. I think there have been issues with it on other floors. It is incredibly annoying and not cost effective, but if it keeps me from losing my license because I forget to waste some that I put in my pocket then it's worth it!

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Myxel67 has 15 years experience and specializes in Diabetes ED, (CDE), CCU, Pulmonary/HIV.

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In many hospitals, this is considered mishandling of narcotics and can get the nurse in trouble. It can be very simple for the nurse to keep an unopened vial for her/himself, and give pts their full dose of meds from one vial. This is really not a good habit to get into.

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