drawing up small amounts of meds?

[LanaBanana]

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!

[ayla2004, ASN, RN]

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.

i'm in agreement if you look at your state reg regarding controlled drugs holding these on your person without permission is an offense.

in the UK only certain persons are licensed to be in possein of controlled drugs these include ward sisters. even doctor need to have a license if they intend having them about there person.

instead of a waste not want not attuide think license and crimanl court

[precious33]

In our system morphine is a controlled drug with protocol for storage ,habdling and administration .It is dispense only in 15mg and the keys for the DDA/controlled drugs cupboard is kept by the RN in charge of that unit.

On every shift both RN leaving and in coming will check and sign the drugs .

when giving to a patient both Rns must check and sign .We have to give account for left overs at the end of the shift.If any spilled both Rns must witness and signed as spilled and report the incident to the office,every controlled drug given also must be reported in the units report book.

As to left overs we cap and store then use within 72 hours. After 72 hours it is then discarded by 2 rns who will sign and witness.A Doctor can also give and/sign along with an RN (but then cannot be trusted with the keys).

The responsibilities is the Nurse in Charge of the shift.

[precious33]

As to the drawin g up of small doses of meds it is always best to dilute after the calculated dosage with distilled water or normal saline as sometimes half the med is trapped with the needle after administration hence the patient seldom get the require amount.

This dilution again depends on the route of administration ,if giving iv the ratio will be up 5mls depends on the nature of the drugs where as the Im route will be a lesser volume.

[CVICURN2003]

We also have computerized bar code (EMAR) and an accudose. We have smaller doses available of Morphine (2,4,10). We are not allowed to reuse a vial. For instance if for some reason we get 5mg out of the 10 mg vial we must waste that in the accudose, co "signed" as wasted by another RN, we cannot give the other 5MG Later. It is an immediatly terminatable (is that a word?) offense at my hospital. Our management does narc audits every once in a while and god help you if what you have taken out of accudose does not correlate with what was given/scanned and/or wasted . Our only mulidose vials are labatolol and insulin.

I use a straw instead of a carpuject thingy for our morphine and demerol. It works so much quicker for me. We usually shoot strait into a central line so we don't dilute alot of the time. And I always draw up appropriate amt of med and then dilute. Usually with "oily" things like Ativan and Haldol. that way I know my patient got the correct amt of med. If I am giving a pt Ativan I want to KNOW that he got all 1mg or whatever, if I don't use the entire 2mg/2ml vial.

[DutchgirlRN, ASN, RN]

We also have computerized bar code (EMAR) and an accudose. We are not allowed to reuse a vial. For instance if for some reason we get 5mg out of the 10 mg vial we must waste that in the accudose, co "signed" as wasted by another RN, we cannot give the other 5MG Later. It is an immediatly terminatable offense at my hospital.

We are allowed to re-use. It saves me time when a pt frequently gets pain meds and there's always a line at one of the 2 accudose machines. i.e. A pt gets 2mg MS q 2 hours. I get a 10 out of the pxyis. I keep it in my pocket labeled with the patients name. I scan the same container each time I give 2 mg. If I have leftover at the end of the shift then I waste with another RN. I do understand though how and why it might not be allowed. I've never had a problem doing this but if I were to be forgetful about wasting I wouldn't do it. I always dilute with NS when giving IV meds.

[TiffyRN, BSN, PhD]

I used to reuse my morphine vials because I worked at a hospital that only stocked 10mg vials. I now realize the potential danger in having all those opened vials of narcs floating around. Not enough accountability. And I agree it seems very wasteful, but I guess I'm a little more numb to that than others due to where I work. Not unusual to throw out 1/2 to 3/4 of an IV bag because it expires after 24 hrs.

But now I work in a different facility and in the NICU. It's not unusual to need to draw up 0.1mg or less of morphine (and the smallest doses stocked are 2mg/ml). And we usually dilute those tiny doses of morphine 1:1 to make the measurement manageable.

[kmoonshine, RN]

LanaBanana:

We have morphine in 2mg, 4mg, and 10mg increments (each dose comes as 1ml). You should really advocate for having several doses to choose from for high-risk meds; imagine accidently giving 10mg morphine when you meant to give 2ml. Also, it's difficult to be accurate with small increments. I'm in the ER and I don't think I have ever used 10mg/ml of morphine. In the past I've given a total of 10mg+ over several doses, but the highest dose I've ever pulled out from the ADU has been 4mg.

When diluting medications: please make sure that the medication can be diluted - some meds can't be diluted.

When I push morphine through a CIV, I take a 3ml syringe and draw the medication out of the syringe/vial. I then take a prepackaged 10ml NS flush, open it, and inject the medication into the flush (you have to squirt out some of the flush first so you don't overfill the syringe). If I'm pushing it through a running line of NS, I will pull the medication up in a 6ml syringe, attach the syringe to the port furthest away from the patient, clamp below the port, and then I draw 4-5ml of NS from the bag into the syringe. To give the med, I obviously clamp above the port, push a little, reopen the IV line, and repeat. In my opinion, diluting morphine helps the nurse have more control when pushing the med over several minutes. Pushing 0.2ml of morphine undiluted would be ridiculous!

[confused101]

We have 10mg/1ml morphine at my work. We just got the carpuject system in Feb. We used to have ampules for morphine and dilaudid. My thumb was so sore after two nights in a row working because dilaudid is the drug of choice. As for the put in pocket stuff. I NEVER would do that because I don't want to be up for diversion. I floated to another floor one time. The nurse got a po med out and then couldn't find it. IT was a narc. I would not believe it. She acted like it was no big deal. She then "found it" where she put it in the sharps container. I have never seen anything like it. Needless to say I felt very uncomfortable how her narc standards were the rest of the shift. Like no big deal. As for dilution... My hospital system that I went through nursing school with ALWAYS diluted everything. I come to another system and the nurses looked at me like I was crazy for diluting my stuff. I always dilute ativan and morphine. I pass out IV dilaudid like it is the elixer of life, so I don't do that unless I know the pt. is opiod nieve. Or the little old people. As I say do what your gut says....

[confused101]

When I push morphine through a CIV, I take a 3ml syringe and draw the medication out of the syringe/vial. I then take a prepackaged 10ml NS flush, open it, and inject the medication into the flush (you have to squirt out some of the flush first so you don't overfill the syringe).

I also do the insert med in predrawn NS. It is very good. Don't know if you have heard about JHACO wanting to label meds not drawn at the bedside?? We now have to do it. I would do it if I had two meds, but I don't see why right now.

[kmoonshine, RN]

"I also do the insert med in predrawn NS. It is very good. Don't know if you have heard about JHACO wanting to label meds not drawn at the bedside?? We now have to do it. I would do it if I had two meds, but I don't see why right now."

You brought up a good point. I am pretty diligent about labeling my meds, but I ALWAYS label medication that I diluted in a NS flush. Even if I am 5 feet away from the patient. I work in a fast-paced environment and heaven forbid I mix up two flushes that look alike. It's also possible that another nurse could grab it, thinking it was a regular NS flush, and would instead be bolusing another patient with mophine. I just tear a piece of tape, write "morphine Xmg", and slap it on the syringe. Much less time than writing out an incident report.

But again, I work in a fast-paced environment where at times I need to literally drop what I am doing to assist with another patient (if I am on the trauma team and we have a trauma level 1 come in - GSW's to the head, torso - I need to be in the code room working on the trauma). If I took the medication with me in my pocket, just imagine how easily it could get mixed in with the other NS flushes flying around the code room.