ER meds

Specialties Emergency

Published

As a new grad in the ER...I am having a hard time with medications. I will see that one nurse will hang 3 antibiotics at one time while another will hang one and wait to hang the next. I've noticed that some antibiotics are hung wide open while others are on a pump.

I never know what drugs can be mixed and what can't.

Cardiac drugs and any drug that gets titrated to nursing judgement...ugh...super scary and yet another issue for me as my nursing judgement is in the infancy stage.

The medication thing is zapping a lot of time because I am constantly having to ask questions or go online to a clinical pharmacology site for answers.

My question finally is this...do you have any good tips or 'rule of thumb' that are easy to remember concerning any type of medication. Do you have any good books to recommend that deal with ER meds and particularly administration from a nurse that would be helpful. I've looked at a lot of books, but they all seem to be missing the NURSING aspect I need. Thank you to anyone who has any tips!

Specializes in Emergency, Telemetry, Transplant.

My rule of thumb...if I am not sure I need to change the rate on a drug, I will ask the doctor. If I think any drugs need to be titrated (pressors, NTG, dilt, propofol, etc.), I will get the order from the doc or he/she should have provided parameters (i.e. titrate the dilt to a HR110). If I see a person who is restless on propofol I may go up by a little bit even if I don't have titration order yet, but I will be sure to immediately talk to that doctor (plus I will make sure their VS, esp. BP, is acceptable before increasing the rate).

As for antibiotics....our facility policy is to run them all 'on the pump' although some nurses will piggyback a dose by gravity--not wide-open, but not on the pump. Our policy also is to piggyback all antibiotics--not run them as a primary. The issue of 3 antibiotics at once...you have to check compatibility (either with the pharmacy or with an approved reference such as Micromedex--sp?). If they are compatible, run them at the same time. If not, you have to run them through separate lines.

Specializes in Emergency/Cath Lab.

my rule of thumb: When in doubt look it up. Med books, we have charts, up to date and as a last ditch effort pharmacy. All of those will say this works with that or dont even think about it. After a while of doing meds and hanging and shooting people up with things, every person develops their own little traits on what they like to do. Just watch a few nurses push morphine and see the differences that they each employ. Finally, knowing what everything does really helps me in knowing how to titrate or push things together or one at a time or what have you. It comes with time and experience.

I never hang more than 1 antibiotic at a time just in case the person has an allergic reaction you wouldn't know which antibiotic did it. i came from 5 years on a med-surg floor and we had to run everything on a pump, so I carried that habit with me. Our ER has "smart pumps" so you just type in the medication and it tells you how long it should be run over.

Specializes in pediatrics, ED.

My rules for my new grads 1. The only stupid question is the one not asked. 2. When in doubt ask, look it up or call pharmacy.

It's overwhelming to be new. it throws a lot at you in a short amount of time with orienting to the floor. I would rather Stop, answer a question with a new grad than have a negative outcome. Especially with Medications.

I basically look at it this way. We are bestowed the power to heal with knowledge obtained through school. However, it's a lot of knowledge in a relatively short amount of time. We are also bestowed the power to kill a patient if we are not careful.

HECK I EVEN CALL PHARMACY!

Just keep that in the back of your mind and memorize pharmacy and lab's extensions. Be nice to them as they are invaluable resources!

Your facility should, at the very least, have an IV drug book in the ER that will tell you y-site compatibility info. Hopefully your facility has an online reference you can use in which you can enter the drugs you're hanging and see what's compatible with what. The longer you practice, the more you'll learn about what can be hung with what and how long to hang things. I'm just happy to see you're not blindly connecting y-sites. :)

Specializes in retired LTC.

Like others have said, do your own research as best you can, and then, if you still need to, call your pharmacy! Write down the EXACT meds as examples and ask your pharmacist for specific info that you can't find/understand. THAT is part of their job despription - to be a resource for others.

As an 11-7 RN with 38 years exp, I frequently wind-up on a first-name basis with our on-call pharmacists for our LTC pharnacy provider. At times when I need to, they are my only professional-level resource for IV calculations or respiratory meds.

Just know that with time, you will become more proficient and knowledgeable. Also, did you try your IV P&P manual? It may have the info you need, but if not, perhaps, there should be an addendum somewhere for reference.

Specializes in Emergency.

It's going to take time. You are also getting confused because, some of the stuff you describe, like the running of some antibiotics etc, are probably being done in a not "best practices" fashion. It can be difficult as a new grad to know which RN is doing things correctly and which one is saying, "It's ok like is" and is acutually just blowing smoke.... Even someone who seems 100% confident may steer you wrong.

I do recommend this book:

Amazon.com: 2011 Intravenous Medications: A Handbook for Nurses and Health Professionals, 27e (Intravenous Medications: A Handbook for Nurses & Allied Health Professionals) (9780323057929): Betty L. Gahart RN, Adrienne R. Nazareno PharmD: Books It is ONLY IV meds, and is spiral bound. It was my bible my first year in nursing. (apologies to the real Bible.)

As far as titration...there should be guidelines. You should have either BP guidelines, Pulse guidelines, pain guidelines (say for nitro), etc. You will feel a little bit more confident if you look up (on your off time) some of the IV drugs most often used in the ED setting. say: Nitro, cardizem, dopamine, maybe levo- depending on your facility. once you get a bit of a memory about them, you will be able to do a quick review before setting up, and you will have a better idea of what side effects to look for and potential risks etc. But yes, get the above book, it is worth it.

Specializes in ER, ICU.

I use Epocrates on my ipod to look up drugs. It doesn't have compatibility but it is the fastest way to find something. It is a free app that is constantly updated. Always look up compatibility if you are not sure.

Specializes in EMERG.

Emerg drugs are scary, because we deal with everything from pain and nausea meds to antibiotics and PALS/ACLS Drugs. See if your facility has a parenteral drug therapy manual. We have one and it is marvelous! We have one at every medication dispensing unit as well as an online resource so it is quick and easy to access. It breaks down everything to who can give each med, how to Dilute, Push, hang piggy back and titrate for all drugs that are in our formulary! Micromedex and Epocrates also has a great aps for this! It also has a syringe/IV and ysite compatibility AP which is great for determining what drugs can be hung together etc. Its good for antibiotics but also other things like Potassium and other drugs. Learn your resources and use them it makes things alot easier for newbie and oldie nurses!!

I use Epocrates on my ipod to look up drugs. It doesn't have compatibility but it is the fastest way to find something. It is a free app that is constantly updated. Always look up compatibility if you are not sure.

Awesome app! Thanks for sharing!!

Specializes in Emergency, Med/Surg, Vascular Access.

Forget epocrates. Get medscape! :-) It's awesome and free!

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