Mixing Medications

optimis · Mar 21, 2018

As nurses at my facility, we do not do any compounding. That is what pharmacy is for.

I also NEVER mix meds in a syringe. I cannot tell you the amount of times I have told people what I am giving them and they suddenly remember a bad reaction or they decide to refuse something they asked for 15 minutes ago. I also like to make sure some meds are pushed slower than others.

NuGuyNurse2b · Mar 21, 2018

We use Micromedex for compatibility checks. If drugs are compatible, we use one syringe for an IM, for example, to save the patient from multiple sticks. If it's unavoidable, we stick them twice or thrice. Like i've given Haldol and Ativan in the same syringe to patients who were just off their proverbial rockers. Those are the ones where you have to have security restrain them and get it in one shot.

Editorial Team / Moderator · Mar 21, 2018

IM meds can be mixed in a syringe as long as they are compatible. You should be able to check compatibility in a drug book or via a computer app - I remember at my last ER, Lexicomp had a compatibility module where you could put in any number of meds and it would check compatibility. Pretty sure Haldol and Ativan can be mixed, not sure about the Benadryl (I think we gave that separately, if I recall; not sure). But we went away from the "B52" in favor of Geodon or Zyprexa some years back.

At my last ER we were not supposed to mix more than three meds - so things like banana bags/rally packs/whatever you call them were out because they had Folic Acid, MVI, thiamine, and the NS in the liter bag. We didn't have pharmacy 24x7, either. We ended up being the pharmacy for making drips (Cardizem, insulin, etc.) for our inpatient floors too. Plus all antibiotics that needed mixing.

Veldtor, BSN, MSN · Mar 23, 2018

At our facility we use Lexicomp's compatibility program. Anytime I have to admin more than one med IV or IM, I always check to make sure they are compatible.

The only problem with mixed meds is if the patient has some kind of allergic response. How do you know which med caused it if they are both infusing at the same time?

As for compounding medications, pharmacy does that, and we are highly discouraged from doing it. Our ED has its own personal pharmacist during the day time hours, plus a pharmacy tech during most overnight hours to provide us with anything we would need.

PeakRN · Mar 27, 2018

Hello, I wanted to ask a couple of practice inquiries?

1) What is your definition of compounding medications and do your department nurses compound medications?

Nurses do not "compound medications" at our facility, but do prepare certain infusions. I have mixed an epi drip before since pharmacy was working multiple codes in the PICU and ICU (and we were already maxed out on levophed and dopamine), and we regularly prepare our own one time ketamine infusions (0.1-0.2 mg/kg in 100 mL NS over 10 minutes) since it takes so long for pharmacy to mix and secure send controlled substances. We also mix vial dose antibiotics, and I have mixed specific doses of vanco when it was our first antibiotic and IM doses of ceftriaxone with lido for patients who are at risk of leaving if we have to wait for pharmacy.

I regularly dilute medications and put it on a syringe pump if I'm trying to decrease side effects or adverse reactions in more sensitive populations (or pretty much any time I'm giving IV dex to a conscious patient). If pharmacy is delayed for mixing other infusions we typically will just push dose the patient until they make it up to their respective units (versed, vec, et cetera on intubated patients).

2) When you get an order to give IM Benadryl, Haldol, and Ativan at once, how do you administer them? Do you mix any of the medications (ie, Haldol & Ativan) in one syringe?

We rarely give a B52 IM, typically they are either compliant to PO meds or they are in restraints and we just start an IV. Since they need to be medically cleared and we need blood for that so it is uncommon for us to give IM meds.

That being said before I give any meds in the same syringe I look them up on micromedex if I'm not familiar with them. I frequently give my prophylactic antiemetic and narcotic in the same syringe, but typically we also discuss the meds we are giving with the patient before we pull them.

Guest374845 · Mar 30, 2018

Drawing up levophed or epi or vanco and shooting it into a bag doesn't rise to the level of "compounding" in my opinion. That may be the superficial definition of this everyday practice, but I work with pharmacists who balk at the use of the word if you're not working in an IV room room under a compounding hood.