ER meds

Specialties Emergency

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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 ER.

ketonesRN (love the name, by the way)

Don't follow what nurses do that you do not know is the right way. No antibiotic should ever be run wide open. I don't run many antibiotics all at once, unless the person is septic and in our trauma bay.

You SHOULD question everything and double check what some nurse, who you think is on the ball, is offering to you. Don't take meds and given them to a patient that you didn't draw up yourself. Always research your meds and do the right thing. It doesn't matter if someone else does it their way and they tell you "it's ok" - smile and move along. Do what you know is right. Be true to yourself. Don't every sway from that and you'll do amazing!

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That's not necessarily true... A gram of rocephin or ancef can be run wide open, as each can safely infuse in under five minutes. There are some, however not many...

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Specializes in Emergency.
That's not necessarily true... A gram of rocephin or ancef can be run wide open, as each can safely infuse in under five minutes. There are some, however not many...

Agree, ancef should be run in 5 minutes. 1st dose if zosyn in 30 minutes. Levaquin & vanco, on a pump and slowish.

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Specializes in pediatrics, ED.

Rocephin can be pushed in a small concentration too. I always run Levaquin on a pump just because of the side effects.

However, you can run the Ancef open if needed. I am a firm believer if you need to know ask, and run for the time recommended by pharmacy if your not sure. However, Some things are just WOW with pharmacy so that is why Drug books are vital. Heck I have one on my iPhone.

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Specializes in 8 years experience in getting yelled at.

Looks like you've gotten a lot of good advice for where you are at based on your experience - ask or look it up, but your question as to how to develop your knowledge and skill has only been touched on by a few, although I think most would agree - it's going to take time. It sucks right now - probably feels really awkward and sluggish to be looking up every damn drug, but that will help you to develop your practice. It's disheartening to hear but it's going to take at least a year (I know many nurses that will say that - and it's true, but a WHOLE YEAR? Too long! Feels like forever) until you feel like you "get it" and at least 2-3 years till you feel like you can rock it.

As far as developing your med skills - everyone will tell you different, but some things you will be thinking about and looking at (probably without even realizing it) once you are comfortable and experienced with the meds are:

-what is the point of giving this patient this med and what is it going to do to them (taking into account what they look like at the time)

-how do most peoples bodies respond to it/what response am I shooting for

-what is a poor response going to look like

-how do I deal with a poor response

-if this is an atypical med or one I just haven't worked with before - can I find a moment to talk with the doc and ask them "what's up?" with you choosing this drug for this patient? (see what I did there - I managed to fit in a very subtle Bugs Bunny reference. Ohh behold the wit.....)

As a side note, my practice is - first dose of ABX is one at a time in case of a reaction. We use Alaris pumps with a drug admin library and I will always use one.

As another side note - our in patient units have started giving Zosyn over 4 hours instead of 30min. I guess a study has shown that over a 24hr period 3 doses of Zosyn(each over 4hr/each dose 8hrs apart) is as effective as 4 doses of 30min/each 6hrs apart. This saves 1dose each day, but when I worked there it was a real pain if you ran late or had incompatible drips to run.

Hang in there. The only cure for what you are going through is experience.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
That's not necessarily true... A gram of rocephin or ancef can be run wide open, as each can safely infuse in under five minutes. There are some, however not many...

The manufacturer's recommendation for the infusion of Ceftriaxone is 30min. AND It can't be mixed in ringers.

Intravenous Administration Rocephin (ceftriaxone) should be administered intravenously by infusion over a period of 30 minutes. Concentrations between 10 mg/mL and 40 mg/mL are recommended; however, lower concentrations may be used if desired. Reconstitute vials with an appropriate IV diluent (see Compatibility And Stability).http://www.rxlist.com/rocephin-drug/indications-dosage.htm

While many do give IV Rocephin IV push the problem is if there is an allergic reaction all the drug is administered and the reaction can be more severs. Many facilities have different policies and procedures that provide guidance for the administration of medicines. Follow the policies DO NOT follow what the other nurse does....look them up and find out. Call your pharmacy. Get an app on your phone....medscape is good and so is micromedex. I have used them both

I know it takes longer now....but it will get better with experience. Good Luck

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Specializes in ER.
The manufacturer's recommendation for the infusion of Ceftriaxone is 30min. AND It can't be mixed in ringers.

Intravenous Administration Rocephin (ceftriaxone) should be administered intravenously by infusion over a period of 30 minutes. Concentrations between 10 mg/mL and 40 mg/mL are recommended; however, lower concentrations may be used if desired. Reconstitute vials with an appropriate IV diluent (see Compatibility And Stability).Rocephin (Ceftriaxone) Drug Information: Indications, Dosage and How Supplied - Prescribing Information at RxList

While many do give IV Rocephin IV push the problem is if there is an allergic reaction all the drug is administered and the reaction can be more severs. Many facilities have different policies and procedures that provide guidance for the administration of medicines. Follow the policies DO NOT follow what the other nurse does....look them up and find out. Call your pharmacy. Get an app on your phone....medscape is good and so is micromedex. I have used them both

I know it takes longer now....but it will get better with experience. Good Luck

Glad you posted this, as I've never given any antibiotic over 5 minutes, much less any shorter than 30 minutes. Some old schoolers will gravity slow drip, but even then, there's no way to monitor the speed if you're in a busy ER and need that pump to beep after it's done so you can disconnect and flush that line.

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That's the difference between what the manufacturer recommends and what pharmacists know to be safe, thanks to clinical research and outcomes assessments. Rocephin, and Ancef for that matter, can be allowed to free flow in if necessary.

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