Medication administration confusion??? - page 4
Hello everyone! I am a nurse who is newer to dialysis. I have only been working there for a short period of time, but I am concerned about their medication administration to patients. There is a... Read More
Apr 15Occupation: A.D.O.N. Specialty: 25 year(s) of experience in Med/Surg/Infection Control/Geriatrics ; From: MN, US ; Joined: Feb '18; Posts: 742; Likes: 1,476Quote from brownbookNo. In MN the LPN may do Heparin flushes, Saline flushes, hang electrolytes, set up the saline and prep the tubing with saline for blood, cross check with an RN, do the vitals for the transfusion. Once the R.N. has started the blood, may monitor the patient. They can crosscheck TPN, Heparin, Insulin, IV narcotics, but the R.N. hangs them and the R.N. does any I.V. med pushes.Seems wrong to me. Is there any logical reason it is done this way? Something to do with LPN's?
Can the LPN's even give the medications (I assume) I V push?
All very confusing to me.
Apr 15Occupation: A.D.O.N. Specialty: 25 year(s) of experience in Med/Surg/Infection Control/Geriatrics ; From: MN, US ; Joined: Feb '18; Posts: 742; Likes: 1,476Quote from chareI don't really think it is fair to say that. Granted, when one hear horror stories in the news, it makes one take pause. However, to be honest, we are all human and any one us can make a mistake. The fact is it simply isn't a safe practice, and not something that a careful and prudent should do, period.Agree with this, so long as the medication is properly labelled.
For those of you making the distinction between meds prepared by an RN, and meds prepared in the pharmacy. You are aware that most of these medications are prepared by a pharmacy technician, and the only time it is seen by a pharmacist is when he or she verifies the information on the label with the order.
ETA: I find it sad that some of you have so little trust and confidence in your coworkers that you would refuse to administer a medication prepared by one of them.
Apr 15Occupation: A.D.O.N. Specialty: 25 year(s) of experience in Med/Surg/Infection Control/Geriatrics ; From: MN, US ; Joined: Feb '18; Posts: 742; Likes: 1,476Quote from dudette10Amen!I don't know why the disagreement about this is so annoying to me. Let's lay out all the potential for error by taking step-by-step the safety check bypass.
Five rights: right patient, right med, right dose, right route, right time. Transcription error.
If the Charge RN draws up the med, right time cannot be checked. The charge RN labels the syringe, introducing the possibility of transcription error. The administering RN cannot verify right med or right dose and, by extension, right patient.
And the question is why take the risk? There is no benefit to this method.
Apr 15Joined: Feb '11; Posts: 622; Likes: 743Drawing up and giving meds someone else drew is a minefield,it depends....I have seen many mistakes made by pharmacy or tech that nurses have caught.
Im just saying....
Apr 16From: CA, US ; Joined: Jul '06; Posts: 2,978; Likes: 7,064I have thankfully only come close to drawing up the wrong med, or caught my error immediately afterwards. Any human can make a mistake even doing something very routine they do every day at work.
I just seems if it's found the wrong med was drawn up and given two nurses are going to be in deep dodo, not just one. And the whole why are you giving IVP a med (NOT in an emergency situation) you didn't even draw up seems like a lawyer's dream.
Apr 16Occupation: N/A From: US ; Joined: Feb '14; Posts: 105; Likes: 72The individual who give the med takes all responsibility, the charge nurse name is no where documented.
Apr 16Joined: Dec '04; Posts: 1,111; Likes: 1,079Yes, but when a pharmacy tech draws up the medication, he/she will attach the empty vial to the syringe so that the pharmacist who does the final checking can sign off that it truly was the drug ordered. So that there is another check in the system.
Apr 16Joined: Jun '01; Posts: 2,732; Likes: 6,280Quote from dudette10Now this topic is starting to really confuse me. My facilities pharmacy is 150 miles away. The vast majority of our meds are in a pyxis type machine. When we get a new order from the MD/PA/CNP we fax that order to pharmacy and pull the med from the machine. We are able to pull the med from the e-kit function of the machine and administer it before pharmacy even enters the order in their system. There's no need to overide the Pyxis, we just select the patient name, navigate to the med in the system and pull it. No consequences, that's how it's done. I can't imagine our facility and our pharmacy has us pull a med this way if it's somehow wrong.Huh?
The pharmacy check is when the pharmacist signed off on the provider order by reviewing the indication, dosing, interactions, etc. for the med to show up on my patient's med profile. I think we agree on that.
MunoRN said "As nurses, we are licensed to administer medications, which means we can legally skip the "dispense" step and instead directly interpret the physicians order and administer the medication without it being "dispensed"."
She seemed to imply that we can just see the order then go override the Pyxis and pull the med and administer without any consequences. That's just not true.
The exception to this process is a controlled med. In that case the pharmacy has to have the order entered in their system before the med can be pulled as those meds require a written order from the provider before being dispensed, though a schedule 3 can be dispensed with a verbal order from the provider given directly to pharmacy. That process can take as little as 5-10 minutes to as long as an hour or more for the med to be approved for dispensing from the machine depending on the providers willingness to call the pharmacy with the order in a timely fashion and the pharmacist entering that order as soon as they get it.
Apr 16From: CA, US ; Joined: Jul '06; Posts: 2,978; Likes: 7,064Quote from kbrn2002I agree. I thought the "correct" answer would be more clear cut!Now this topic is starting to really confuse me.
Apr 16Specialty: 6 year(s) of experience in Emergency, Telemetry, Transplant ; From: US ; Joined: Mar '11; Posts: 3,954; Likes: 9,676Quote from Alex EganI'm asking this because I don't know, not because I'm trying to be argumentative: is this for free standing dialysis clinics, or does the gowning, change gowning, etc. apply to inpatient, hospital dialysis as well?CMS guidelines specifically forbid the drawing up of any medication at chair side.
Thats most likely the reason they want to do it this way, is to comply with the current CMS guidelines around infection control. Medications in dialysis must be prepared in the "clean area" of the clinic. To work in the clean area you must be wearing a different clean gown (different than the one you where on the floor) and wash or sanitize you hands when entering and leaving. So. I enter the clean area, change gowns, wash hands prepare med, remove gown, wash hands, apply "dirty" gown walk over administer med. repeat 36 times a shift. When your doing it as OP discribed you can hand the meds across the clean dirty line and still be in compliance.
Apr 16Occupation: Critical Care Specialty: 10 year(s) of experience ; From: US ; Joined: Nov '10; Posts: 9,433; Likes: 26,184Quote from dudette10Pharmacists certainly play an important role in the medication review process and they should be utilized whenever the clinical situation allows, but they aren't a required part of the process between a physician writing an order and the nurse interpreting the order and giving the med.I think we are getting stuck on the definition of the word "interpret" so let's skip that part and go directly to a role discussion.
It seems that what you're saying is that, as a matter of course, nurses are fully able to bypass in-patient pharmacy all together and administer any medications a provider orders that he/she also agrees is clinically appropriate.
It leads to the question, then, why have in-patient pharmacists at all?
Do you believe they have no important role in the patient medication process, and that a nurse's education and clinical expertise suffices to ensure patient safety?
Apr 16Joined: Jan '10; Posts: 3,923; Likes: 11,213Quote from MunoRNOk, now I get that you are saying pharmacists are not LEGALLY REQUIRED to be a part of the inpatient medication process.Pharmacists certainly play an important role in the medication review process and they should be utilized whenever the clinical situation allows, but they aren't a required part of the process between a physician writing an order and the nurse interpreting the order and giving the med.
Apr 16Joined: Jan '13; Posts: 1,975; Likes: 4,306I would not feel comfortable. This violates the 5 rights. How do you know it's the right medication, and dose if you didn't witness her draw it up?