Mixing IV Medications...Illegal??

RochesterRN-BSN, BSN, RN · Apr 4, 2009

Nit sure on that one.....when I was on an inpatient medical unit we did mix some things, but not those. And NEVER ever potassium. If you have to do it under a hood then that is a bit odd. It is usually the cancer meds that you have to do this with. Funny I was going to say to check with your pharmacy but seems as though they are in on the practice as well...... I am not sure who you would go to for a correct answer. Maybe a pharmacy other then the one you are using?

SandBetweenMyToes, BSN, RN · Apr 4, 2009

When in doubt, always contact your state Board of Nursing and ask to speak to someone who can answer a nurse practice question. I believe they all have practice consultants. I noticed on the Florida Department of Health website, there are lists of email addresses to ask questions...maybe you could start there?? It seems odd to me that there are no readily identifiable numbers to call for nurse practice questions.

http://esetappsdoh.doh.state.fl.us/contactussearch/[email protected]%20%20%20%20%20%20%20%20&Office=Clinical%20and%20Preventive%20Practice%20Management

XY_RN · Apr 4, 2009

I was suprised as well and thanks for the info. :bow:

Columnist · Apr 4, 2009

just a friendly reminder...

while you are receiving some sound suggestions to contact the bon, please be aware that allnurses.com cannot be responsible for problems resulting from reliance on legal advice received here. if you have a legal problem, please seek legal counsel.

the legal nsg forum is not for those seeking legal advice, but rather for those interested in seeking information re. legal nurse consultants. i am moving this thread to the gen. nsg. forum.

whipping girl in 07, RN · Apr 4, 2009

This is probably a question for your state PHARMACY board as opposed to NURSING but...

Several years ago I worked in an ICU where we mixed all our drips. We had vials from Rx and IV bags. TPN was the only thing we got from the Rx premixed.

When I moved here, that was not the practice at either hospital I've worked at. We got our drips already mixed from Rx. But we had some vials and IV bags available to mix critical drips if we hadn't gotten them from Rx yet. We mixed these at the bedside, not under a hood.

You might check out the USP to find out what the best practice recommendation is. Just because something is legal doesn't mean it's best. Some antibiotics have a short shelf life once they are mixed, which is why you may have vials and bags because you only get your meds from the Rx weekly or even less.

Hope this helps you.

loricatus · Apr 4, 2009

You are supposed to have MSDS sheets for all substances. If you refer to those, you can find out if they need to mixed under a hood. I suspect that they do not and the info you received is incorrect; but, with Florida law, it wouldn't surprise me that something like you describe might be in effect to protect the jobs of pharmacists and pharmacy techs.

morte, LPN, LVN · Apr 4, 2009

You are supposed to have MSDS sheets for all substances. If you refer to those, you can find out if they need to mixed under a hood. I suspect that they do not and the info you received is incorrect; but, with Florida law, it wouldn't surprise me that something like you describe might be in effect to protect the jobs of pharmacists and pharmacy techs.

i have mixed heparin and k+ plus skads of ABT.//...i think lori hit this one on the head

azhiker96, BSN, RN · Apr 4, 2009

It might help if you clarify what you mean when you say mixing.

I rehydrate meds every day and it is not a problem. For example, I may take a bottle with 2g Mefoxin and attach a NS 100ml bag, break the seal, rehydrate the powder and then hang the bag. There's nothing wrong in my state for an RN to do this. I've even rehydrated, calculated, and administered a partial dose from a vial as ordered. I don't mix one abx with another though. I prefer to give them separately.

lamazeteacher · Apr 4, 2009

As a nurse with much experience, although none working in ICU, I always use the mantras, "when in doubt, don't"

and "play it safe" or CYA

The first time you do anything, especially on a doctor's order, check it out! It doesn't matter if the Director of medicine and the Director of nursing do it, it's your license and your future ability to practise nursing at stake.

Having come from the dark ages of the '60s, I wonder what the rush is, to give more than 1 med IV, simultaneously. OK, in a code it is! But with 2 different antibiotics, it's prudent to know when/if a reaction occurred, what med caused that.

I'd be much more comfortable flushing the tubing of one antibiotic, and than starting the other..........but then, at 3 days short of becoming 70 years of age, I doubt that I'll be working in ICU in this lifetime. However, I am interested in knowing what's considered state of the art practise.

I do know a bit about legalities, and that is that we are liable for any bad result of something we do, so we'd better have a good reason for doing it, and how we did it, where we did it, and with what we did it, other than, "Well, the doctor ordered it" (lame). It is important to get the doctors' signatures on anything you write for them, ASAP (preferably before any bad reaction could occur).

The prevailing reason for malpractise lawsuits, is that some damage has to happen as a result of someones action or inaction, and that could be anything imaginable, not death or disabling, necessarily. Causing anxiety can be damaging....... for some fragile souls...... The extent or degree of damage is often the deciding factor in awards of lawsuits.

nrsang97, BSN, RN · Apr 4, 2009

I only mix a neo drip if I need it STAT. I mix mag sulfate so I don't have to wait for it from the pharmacy (takes too long when we have someone on q6h lytes with replacements). Otherwise everything comes premixed.

MAISY, RN-ER, BSN, RN · Apr 5, 2009

We reconstitute a million meds in the ER, if we had to wait for pharmacy for drips we'd wait forever! That being said most infusions that go to our other units and floors are pre-mixed in the pharmacy.

I agree with the others regarding questioning Florida's pharmacy and BON rules for exact legalities. If you are performing infusions at an infusion facility, I would assume they have policies and guidelines for preparation and infusing these medications. They would have been looked at by some type of risk managment and legal issues.

As for the hooded thing: chemo infusions are normally prepared by a pharmacist in our facility under these circumstances. As a nurse, I wouldn't want to handle something so volatile.

As for other meds like Rocephin and Vanco, I am assuming you have premeasured vials and are reconstituting and adding like I would to some carrier fluid. If so, it isn't necessarily uncommon. Just make sure it's in your scope of practice and you are protected by the facility.

Also, It's a little unclear, if you are talking about combining meds....then I am totally against that! How would you know what caused a reaction if you got one? If I misunderstood I apologize, but unless someone is dead (coding) and we have only one line would I even consider such a thing....even then don't like it!

M