Incompatible IV Meds

[nurse2bguy555]

Hi. If you have more than 1 INCOMPATIBLE IV meds to be administered at the same time, would you just run them n 3 different pumps or just wait until each one finishes, then run the other?

[NRSKarenRN, BSN, RN]

What does your facility pharmacist or policy say about this issue?

[nurse2bguy555]

10 minutes ago, NRSKarenRN said:

What does your facility pharmacist or policy say about this issue?

Hmm, I'm not sure. I guess it would be best to ask them about it specifically. Thank you ?

[JadedCPN, BSN, RN]

Definitely go based off your facility’s policy and procedures. However even if you run them on three different pumps, if they’re still going into the same line (ie one Peripheral IV, or a single lumen central line), they’re still incompatible so shouldn’t be infused at the same time in the same line.

[TriciaJ, RN]

Are you still an RN2B?  Is this a homework question?

Incompatible means if they mix together they will precipitate.  If it happens in the tubing, you will see it.  If it happens inside the patient, you won't see it, but it will still happen.  If that is okay, then why would we care if it happens in the tubing?  They're deemed incompatible for a reason.

If the meds are to be given at the same time, does that mean the patient needs all 3 simultaneously?  Or does it just mean that's how they were scheduled?

Remember that on-time med admin gives you an hour before and an hour after the scheduled time.  So start with the med that will take the shortest time to infuse, 1 hour prior to the scheduled time.  Flush with saline or infuse maintenance fluid between meds.  You should be able to start the 3rd medication within the hour after it is scheduled, so all three meds will have legally been administered on time.

If you do the math and it still doesn't work out, then ask pharmacy for their recommendation and document that you did so.

[Hannahbanana, BSN, MSN]

You can alter the times. I know that in some institutions Q4h means 8-12-4-8-12-4 and QD means 0900 or else, but this is obviously not a case when you are rigid.

Also, the Institute for Safe Medication Practices  (https://www.ismp.org/) gives windows for flexibility with times. Obviously not everybody gets an 0800 med at 0800 on the dot; it’s not possible unless they’re all 1:1 care (and sometimes not even then, LOL). If you have two incompatible meds q4h due at 0800, give one at 0730 and the other at 0830. They do allow for longer intervals for meds at q6, 8, 12, or 24h intervals, and shorter for q1 or 2h. You can print that chart out and post it. 
 

[Guest219794]

On 4/23/2021 at 9:10 AM, nurse2bguy555 said:

Hi. If you have more than 1 INCOMPATIBLE IV meds to be administered at the same time, would you just run them n 3 different pumps or just wait until each one finishes, then run the other?

Incompatible meds are always more than 1.
 

[nurse2bguy555]

On 4/23/2021 at 2:35 PM, TriciaJ said:

Are you still an RN2B?  Is this a homework question?

Incompatible means if they mix together they will precipitate.  If it happens in the tubing, you will see it.  If it happens inside the patient, you won't see it, but it will still happen.  If that is okay, then why would we care if it happens in the tubing?  They're deemed incompatible for a reason.

If the meds are to be given at the same time, does that mean the patient needs all 3 simultaneously?  Or does it just mean that's how they were scheduled?

Remember that on-time med admin gives you an hour before and an hour after the scheduled time.  So start with the med that will take the shortest time to infuse, 1 hour prior to the scheduled time.  Flush with saline or infuse maintenance fluid between meds.  You should be able to start the 3rd medication within the hour after it is scheduled, so all three meds will have legally been administered on time.

If you do the math and it still doesn't work out, then ask pharmacy for their recommendation and document that you did so.

Thanks, I appreciate this post along with the others. I'm a nurse now but I just recently finished orientation, so I wanted to be sure on this subject before I start.

[Guest219794]

2 hours ago, nurse2bguy555 said:

Thanks, I appreciate this post along with the others. I'm a nurse now but I just recently finished orientation, so I wanted to be sure on this subject before I start.

Honestly not sure I understand the question.

If you are off orientation and this has not come up, there may be some very serious gaps.

 

[DavidFR, BSN, MSN, RN]

I don't know how you stand legally in the US but here in France it's us nurses who schedule the timing. So if for example a drug is prescribed 4 times a day it may be scheduled for 6h, 12h, 18h and 0h, but if that falls with a newly prescribed incompatible drug at 6h and 18h for example and nobody's noticed, you simply alter your new drug's schedule perhaps to 8h and 20h and that's perfectly acceptable for us to do that.  

[Hannahbanana, BSN, MSN]

I used to see that done all the time here, but it seems lately that standardized times are set by pharmacy or something, and nurse judgment has been disqualified from participation in many of the charts I review. I’ve seen meds ordered for q8hours on a patient who returned from the OR or admitted from ER an hour and a half ago and the first dose isn’t given for 6 1/2 hours because they missed the cutoff. Or a BID med ordered for 0900 and 2100 could be delayed for ten hours because “this is our standard schedule.” This is just so wrong. 

[nurse2bguy555]

11 hours ago, hherrn said:

Honestly not sure I understand the question.

If you are off orientation and this has not come up, there may be some very serious gaps.

 

Hi. It has been addressed in orientation. I just wanted to be 100% sure before starting. Just a quick refresher so I don't make any mistakes.