Published Nov 6, 2016
I want to ask: Is knowing JUST what the med is for really enough?
I am a new grad and I still don't know much about med compatibility, side effects, contraindications etc for majority of drugs.
I know that most EMR systems have links where you can check IV meds compatibilities as well as PO meds etc.
But when a patient have like 10+ meds and you have like 5 patients...... how do I really just sit there at the computer looking up the compatibility?
I know this may be a irrational fear but how do I know if say.... it's okay to give PO .... lisinopril with .... protonix..... with Colace..... with Norco..... with some other med?
I know what all of these meds are for and maybe 1-2 side effects..... but that's it! I don't feel this is enough so how do you learn through all of these? Is it really one of those things where you just have to be patient and let time teach you the experience?
Ruby Vee, BSN
The answer is -- it takes experience. But only if you've spent the time while you're getting the experience looking things up. There should be a few basic meds that everyone (or most of your patients) get. Make sure you know the drug's generic and trade names, recommended dosage range, side effects, toxicities and drug interactions. Make a list the next time you're on shift -- take the top five (or ten or however many drugs you think you can handle at once) most frequently prescribed drugs and look them up. Make drug cards, or write the information down on a page in a pocket notebook. Taking the time to write things down helps you remember them. Once you know those five or ten drugs, make a list of the next most prescribed drugs, and so on.
There are always going to be new drugs, drugs you've never heard of and drugs that are being prescribed for an off-label use. Those you will have to look up as you encounter them.
Infrequently, you will encounter drugs that shouldn't be given together. Do you REALLY want to give three anti-hypertensives together at 10am? The pharmacist can help you with that -- maybe one has immediate onset and peaks in an hour and another peaks in three hours but lasts for 24 hours. (I'm sorry-- more things you have to know.). Make special note of drugs you encounter that have special considerations.
At first, you're going to have to spend time at home looking things up in your off hours. As you learn more and are adding to the knowledge base you've already started, you'll be spending less time looking things up at home, but in the beginning you really have to.
HouTx, BSN, MSN, EdD
Although you will become very knowledgeable about meds that you administer frequently, it's pretty much impossible to know everything. This is what pharmacists are for. They are responsible for reviewing all the the meds for each patient, as well as all new orders. They should be providing information about interactions (drug-drug, drug-food, IV incompatibility, etc) as well as any other precautions. This information should be noted somewhere in your MAR system. If you have any questions, the pharmacist (NOT pharmacy tech) is your best resource.
High quality patient care is the result of a multidisciplinary team effort. You're not in this alone.
Pharmacists are a great resource, I've called them multiple times when I had questions about medication administration, side effects, or compatibility that is more in-depth or complex than I can find the answer to on my own. If I don't know a med, I look it up in our medication info system before giving it to a patient.
Always ask if you have a concern or question.
Although you will become very knowledgeable about meds that you administer frequently, it's pretty much impossible to know everything. This is what pharmacists are for. They are responsible for reviewing all the the meds for each patient, as well as all new orders. They should be providing information about interactions (drug-drug, drug-food, IV incompatibility, etc) as well as any other precautions. This information should be noted somewhere in your MAR system. If you have any questions, the pharmacist (NOT pharmacy tech) is your best resource.High quality patient care is the result of a multidisciplinary team effort. You're not in this alone.
The bolded text applies to electronic MARs but not to handwritten paper MARs. Until a few months ago, our unit used only hand-transcribed MARs, and admin times were determined by the RN assigned to the patient. Then. as a result of our system's transformational ideology for "operational best practices" we were forced to adopt the Cerner e-MAR (but only in as much as it's generated by Cerner - we're still doing it all on paper), which is relatively inflexible with its standardized administration times. When I get new orders on a patient, I'm not going to time Lasix, captopril and clonidine all for the same time. But the e-MAR does... because the orders are entered by a tech and only reviewed by a pharmacist for accuracy. We don't have a unit-dose system so things like this get overlooked. When a newly graduated nurse is assigned to this patient, all of those meds will be given at 0800 as indicated by the MAR, with predictable results. The OP is wise to be wary!
CCU BSN RN
As a rule, all PO meds can be given together. There's usually a huge note in the MAR or the order itself if they can't. Looking up PO compatability would definitely drive me crazy, and FAST. Unless there's a notation otherwise, I don't even bother.
The DO NOT CRUSH list is a good one to know where it is. Some things like Finasteride can apparently cause fertility problems if you crush it. And some will just clog the crap out of your tube or not work right. Basic rule is no extended release or sustained release should be crushed, anything that ends in ER XR or SR.
I like to know generic and trade names, and again, these you will get better at with practice. They may be right on your MAR. Patient's may know their drugs by one name or other other, usually not both, so I say both every time.
IV compatibility is obviously important. If you're going to have the same patient for a few days, it would make sense to keep the compatibility info handy. At my old job we had a chart, and I would print it off and highlight the meds the patient was on for easy reference, and then hang it in their room. Why not make it easy on the next RN as well?
You should have some idea of the meds you're giving and if they can cause disasterous side effects. You shouldn't be pushing antihypertensives or beta blockers or dig or lasix without knowing more about them. Pushing lasix too fast can cause irreversible ototoxicity, for example.
If you feel you're lacking, ask an experienced RN or call pharmacy, and keep a list of medications you want to look up. Spend 15 minutes a week at home looking up medications you're unfamiliar with.
If you feel the pharm course you got in school was inadequate, you can always sign up for a pharm refresher. I think Itunes U has some pretty good free courses in a variety of subject matter, including Nursing and Medical.
If you just need to know what a med is given for so you can tell the patient, it's okay to google it. Don't get complex info from Dr. Google, but you can find out common indications for a certain med.
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