IV Push Meds

[AlmostThere19]

I'm a new graduate who just started working. In nursing school, they taught us how certain medications had to be pushed over certain time frames. I also know that some meds are supposed to be diluted. When I've asked other nurses about what rate to push or if a med should be diluted, they always seem to not know or act like it doesn't matter. I am so confused by this. What is the right way to give IV push meds? I've looked up the directions for some meds in my drug book and plan to just go by that, but why does it seem like it doesn't matter how fast you push it or if it's diluted when I ask other nurses?

[dream'n, BSN, RN]

When I worked the floor, only about 3 1/2 years ago, I always looked up my IV push meds unless I already was aware of how to give it. That's just safe practice. I kept my own Nursing 2015 medication book in my locker. I wonder if any of the nurses you work with just slam in the Lasix and have had a patient lose their hearing.

I wouldn't take any shortcuts with medication administration. Remember if something happens, it'll be you in front of the BON. When in question about anything, I always took a moment and thought about what my justification would be if I was ever called into the Board. That always clarified the question for me.

[L-ICURN, BSN, RN]

On 9/22/2019 at 9:05 AM, FacultyRN said:

I'd recommend looking up the common meds on your unit in your drug manual from nursing school if you still have it...

It's also not pharmacy's responsibility to educate the nurses on administration of each med (although they're a great resource). These are nursing considerations, so they're a nurse's responsibility to find out before administering the med.

Please disregard the poster who said "you need to forget what they taught you in nursing school. This is the real world." Yes, it is... and the real human lives that are relying on you to provide evidence-based best practices to avoid harm would like you to remember what you learned in this case. Barring a code situation, rates of administration should absolutely be followed. To say that's not reasonable for a busy nurse is really just crap...

Remember, you may be a new grad, but you are already an RN and held to RN standards.

All of this. I just deleted part of it for space considerations. I don't rely on pharmacy all the time. Know your meds. Make it a point to know your meds, rate of administration, side effects, etc. Like another poster said, it won't be the pharmacist or a coworker facing the board if a disastrous error is made.

[K9lover, ASN, RN]

I don't know why they teach that narcotics must be diluted. Very few RNs did so, when I did bedside nursing I never diluted narcotics and the only problem I ever encountered was if the previous RN did so without explaining to patient so I'd get the rare patient who thought the previous RN gave them half a 5 CC syringe of all Dilaudid. I'd tell them that 5 CC's of Dilaudid would be lethal and most of that previous dose was NS, if they wanted it pushed fast I'd push it fast...they'd get their 2 second rush (and know it was Dilaudid.)

I am not their 12-step sponsor, this sort of thing did not faze me.

[brownbook]

I don't think the fear mongoring of, you'll be the one in front of the Board of Nurses, not the pharmacist or your colleague, is helpful, accurate, or appropriate.

It's been mentioned 100's of times. Nurses lose their license from drug diversion and other issues. Rarely, if ever, over med errors.

There was an article on Allnuerses by a nurse who had made a deadly med error and how she and her facility dealt with it. It was handled rationally and compassionately. Don't remember if anything was done to her license. But she is currently working as a nurse.

[KarenMS]

We have an IV med administration guide on our hospital intranet that addresses where in the hospital certain meds can be administered (only critical care areas, OR, etc), dosing, rates. It’s very helpful, but when things aren’t addressed, I am a heavy pharmacy caller.

[NRSKarenRN, BSN, RN]

Disagreeing with my colleagues: Pharmacist IS the appropriate person to call when question if IV drug needs diluting and EMR medication order does not have any parameters nor drug resource book/online med compendium. They are the MEDICATION experts.

Hospitals safety committee composed of nursing staff, pharmacy, Clinical Managers, physicians, IT staff often involved in setting up medication order parameters when new EMR system implemented and periodically thereafter to add new meds/update current ones. If your facility does not have IV drug parameters, I'd send email to Nursing Manager/ Nursing Informatacist/ floor based Pharmacist requesting addition.

[piscesneuronurse]

Hiii! Also a new grad and literally googled this today because sometimes I don't have the time to look up each med and I'm ready to just have it by heart. Here's just a few specific tid-bits I've learned in my short time in nursing.

Fentanyl my 35+ year experience preceptor pushes fast no problemo.

Labetolol seems like 20mg pushed fast once put a woman into cardiac arrest and killed her. (I normally give 10mg at my job, so I'm going to just push it semi-slow now)

Hydral our MAR tells us 1-5 minutes, its a small volume so I'll do it slowly to reach that 1min

Prednisone and Dexamethasone apparently can cause tingling in the genitals if pushed too fast

Lasix can injure the inner ear if pushed too fast

These are all I know for now! I hope it was some kind of help!

[Kamilah Coney, ASN, BSN, MSN, RN]

In the facility where I work, the dilution directions can be found in the MAR once you hover over the medication. We don't dilute the IVP narcotics. IVP medications like zofran and protonix, we dilute those in 10ml normal saline and pushed over 2 minutes. When in doubt, check your facilities policies.