Knowing your meds. . .

[R.NICU]

I Had an awesome instructor for clinical last semester. Ideal. She had a funky-fresh funny attitude, cute sayings, and wasn't the psych-b^+cH from hell that everybody is scared of getting. Very knowledgeable as well :). Anyway, I loved how thorough she was when it came to passing meds (very thorough with everything actually). she'd ask us the 5 rights (Our school actually has 8 or 10) and also wanted us to look in the drug book to find out it's mode of action, what it's used for, dose range, most crucial adverse effects, and check other pertinent info, such as bp or pulse if giving a beta blocker or check the pts K+ if we were going to be giving lasix, etc, you get the point. I ended up catching two mistakes by doing all of this. In one instance, the patient was mildly hypokalemic and had an order for lasix w/o a K+ supplement ordered... got that corrected, physician ordered k+ supps. Another instance, had a new order for a drug to be given twice a day at 100mg when the max dose was no more than 100mg qday... once again, got everything fixed.

When i told the nurse about the K+ issue she stated "Often times, there's no time to question what's ordered. The doctor orders it and you give it." So i told her i wasn't comfortable giving the lasix. Lo and behold, she found me later and showed me a new order for K+ supplements.

Now this clinical was on a med-surg oncology floor and the instructor works in postpartum outside of school. She checks all of this because she's new at teaching med-surg and doesn't give alot of these meds in postpartum. Once she starts to remember the drugs she's not as thorough. So i guess my questions is:

When starting as a new grad, did you look up all the meds you weren't familiar with until you committed them to memory? Or do you just do the 5 rights, check meds against the MAR and go? There are a lot of meds that I remember, but plenty that i don't know or remember and i don't want to hand out medications of which I know nothing.

Realistically, how did you approach this as a new nurse? Is there enough time to look them up?

Thanks for listening to my gobble-dee-gook

[KeepingItRealEeyore]

I still look up meds to this day if I don't know waht it is for. most places have something called micromedex on their system so when you are doing your med pass, you can quickly look up a med and find out about. When I was in nursing school whe had to look up meds and know the things as you stated in your post. Just because a Md writes an order for something doesn't mean it is correct. This is why critical thinking as a nurse is so important. Plus if anything were to go wrong you are responsible as much as the doctor.

[R.NICU]

I still look up meds to this day if I don't know waht it is for. most places have something called micromedex on their system so when you are doing your med pass, you can quickly look up a med and find out about. When I was in nursing school whe had to look up meds and know the things as you stated in your post. Just because a Md writes an order for something doesn't mean it is correct. This is why critical thinking as a nurse is so important. Plus if anything were to go wrong you are responsible as much as the doctor.

Thanks for your prompt reply !

I've had rotations at hospitals where they have computer charting and this information can be checked on the electronic MAR, very convenient. But during that rotation, we were at a hospital that didn't have the luxury of computer charting so you have to look it up. The nurses there would surely benefit from Micromedex. Also, the facility i'm employed with doesn't have computer charting. Most likely, i'll be working at this facility as a new grad. So... to all of you who have to flip through a drug guide for the answers to your medication questions, .... do you? I've seen nurses say "Carafate? What's that?", with a puzzled look on their face they continue to pop it out the package and proceed into the patient's room.

[Lovely_RN, MSN]

The bolded is really bad nursing practice. Never mind what they do look it up!

Thanks for your prompt reply !

I've had rotations at hospitals where they have computer charting and this information can be checked on the electronic MAR, very convenient. But during that rotation, we were at a hospital that didn't have the luxury of computer charting so you have to look it up. The nurses there would surely benefit from Micromedex. Also, the facility i'm employed with doesn't have computer charting. Most likely, i'll be working at this facility as a new grad. So... to all of you who have to flip through a drug guide for the answers to your medication questions, .... do you? I've seen nurses say "Carafate? What's that?", with a puzzled look on their face they continue to pop it out the package and proceed into the patient's room.

[asfreeasabird]

I wonder what these nurses tell their patients when they ask what carafate is for.

[mustlovepoodles, RN]

I'm not at the bedside anymore, but when I was there were no computers on floors. It was all paper charting and the only computer in the hospital was bigger than a Suburban. Anyway, what I did was keep a running list of drugs as I came acrss them orientation, before I was actually giving the meds. At night I spent time looking them up, writing pertinent info on an index card which i carried with my other drug cards on an O-ring in my pocket. Very quick reference for me. I learn best by looking things up and writing them down. Printing off a copy does me no good at all.I have to write it out by hand to remember it.

[KeepingItRealEeyore]

When I was at places without micromedex, I was known for keeping my drug book in my pocket along with note cards about meds. I think it is important to know the meds you are giving patients because when I do I feel more comfortable. when I give meds I educate the person about them, remember pt education is a huge part of nursing.

[highlandlass1592, BSN, RN]

I looked up all my meds as a new grad, until I had a good understanding of what it did and why it was ordered. And 12 years later, I'm still looking things up. I find new things out all the time about drugs. I don't use a drug book however. I found some great apps on ITunes for nursing and physician drug guides and use those on my Iphone. Much, much easier than carrying around a clunky drug book...plus the apps are updated much quicker than a hardbound drug book. Easier to carry too. You may want to look into something similar.

[R.NICU]

Thanks to all that have replied.

Highlandlass1592,

I think having the drug guide on your phone is an excellent idea. I'd imaginie it'd be much quicker to access the info, and getting the most up-to-date info would be as simple as a download instead of purchasing the newest edition of Davis. Approx. how much do they cost? I'm certain i'll be getting one.

[JulieCVICURN, BSN, RN]

I don't know about other phones, but the Davis drug book for the Droid is $99. A bit out of my price range for something that I'll lose the next time I upgrade my phone!

[netglow, ASN, RN]

I have an itouch. A itouch is good because you can show your co-workers, NMs that you are not texting because it is not a phone.

Bought the Davis Drug guide for my touch a year a go I think August... was $50 something, it always updates. My Mosby drug book, fell apart in chunks after less than a year of purchase. I just upgraded my itouch system software (should have a long time ago, LOL) and all apps I have, prompted themselves to auto-upgrade. Nice. I also joined Medscape, they gave me their drug guide. I use it as well and it's free. I had downloaded Epocrates free version, and do not ever use it as it hits you with ads, and is a pain to use. For Epocrates, you'd need to drop some serious $ to actually purchase it in order to access most of it's info, so Medscape is a huge assest in comparison to Epocrates. A neat thing in Medscape, is that you can save your "scary" drugs in a special group for quick access.

[BookwormRN]

I am known for carring a pocket drug guide for nurses on my COW (computer on wheels), as I always look up meds that I am unfamiliar with. If I cannot find it in my book, then I will resort to the computer (I prefer books!). If I don't at least know why the Pt is receiving the medicaiton and what it is used for, I have no business giving that med.

Keep in mind; you will never remember everything about every med.