med error panic

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I'm a new RN working on a surgical floor. I'm still in orientation & working with an excellent, experienced preceptor. Yesterday we had a patient with a long history of IV drug abuse admitted. He had IV Ativan ordered, and over the course of the shift I gave him three 1 mg doses. As I was leaving, I noticed the next nurse preparing his Ativan by diluting it with NS. My preceptor had already gone, so I went home and looked it up (which of course I should have done before I ever ever gave it b/c I've never given IV Ativan before) and of course it says to dilute. I showed my preceptor all 3 doses (1/2 ml, obviously not diluted) before giving it each time and she watched me walk into the room with it. I gave the small amount very slowly (over 3 minutes) because it was viscous. Pt's IV line was still patent at the end of the day and he said the site was not painful. What should I do now?

I agree - don't panic.

Check with your institution, as others have said. We don't dilute Ativan. ;)

Always look up drugs - no matter how rushed you are.

I wish you the best.

steph

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Specializes in Travel Nursing, ICU, tele, etc.

Yes I Definitely agree to look up drugs, I have a PDA in my pocket that I look up stuff on all the time.

However, I would be VERY concerned, if from a systems standpoint that your MARs don't include instructions that you need to know for that medication....like dilution or give slowly over 2-3 minutes or whatever...

I'll be curious to see what you find out....

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Specializes in Med-Surg.
When I was doing my senior preceptorship, I was told to dilute every single IVP as a rule. Don't give anything straight. Those of you with more experience, tell us if this is a reasonable rule.

It's important to look up the drug and find out for sure. For example IV Phenergan is recommended to be diluted a whole lot more than IV Ativan. I usually don't dilute Lasix, Solumedrol, Reglan, Dilantin and other things.

Rather than have a blanket rule to dilute everything, it's still best to look it up and follow established recommendations for the drug, although almost all drugs can be diluted without harm.

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It's important to look up the drug and find out for sure. For example IV Phenergan is recommended to be diluted a whole lot more than IV Ativan. I usually don't dilute Lasix, Solumedrol, Reglan, Dilantin and other things.

Rather than have a blanket rule to dilute everything, it's still best to look it up and follow established recommendations for the drug, although almost all drugs can be diluted without harm.

I'd never heard of diluting Lasix or Solumedrol or Reglan until I came onto allnurses. . . .of course we add NS to Pepcid and slow push it.

I actually do dilute Ativan, just because it is so thick.

Again, check with your hospital P&P's.

steph

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meridith T- while diluting meds can be a good practice like everything we nurses do it needs some critical thinking for the average adult healthy patient I am a big advocate of diluting and running things toward the conservative rate but in kids especially little ones you need to be very careful about fluid limits and things need to be given within safe concentration ranges but towards the more aggressive side.

Vaccina- Again thankfully the patient wasn't hurt and this is a learning experience, you are new and your preceptor should provide a second level of protection that they failed you on but if this is your only med error (and it almost certainly won't be) you should be alright:wink2:

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Specializes in Neuro, Critical Care.
I really don't think giving that dose of Ativan undiluted is a big deal.

The recommended dilution for Ativan is 1:1 with normal saline, so the dose you gave really only called for 1/2 cc of saline to be added. You stated that you had pushed it over 3 minutes...IMO, pushing it that slowly really ends up having the same effect as diluting it would have, as pushing a 1/2 cc over 3 minutes would result in a very tiny amount of the med hitting the circulation each second...think about it, that's like giving 0.16 cc over a minute and the normal circulation of blood is more than enough to dilute that miniscule amount of med passing through. (If the pt had IVF running as well, then you don't need to dilute)

I've given Ativan many times without diluting it, to pts with active seizure activity. I have seen probably all of my co workers do it as well. In these instances, it's just pushed in, and not slowly. (this is in the ER where its given very frequently) I've never seen it cause a bad outcome or ruin an IV site. (Obviously, I wouldn't try this on a little 90Y/o with a 22 in the hand!)

No, I'm not advocating going against the recommended administration for most meds! My point is that it is very unlikely that you caused this pt any harm.

My only concern is that you did not look up a med you are unfamiliar with; you need to look up any first time med before you ever even draw it up. ALWAYS! No, this time wasn't a big deal, but there are many meds that could have very severe adverse outcomes if not given properly, and you are lucky that this wasn't one of them.

I work in neuro critical care and we have seizures all the time. Ive seen ativan given undiluted many many times. Never harmed any of those pts. Of course i'm not saying ignore what the books say..but it prob isnt going to harm the pt. Ativan is just really thick and diluting it makes it less viscous. Do always always look up drugs you aren't familiar with though...and ativan is a pretty common one.

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Specializes in Neuro, Critical Care.
It's important to look up the drug and find out for sure. For example IV Phenergan is recommended to be diluted a whole lot more than IV Ativan. I usually don't dilute Lasix, Solumedrol, Reglan, Dilantin and other things.

Rather than have a blanket rule to dilute everything, it's still best to look it up and follow established recommendations for the drug, although almost all drugs can be diluted without harm.

I always dillute dilantin. IV dilantin I dilute in NS and slow push. If i'm giving it down the tube flush before and after...dilantin doesn't agree with other drugs. I don't dilute Lasix or reglan. Sometimes I dilute phenergan, depends on the pt and their blood pressure. I usually drip solumedrol. Sometimes morphine, again, depends on the pt. their size, BP,etc.

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Specializes in NICU, PICU, PCVICU and peds oncology.

Just to deviate from the topic a bit... Did you know that if you dilute chloral hydrate at least 1:1 with water, it will be effective almost immediately? The hyperosmolar a med, the slower it takes effect, so lowering the osmolarity gets it abosrbed faster and gets it working faster. When I dilute chloral and give it via NG or NJ to my wigging out babies, it's almost like an IV med in how quickly it works.

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Specializes in Adult and Pediatric Vascular Access, Paramedic.

also... dont forget to check compatability, as some drugs are not compatible with certain IV fluids, and mixing them could change the chemical composition.

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Specializes in Trauma ICU, MICU/SICU.
When I was doing my senior preceptorship, I was told to dilute every single IVP as a rule. Don't give anything straight. Those of you with more experience, tell us if this is a reasonable rule.

That's not such a great idea eitther. Valium will precipitate when diluted with NS, well usually. I've seen it. If you look up valium it says NOT to dilute, just flush before and after. As a matter of fact, if pt. has IVF, I put them on hold, flush, push the valium, then flush again before re-starting the fluids. ALWAYS look up IVP meds or call pharmacy, ALWAYS.

P.S. This is from a toucy, feely nurse who has been known to treat certain rules as guidelines. This rule however, is a hard and fast one.

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