hanging IV antibiotics

[orangepink, NP]

i'm a new grad nurse in a med tele or med surg unit. it's my 2nd month of training and i've been taking the full load, which is 7 patients. i have a question about hanging IV antibiotics. in one of my shifts, i had several patients that needed IV antibiotics. my unit policy states that we can give medications one hour before and after but i was so overwhelmed that i decided to give the zosyn two hours before just so i can catch up with all my other tasks because i had 4 patients with achs accuchecks. is that okay?

also, aside from vanco, what antibiotics (and medications) should i give on time?

[Mommy_of_3_in_AL..RN]

In reality you should try to give them all on time, but usually the vanco and levaquin get given first by me, then merrem, flagyl, clindamycin, etc. Try looking at what all you have to do, and plave the antibiotics and blood sugars first, take vitals while hanging them ,then worry about baths, linens, etc. In real life though, everyone will want their PRN meds at this time, so maybe if there is a patient that you know is going to ask for pain meds at 10 am, when they are to get antibiotcs, ask them if they need something before you go in the room, so you can take it all at once. If a patient has multiple antibiotcs back to back, see when ones you can hang at the same time and knock as many as you can out. 15 minutes isnt going to turn into a disaster. just get your assignments, look at the MAR and plan your day accordingly, you jut have to get a goodl look at the overold

[sonja77]

i usually look at the frequency and decide from there which abx to give first. zosyn e.g. is usually given q6 hours, so i would try to give that as close to the scheduled time as possible. levaquin on the other hand is given daily so i wouldn't worry too much if i would give that an hour late.

another thing to look at is the volume of the bag. i had a pt the other day that was on rocephin (50 ml) and zithromax (250 ml) daily, both due at 0900. i started the rocephin first at 0830 and then the zithromax at 0915. that way i got them both started within the allowed time frame.

[RheatherN, ASN, RN, EMT-P]

The meds that are given certain amt hrs apart HAVE to be given on time, they are scheduled that way for a reason. others like PO, and daily are impt, but can be delayed a tad if needed. just try and organize diff maybe?

-H-RN

[Mommy_of_3_in_AL..RN]

generally that is true. Scheduled meds, like antibiotics that are scheduled every 8 hours, should be given on time if at all possible. Although, sometimes, especially in a unit or with an unstable patient, you have to look at the overall importance of the med, what can be given together, and what access you have. For instance, ihad a patient today with a critical low potassium and hematocrit. He had to have several units of blood products, IV potassium replacement, and a nexium drip for GI bleed. There was only one access through a portacath, and none of those meds/products could be given together. He also had a scheduled broad spectrum antibiotic and a couple scheduled pushes. He has no active infection, and although we got a second access, th most important things were the blood and potassium, so the times we gave the other things had to be altered and given between blood infusions. All in all, we managed to give 6 of the 8 blood products, and all the schedule pushes in time, i was able to get

[classicdame, MSN, EdD]

the schedule is not made for your convenience, but for the patient's welfare. I know that sounds harsh, but that is how some lawyer might interpret your logic. Be careful. Too early or too late is still a med error.

BTW, this balancing act is one of the harder parts of nursing. Even when you figure out how to prioritize, something comes along to upset your plans. I commend you for asking for input!!!!