Medication Administration through a feeding tube

[lalexa15]

hi everyone!

this week was my first official med pass as a nursing student! my question regards one of my patients with a feeding tube. first, let me explain to you what happened. in lab we were taught if the patient is on several medications, you need to crush each one separately, put them in individual medicine cups and mix with 15 ml of warm water to let them dissolve. next you need to first flush with 30 ml of water to clear the tube and administer each medication separately, flushing with 15-30 ml of water in between each medication. well, on the first day, i had prepared all of my medications in their individual cups and turned to my instructor and asked her if she was ready to go into the patients room with me to administer the medications (it was my first time and assumed she was going to come with me). she replied "no". fine. i then said ok and explained to her that i have all the medications crushed, in separate cups and that i would administer each one separately with the 15-30 ml of water flush in between. she cut me off and told me not to administer them separately, just mix them all together and administer them all together at once. i was kind of surprised because of all the things we were taught about what could happen if you did not administer each medication separately (clogging the tube, adverse effects from mixing the medications together, etc.) well i did what she told me and put all the crushed medications into one cup and administered them. well yesterday after i finished my pharmacology final, my professor told me she needed to speak to me. apparently, one of my fellow clinical students had told the teacher that i was administering the medications incorrectly and that our clinical instructor was telling me to do so. i had to explain to her the whole situation and tell her other things that the instructor was telling us to do differently (like signing the mar before we give the medications and borrowing medications from other patients) my instructor told me that she was going to have to report this to the program manager and that she will have to make a decision on what happens next. i do not know what is going to happen next and i am horrified that i am going to get kicked out of my program. i feel extremely guilty for not administering the medications in a way that we were taught, but my instructor told me to.

my question to all of you is this: what would you have done? did i do the wrong thing? should i have ignored what my clinical instructor told me to do and administer them separatly like i was taught? how do you administer your medications through a feeding tube? do you administer them all separately? we always hear that what you learn in school will not always apply to the "real world".

thank you all so much for reading this long post and i'm looking forward to hearing your comments, replies and criticisms.

[JDZ344]

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[applewhitern, BSN, RN]

I don't administer them all "separately." They will all be going to the same place, and mixing there, such as in the stomach. If certain meds shouldn't be given together, then they need to be given at different times. There are a few meds that will clog a feeding tube, but most can be given thru the tube without any problems. Many of them can be in liquid forms, also. If the patient were able to swallow, they would be swallowing them all at the same time, wouldn't they? And once they all get in the stomach or small intestine, they are mixed, aren't they? Like I said, the meds that shouldn't be given together would be given at different times; some meds shouldn't be given with other meds, such as iron, calcium, etc. If I had to give each med separately, and flush after each one, I would be in there all day.

[Esme12, ASN, BSN, RN]

:hug:....relax. I believe that the pharmacology professor was referring to the clinical instructor teaching things that are not the "proper technique" You will find however that while crushed separately and mixed separately many nurses give them together, in groups, in the real world.

Shame on that clinical instructor for not watching and guiding you the first few time you give meds....what a lazy .......teacher. YOu don't sign the MAR first and you DO NOT borrow meds from another patient.....

http://www.factsandcomparisons.com/assets/hospitalpharm/mar2004_peer1.pdf

http://www.med-pass.com/Docs/Products/samples/A96970RCK_sp.pdf.......this has sample plastered all over it but I think you can glean a lot of information from it...

[honeykrown, MSN, NP]

Did the student tell your instructor that the instructions were given by your clinical instructor. If this person did then i believe there's nothing to worry about.

But really i dont see the problem with mixing the meds together. I now understand a lot that in school it totally different than in real world. I would also be concerned about giving iti in different cups if the pt was on fluid restriction. Imagine 10 meds 30cc inbetween and 30 before and after and mixing such meds in (at least) 15cc. Thats so much going down a pt on restriction

[Forever Sunshine, ASN, RN]

The real world way: Mix them up all together and administer at the same time.

The student way, or the way we do it when we are being observed: Like you learned in lab. It doesn't hurt to do it that way in the real world from time to time to keep your skill up for it so when you are being observed.. you dont screw it up.

I would speak to the program director and tell them that thats what the clinical instructor told you to do. I don't see the issue with mixing them up and giving them all together either.. after all thats what is going to happen in the stomach anyway. But this is nursing school and you have to do things by the book until you are in the real world and off orientation.

[systoly]

What were the orders? I have orders to cocktail G/T Rx for pt.s on fluid restriction

otherwise I give them one at a time. I don't know about this instructor. I'd not only

wanna observe you admin, but set up as well. I'm not quite clear as to who, professor/instructor, is reporting what, but the fact is you're a student, this was your first time and faculty chose not to observe.

[ICU, RN, BSN, B.S.]

They are all going into the stomach. The stomach is not sterile either. They all go down together.

[nurse2033, MSN, RN]

Mixing meds is fine, what happens in the stomach? You just want to use enough water so they are well mixed and will not clog. I'd be furious about being ratted out by a fellow student. That student should be told to mind their own business and pay attention to their own practice. You did nothing wrong. What would have happened if you argued with your clinical instructor. You shouldn't catch any heat for this. You followed protocol, and were told to modify by your instructor. They may catch heat for it, but not your fault. If your program is run by idiots and you do get kicked out, just get a lawyer. What you did was prudent and reasonable. Who was wrong? Student A for sticking their nose in. The instructor for not following the protocol you were taught. Hand in there!

[caliotter3]

I, too, would have done what my instructor told me to do. It will be a shame if you are punished for your instructor's actions. Yes, she told you one of the "in the real world" ways to do things, and she should have not done this while you are in school. There is plenty of time to learn the "real world" ways to do things once you get to the "real world". Kudos to you for recognizing the difference.

[littlemammanurse, BSN, RN]

In school I learned to mix all the crushed meds together and all the liquid forms of medications together unless otherwise specified by the doctor or if there were other contraindications with other drugs.In the real world this is how I practice as well.

[TonyaM73, ASN, RN]

You definately should not be punished for this, but I am always one to prepare for the worst. I would document everyone who was there and their phone numbers. I would also document time, place and exact words if you can for the situation, so that if by chance you have to produce evidence you have it all nice, neat, typed and with plenty of info. Write it down now while it is still fresh in your mind.

Honestly, I think the instructor was just talking about the clinical instructor (if you can call them that) and not you.