Mixing IV Medications...Illegal??

[XY_RN]

can anyone help me? i am in south florida. i realize there will be differences from state to state but i need to make a decision. do i continue this practice or refuse to do it? i have combed the nurse practice act and nothing is mentioned (only lpn regulations about iv's). what are your state regulations on mixing iv medications (all of them are antibiotics like vanco and rocephin) in a physician's office? i am the infusion nurse in an id office and i have been mixing these medications for patients daily. i recently heard that it's against the law for me to do so? i was told they must be mixed under a hood in special iv rooms. i also was told that the pharmacy that is supplying the meds to us unmixed, is also breaking the law. i thank you in advance for any help or direction.

[southernbeegirl, BSN, RN]

i'm in LTC. we give tons of IV antibiotics. some come from the pharmacy premixed and some i have to rehydrate. according to our facility it is against "state policy" for our LPNs to rehydrate the antibiotics. i think that is ridiculous. i also believe it's a company policy not a state reg. what do yall think?

[NRSKarenRN, BSN, RN]

jcaho medication management standards for january 2004

when an on-site, licensed pharmacy is available, only the pharmacy compounds or admixes all sterile medications, intravenous admixtures, or other drugs except in emergencies or when not feasible (for example, when the product's stability is short)." intravenous admixture is defined as "the preparation of pharmaceutical product which requires the measured addition of a medication to a 50 ml or greater bag or bottle of iv fluid. it does not include the drawing-up of medications into a syringe, adding medication to a buretrol, or the assembly and activation of an iv system that does not involve the measurement of an additive. this standard 4.20 specifies that preparation of such an iv admixture must be performed in a class 100 environment (airborne >0.5 micron particulate count of

http://www.apsf.org/resource_center/newsletter/2005/summer/11jcaho.htm

a guide to jcaho's medication management standards - google books result

you are working in an outpatient setting so these hospital standards do not apply as stated working in an infectious disease physician office. state specific regulations regarding the preparation and dispensing of medications found under the board of pharmacy and health care facility licensure laws.

see : http://www.floridashealth.com/mqa/pharmacy/ph_statutes.html

pharmacy services - drugs, devices and cosmetics regulation

the board of pharmacy is pleased to announce that rule 64b16-27.797, florida administrative code (doc), standards of practice for compounding sterile preparations - (csps), became effective on wednesday, june 18, 2008.

reconsituting single dose vials and adding to iv bag for administration should not be an issue if you have had prior education,training and compentency in iv administration, knowledage about medications handling and side effects, p+p covering emergency treatment and anaphylaxis kit available. mixing several iv medications into one infusion bag from multidose vials crosses over into compounding of sterile preparations and above regs then would apply.

since you are having qualms about iv administration, frank discussion with physician indicated to protect your license, limit physician liability and optimize patient safety.

[BabyLady, BSN, RN]

The hospital that I work at drugs are mixed all the time...however, it does depend on what it is. Not everything is mixed or added to IV bags on the floor.

A special hood is not necessary for IV medications unless, as the other poster mentioned, they are cancer drugs.

I think when you check, you'll find it's not a matter of mixing the meds that is against the law, but that it's not common in some places due to increased liability. There is a huge difference.

[blondy2061h, MSN, RN]

We only mix chemo under a hood. I mix IV antibiotics all the freakin' time. We need to mix our own meropenem, bactrim, primaxin, etc...

I'm on an RN only unit, so I have no idea if LPNs can do it.

[canoehead, BSN, RN]

When I worked as a night supervisor we frequently went to the pharmacy to mix meds (with extra training, and the blessing of TPTB). If you are licensed to give the med you can mix it outside the pharmacy, with the exception of meds that are toxic when inhaled, like chemo drugs. If you are adding meds to a bag whether it be one medication or five it needed to be mixed under the hood if you were going to be puncturing the receiving bag 3 times or more. That included adding anything to the TPN bags, even though I was only puncturing once, the bag itself had more than 3 meds added.

All of the above I haven't checked with state law, but our pharmacist was a real stickler. I'd recommend writing to the BON and looking up state law online to be sure.