mixing po meds

[ambrscot]

I have worked for 27 years in Pediatrics and have always mixed po meds together in a medicine cup and they administered them with an oral syringe, i.e. antibiotic and orapred. Now, my manager is calling me on it. I have never had any ill effects with any of the kids. What is everyone's take on the situation?

Thanks,

Kate

[NotReady4PrimeTime, RN]

I wouldn't do that. Not because of physical incompatibilities necessarily (they're going to mix together the minute they're in anyway), but more because you aren't actually getting the whole dose of either med by mixing them in the med cup then drawing them up. It would be much less of a challenge to only have to approach that suspicious 3 year old with just a single oral syringe, and Orapred tastes absolutely vile, but accurate dosing is important.

[ChristineN, BSN, RN]

I never mix meds together, and that goes for when administering PO or via a NG/G/J tube. Reason being, what if pt starts spitting up, tube get clogged, etc you have no idea what meds the pt got and which they didn't. Too risky.

[amers_here]

I've seen meds mixed in a syringe like that, but that was during my preceptorship at a pediatric SNF and most of the kids had G tubes. For a kid who's really taking it by mouth, then separate syringes would be better because if halfway through the kid decides they're not going to take any more medicine, you know exactly which meds were not taken.

[NeoPediRN]

If meds can be taken together, they can be mixed together. I always crush meds, mix in juice and draw up in a syringe. Kids generally don't swallow pills, and they're not going to drink what they can taste. I've yet to see a policy that says not to do this, and by common sense, they end up in the same place anyway.

[NeoPediRN]

I should specify that I draw them up from separate med cups into the same syringe.

[ambrscot]

I do measure out the individual medications in syringes to get the correct dose and then mix them together and draw them up in a new syringe.

[ChristineN, BSN, RN]

If meds can be taken together, they can be mixed together. I always crush meds, mix in juice and draw up in a syringe. Kids generally don't swallow pills, and they're not going to drink what they can taste. I've yet to see a policy that says not to do this, and by common sense, they end up in the same place anyway.

But what if the pt is fussy, decides half-way through they are "done?" I have held my share of toddlers down that were kicking and screaming trying to get them to take one med, I would not feel comfortable mixing multiple meds together and then not knowing which ones the pt doesn't get.

My way might take longer, but I feel better knowing when the kid spits the "red liquid" all over I know what exactly it is.

[NeoPediRN]

I've been lucky to rarely have this problem. I do a lot of juice races with the kids, or use a reward system. For the very difficult ones, I give them a break and try again in a bit or have the parents try to administer with me present, which is allowed at my work. Most of our sick sick kids have ng or g tubes though. Doesn't do the kiddos any good to not be able to get all of their meds.

[nursel56]

If liquid oral meds were drawn up in a syringe, because a child is too young or unable to drink from a cup or straw, they are drawn up in separate syringes. That's how I was taught, and I never questioned it. I think it's probably more accurate that way, because some liquids are an oil base, some are suspensions, some are alcohol free elixirs, etc. that don't mix evenly.