New Nurse: which psych meds can be mixed for IM?

[Sophie H]

Hello, Im a new nurse who got hired in adult psych inpatient. 

I learned antipsychotics at school and I thought I knew most psych meds  pretty well.

Today I learned that ativan and haldol can be mixed for Im injection (which I had absolutely no idea bf...). I came home and started looking up (as I freaked out for not knowing such basics...sigh) Im really sorry for asking a dumb question here ?

I checked textbook but theres nothing about mixing psych IM meds...

Is there any other psych meds that can be mixed for injection? 

If so, what are they? And which ones should I draw up first?

Thank you! 

[B52, BSN, MSN, RN]

This is not a dumb question. Many nurses I work with did not know that you should not mix IM Zyprexa and Ativan (or any other benzodiazepine). The combination can increase cardiorespiratory depression.

[TheMoonisMyLantern, ADN, LPN, RN]

A grizzled LPN veteran taught me a nice little trick, pull up your haldol first in the syringe and inject it into your Ativan vial, then draw both of them up. Ativan is oily and hard to draw up by itself but by instilling the Haldol it causes it to draw up much easier!

[futurepsychrn, ADN]

Hmmm....pharmacy told me not to mix haldol and Ativan.

[verene, MSN]

9 hours ago, futurepsychrn said:

Hmmm....pharmacy told me not to mix haldol and Ativan.

Did they give a reason? It's pretty common practice. 

[NRSKarenRN, BSN, RN]

Best to consult your facilities Syringe Compatibility Chart -- if you don't have one, request from your pharmacy department. Otherwise, consult  pharmacy department or a drug guide for best response.

Examples:

http://www.vhpharmsci.com/Resources/PDTM/APPENDIX X = Syringe Compatibility Chart-VA.pdf

 

FA Davis Drug Guide:

 

 

[futurepsychrn, ADN]

12 hours ago, verene said:

Did they give a reason? It's pretty common practice. 

No. I was a new nurse and wanted to make sure. Maybe it was facility specific.

[mell0nurse]

I just learned you can’t mix Benadryl and Ativan in the same syringe. 

[AnnaCARN, BSN]

You should have some kind of drug compatibility program on your computer, like Lexicomp.  Everywhere I've worked has it.  When in doubt I always call pharmacy.

[SarahMaria, MSN, RN]

Where I work, it is policy not to combine any drugs in an IM syringe.  So we often have to give 3-4 injections at a time.  Stupid...

[BrianaRN28]

I am glad I found this thread. I am having a similar concern at a psych ER that I am currently in orientation with. I know good and well that Benadryl cannot be mixed in a cocktail but this facility is drawing up the Ativan, Haldol, and Benadryl all in one syringe. When I made a point of asking about this, I was told that it "takes too long" to administer two IM's during a takedown. This facility takes in violent, psychotic patients who are out of control. I am not a new nurse by any means but being the "newbie" honestly sucks. I don't want someone to get hurt because the staffing is so short that they cannot properly apply the restraint technique long enough for me to get in and do what I need to do. I am well practiced with giving two IM's quickly but I am also realizing that I am going to be the only nurse giving two shots during takedowns. I am worried that this is going to cause some static with my new co-workers.  Any advice? 

[B52, BSN, MSN, RN]

My advice is to honor your facility's compatibility chart.