Hi! I need opinions. I am in my first year of nursing on a small med surg floor. I work 7pm-7am and our pharmacy closes at 9. We get coverage from 9pm till 7am through fax and computer, under a contract made with another area hospital. As far as I can tell, that pharmacist will review new med orders and unlock those med drawers in the PYXIS under the name of the pt for whom the drug has been ordered. Many times, we mix our own antibiotics because they were not brought to the floor before pharmacy closed for the night, even standing orders. However, the antibiotic can usually be over ridden, removed from the PYXIS and mixed appropriately. I have never been comfortable with this system as I am not a pharmacist. Two nights ago, I had an order for IGG serum IV. I did not find it on the floor. I then paged the nursing supervisor who went to the pharmacy, got the vials, and told me to mix them. I opened the first box and discovered that it was a powder, and had no real useful instructions for mixing. I paged the supervisor who told me to take the vial to ICU and they could help me with it. Well, to make a long story short, they could not tell me. We sat down together to look at the instructions and discovered that the vials could not be mixed in the % necessary for the dose ordered. That's when I said "not doing this!" I paged the nursing supervisor again, explained the best I could. She sighed, came back to the floor and picked up the 2 vials and took them back to pharmacy. I found out in the morning when pharmacy opened back up that the drug need to be mixed under strict procedure and under a hood and takes an hour to do properly.
On the very next shift, I had just taken report on a care and comfort pt who was awaiting a morphine drip. Pharmacy had closed even earlier this day, due to "staffing issues" The nursing supervisor who had promised to go get the med. When I walked out of the report room, there was the nursing supervisor (different supervisor from the night before). She handed me the vial of morphine (10 mg per ml for a total of 10 mls) said "Here", turned heel and disappeared up the hall. I looked up how to mix it in the drug reference book, but then felt EXTREMELY uneasy. I took the vial back to the nursing supervisor and told her I was not comfortable with mixing it. She gave me verbal instructions on mixing it, and along with the instructions in the drug book, I mixed it. The other nurses on my floor said they would have refused to mix it but my pt was in a great deal of pain (severe COPD, and a broken vertebrate) and I felt a duty to her and her family.
NOW-Sorry for the long post, but has anyone else had this experience? And by the way, I am told that we USED to have a full time pharmacist. What do you think I should have done? Previously this pt had been on 2-3mg q 30 minutes.
