standard concentrations, does your facility use them ? - page 2
We use them here and the patients on them seem to have wicked labile blood pressure that I never saw when pt's were on gtts made with rule of 6's (my other 2 hospitals). Anyone else seen this? It's... Read More
Jan 13, '08Occupation: PICU RN Joined: Jan '08; Posts: 8Within the last 5 years we went to standardized concentrations, eliminating the "rule of 6." Some of the reasons were cost conscious: all Dopamine comes in bags mixed off site (1600 mcg/cc and the lesser concentration which escapes my tired brain right now). Some of the reasoning reflected safety: all actual concentrations of drugs mixed in the unit were of different concentrations despite using a universal formula. A 60kg teen has a lot more epi in that syringe than the 4 kg baby in the next room on the same drug, running at the same dose. So, our pedi pharmacist, management folk and attendings created our standard infusion book. All drugs are mixed according to the 'recipe card' with a choice of concentrations (depending on fluid restrictions) and a graph is followed, one specific to infant, child or teen, matching the weight and the dose with the appropriate rate of the pump. This new policy also came with a pledge from the pharmacy that, other than the initial, emergent start of an infusion, they would supply all other bags or syringes of the meds. That part is still in the working-out phase. I have to say, it took a while for me to embrace this standard concentration thing. I felt like it was "too easy" to put a dopa, epi or terbutaline gtt together.....just follow the recipe, no math. No more easy increase or decrease on the dosing since 1cc no longer equals 1mcg/kg/min. you've got to follow the recipe card (We don't really call it that, can't think of another name right now) 2 RNs must sign all gtts on creating, even if just diluting Versed or Fentanyl, 2 RNs sign off at the beginning and end of shifts or whenever there is a change in the dose of a cont. infusion all part of a JCAHO safety audit. Mistakes certainly do happen but I like to think they're caught a lot sooner if we all pay attention to what we're supposed to do coming on and off shift and actually do it.
Jan 17, '08Specialty: 13 year(s) of experience in PICU ; Joined: Jun '06; Posts: 866; Likes: 1,695Our hopsital is going to be geting the ALaris smart pump. We use certain concentrations such as 800mcg/ml or 3200mcg/ml of Dopa, 30mg/ml of Epi. 1mg/ml of Morphine, etc. Do these smart pumps recognize our concentrations?
Jan 17, '08Joined: Jun '01; Posts: 10,086; Likes: 8,453I'm pretty sure the libraries are programmable to the user's specifications. I'm not a fan of Alaris volumetric pumps for a number of reasons. We use the SE Gold pumps, which have been programmed, but we don't use the programmed settings. I don't find the pump or its components to be particularly user-friendly. See what you think when you start using them.
Apr 5, '08Joined: Apr '08; Posts: 6; Likes: 13I am a PICU travel nurse and the hospitals that I have been to in at least the past three years, if not five,
have had standardized doseing. It makes perfect since to me. With this said, if you were to turn over my calculator, you would find the "RULE of THREE" writen out on a piece of tape, just in case. I do understand that most of the hosp. on the West Coast do still use the Rule of 3 and the Rule of 6. Must say that it did work for years!