Prefilled Heparin/Lovenox syringes and cosigning

[pjdksmith]

A quick question. Recently our facility has gone to prefilled 5,000 units Heparin for SQ injections. My question is: since it is now pre-loaded, do we still need two signatures? Same with Enoxaparin, we have 30, 40 and 60mg syringes preloaded.. if we are not using a multi-dose vial; can we be legally allowed to have just one signature?

[Chin up]

We only need one signature in my state with the multi dose vials. I guess you need to check with your state or facility.

[MunoRN, RN]

High alert medication double checks aren't a "legal" requirement, they are highly recommended by ISMP but are not law in any state I'm aware of. What requires a double check is defined by facility policy, and even then you'll often find different requirements based on the level of care within the same facility. In my facility for instance, we don't require an RN double check for 5,000 unit prefilled syringes unless you are measuring out a dose (such as a 3,500 unit bolus).

[Double-Helix, BSN, RN]

That would be a good question for your facility's management. It really depends on where you work. In my hospital, you do not need a co-signature for sub-cu heparin or lovenox. The nurse needs a co-signature for IV heparin when hanging the bag and during a rate change. Does your facility have a policy and procedure manual on this topic? That would be a good place to check.

Ashley

[ObtundedRN, BSN, RN]

We don't use prefilled heparin, but do use prefilled lovenox. We are required to have a co-signer for both.

[RNmilwife]

We don't use prefilled heparin, but do use prefilled lovenox.

this is what we use but not required a cosigner. We only need a cosigner for IV heparin drip.

[psu_213, BSN, RN]

When I worked on an inpatient unit, the hospital required 'co signs' on any heparin injection/heparin gtt initiaition/rate change, lovenox, insulin, and coumadin (the last was pretty ridiculous IMHO). Now, working in an ED, we do not require a co-sign for anything (single dose vial or not).

[Mrs. SnowStormRN, RN]

Safest thing to do is to check your hospital's policy and procedure manual and follow the protocal specific to your place of business.

[miss81, BSN, RN]

Wow... I like learning about what other facilities do. We don't need co-signatures for anything except narc discards. If we did we'd never get our meds done. Hard enough to find someone to help you turn a pt, let alone sign everything from a multi dose vial. Interesting tho'...