Preparing injections for doctor

Nurses General Nursing

Published

Hi,

I've been working for a neurologist/pain specialist for about 9 months now. One of my duties has been to prepare injections with depo medrol and/or marcaine, depending on what type of injection it is.

During training I was never advised to document anything. The nurse here before me didn't and the nurses at the family practice who worked for doctor who was family practice and an orthopedic specialist.

Should I be documenting something in the pt's chart, like "what's in the syringe and that it was prepared under aseptic technique", "syringe labeled" etc?

Any advice is appreciated.

Up Vote Up Vote ×
Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

No, that's not necessary to document. It's assumed that you washed your hands and used clean technique when drawing up the meds. Do you chart "washed hands before giving IM injection"?

Your responsibility is in using the appropriate technique in drawing up the meds, and then making sure they're labeled with the patient's name and what the medication is. THe person giving the meds is responsible for documenting what was given in the patient's chart.

Although, TJC standard is that only the person GIVING the med should be PREPARING the med.

Up Vote Up Vote ×
Specializes in Oncology.

Yes, I would not prepare an injection for someone else to give. That opens you up for liability. What happens if the patient has a bad reaction and they accuse you of putting the wrong medication or wrong dose in there? Crap rolls down hill. Or worse yet- what if you're questioning whether you did something wrong and want to redraw it up and then they say, "Nah, I'm in a hurry, I'm sure it's fine." If different people are preparing and giving meds none of the 5 rights can be verified. Except route, I guess. You don't know what patient it's going to, and they can't know for sure what's in that syringe. The only exception is medications coming up from pharmacy with an official pharmacy label.

Up Vote Up Vote ×

Thank you both. I'll no longer be drawing it up now.

The reason I asked about documentation is because when I did medical transcription, the pain doctors or orthopaedic surgeons always always documented "performed under sterile technique" so thought it might be appropriate if I'm preparing injections. However, like I said, I'm not going to prepare injections anymore so it's a mute point.

Thanks again.

Up Vote Up Vote ×
Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
Thank you both. I'll no longer be drawing it up now.

The reason I asked about documentation is because when I did medical transcription, the pain doctors or orthopaedic surgeons always always documented "performed under sterile technique" so thought it might be appropriate if I'm preparing injections. However, like I said, I'm not going to prepare injections anymore so it's a mute point.

Thanks again.

Are you going to tell the physician that s/he will need to draw up his/her own injections?

How do you think your physician will react to that?

I'm asking because a) I'm assuming this is a physician-owned practice where they are the boss? and b) We went through this with a physician at a clinic at which I worked (which, luckily, was part of a greater hospital entity and the physician was an employee, and we could fall back on P&P for our rationale) and it became a VERY BIG DEAL.

Up Vote Up Vote ×
[…]

Although, TJC standard is that only the person GIVING the med should be PREPARING the med.

Exactly which TJC standard is this? I have found much regarding labeling of medications, but am unable to find this.

Yes, I would not prepare an injection for someone else to give. That opens you up for liability. What happens if the patient has a bad reaction and they accuse you of putting the wrong medication or wrong dose in there? Crap rolls down hill. Or worse yet- what if you're questioning whether you did something wrong and want to redraw it up and then they say, "Nah, I'm in a hurry, I'm sure it's fine."…

Orange_dolphin, if there is ever any doubt you need to waste everything that you have prepared and start over.

…If different people are preparing and giving meds none of the 5 rights can be verified. Except route, I guess. You don't know what patient it's going to, and they can't know for sure what's in that syringe…

If the medication is properly prepared and labeled, all 5 rights of medication administration can be verified. Labelling of medications was included in the Joint Commission's 2015 Hospital National Patient Safety Goals, Goal 3: Improve the safety of using medications (NPSG.03.04.01). If all elements of performance are met, using medications prepared on the unit by a nurse is no less safe than using medications prepared by the pharmacy.

…The only exception is medications coming up from pharmacy with an official pharmacy label.

It amazes me the number of individuals that absolutely refuse to either prepare a medication for a coworker, or use a medication prepared by one of their coworkers, but accept a pharmacy labeled syringe without question. Most, if not all, medications supplied by the pharmacy are prepared by a pharmacy technician, not a pharmacist. I don't know about most of you, but I trust my coworkers considerably more than I trust most of the pharmacy technicians at my facility. Although they are verified by a pharmacist, this is little more than checking the label against the order. I have lost count of the number of medications that I have received from the pharmacy that were incorrectly prepared: wrong dose, wrong concentration, syringe and bag labels don't match, etc.

Up Vote Up Vote ×

At my former hospital, we would draw up medication for the physician. The difference being, we did them in the patient's room, while checking the 5 rights and with the doctor present confirming the medication. I would never draw something up, label it, and leave it. The doc should be checking the vials. It's not best practice, but it's safer that everyone is checking them and nothing is being left the question.

As far as telling the doc that you're no longer going to do what you and everyone before you were expected to do...good luck. I hope he sees that you're bringing this up to protect everyone involved. It may be a difficult conversation to have. Mention evidence based practice, patient safety, and whatever else supporting research that you can find. I hope he is open to listening and finding a solution that works for everyone involved!

Up Vote Up Vote ×

It's not a physician-owned practice. It's a practice owned by a hospital. The organization has several hospitals and hundreds of doctor offices. The physician is an employee.

I've already told him "I'm not allowed to" reconstitute and prepare botox injections anymore. My administrator gave me the option of not doing that. He was disappointed but not angry with me.

Yesterday, for an occipital nerve block, I just said it would be a while before I would have time to draw it up, he knew I was incredibly busy, so he did it without complaint.

I'm more worried about botox injections (migraine patients) than occipital nerve blocks, trigger point injections, etc. because reactions from botox are much more serious.

Up Vote Up Vote ×
Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
Exactly which TJC standard is this? I have found much regarding labeling of medications, but am unable to find this..

You're right; I stand corrected. I re-read their national patient safety goals for 2015. It CAN be administered by someone other than the one drawing it up, but if that happens, then there needs to be two people verifying the medication at the time of drawing it up.

I also learned something interesting - if there is only one medication and there is no break in the process of drawing up, bringing to patient, administration, then it does not need to be labeled.

Up Vote Up Vote ×
Are you going to tell the physician that s/he will need to draw up his/her own injections?

How do you think your physician will react to that?

I'm asking because a) I'm assuming this is a physician-owned practice where they are the boss? and b) We went through this with a physician at a clinic at which I worked (which, luckily, was part of a greater hospital entity and the physician was an employee, and we could fall back on P&P for our rationale) and it became a VERY BIG DEAL.

This is not a physician-owned practice. I have the okay from the administrator not to reconstitute/prepare botox injections for migraines. She hasn't said anything about the other injections I prepare, occipital nerve blocks, trigger point injections and supraorbital nerve blocks.

Up Vote Up Vote ×
Exactly which TJC standard is this? I have found much regarding labeling of medications, but am unable to find this.

Orange_dolphin, if there is ever any doubt you need to waste everything that you have prepared and start over.

If the medication is properly prepared and labeled, all 5 rights of medication administration can be verified. Labelling of medications was included in the Joint Commission's 2015 Hospital National Patient Safety Goals, Goal 3: Improve the safety of using medications (NPSG.03.04.01). If all elements of performance are met, using medications prepared on the unit by a nurse is no less safe than using medications prepared by the pharmacy

Thank you for the link. I will read that thoroughly. Good idea with throwing it out, if there's any doubt.

Up Vote Up Vote ×
+ Add a Comment