Gray Fox

Seriously, if you think there is a collective conspiracy in your hospital to force unnecessary treatment on patients, you should probably take a break from nursing. You may be overwhelmed and losing your perspective.

why is any hospital providing Morphine 10 mg/ml vials? If you are practicing in the US, concentrated morphine should not be available on the nursing unit. Your hospital pharmacy should be dispensing products with the most appropriate size and dilution. For a Morphine 2 mg dose, the pharmacy should be providing either a 2 mg vial or a 2 mg prefilled syringe/cartridge.

On being a nurse manager - the most important lesson I learned is to let go, engage the staff with the goal of creating a self directed work team. Let them take responsibility for things like scheduling and orientation. Encourage each of them to find a special project - either short term or long term - that matches their goals and interests. Investigate some of the shared governance models and see what would work in your unit.

Perhaps we need to take a different approach. As nurses we have a unique opportunity to educate and coach families in end of life care/ decision making long before the critical encounter in the ICU. Imagine the power of AACN and SCCM collaborating to raise public awareness and provide tools for healthcare providers to use in wellness settings to start the conversation. Let's start working on root causes that put our Critical Care colleagues into this daily conflict.

I found that hand offs with EMR went well when sending nurse and receiving nurse were looking at pstient record simultaneously and used record to guide hand off.

Great feedback to Flutist! Mixing IV push meds is a practice that deserves a serious second look. Let's just talk about narcotics. First of all, they should be provided to you in the most ready to administer form available. Your pharmacy should be making a range of concentrations available to you. Secondly, diluting and saving the syringe for future doses does not meet requirements for medication storage and security. As previously noted, who could witness the waste with integrity? Third, syringe to syringe transfer (using Carpujects) is a contamination risk. Fourth, narcotics do not need dilution for administration - they are not vessicants. If you are diluting to control the rate of administration, consider this: the rate of administration if better controlled by the rate of the a)running IV, or b)rate of flush following injection.

I sure hope that some of you have seen the ISMP survey results from 2014 about diluting IVP meds. Very few IVP meds need to be diluted. Diluting meds, especially in saline syringes, adds significant risk points to the process without adding value. Even small volume narcotics can be managed without dilution. Think about it - if you are injecting into a saline lock with extension tubing or a running IV, you would use the SAS method - flush, give med, then flush. The undiluted med volume is likely still in the iv tubing no matter how fast or slow you give it, so the rate of the flush administration is more important than the rate of the med administration. I have seen some new ready to administer syringes on the market (not like carpujects) that do not need diluting. Maybe it is time to question an old habit.............