Reading the MAR

[lexieanders]

Based on the MAR, how do I know if a medication is an IV push. Most of the time, the MARs at my facility doesn't actually say "IV Push" next to a medication.

 

[MunoRN, RN]

Do you mean it doesn't indicate the route at all? (PO vs IV vs SQ etc)  

[lexieanders]

For IV’s it usually says infusion, but it doesn’t specify whether IV or IV push. 
For example, Pantoprazole Injectible, 40 intravenous once BID. I was told that this was an IV push, but the drug book says that it can be given as either an IV, IV push, or intermittent. So, just based off the MAR, how would I know that?

[CalicoKitty, BSN, MSN, RN]

Does it list a volume (10 mls for push) vs 100 mls (infusion), or a time frame "over 2 minutes".  If it is BID, it is likely push. Infusions are usually continuous fluids that run all day.

[chare]

22 minutes ago, lexieanders said:

[...]

For example, Pantoprazole Injectible, 40 intravenous once BID. I was told that this was an IV push, but the drug book says that it can be given as either an IV, IV push, or intermittent. So, just based off the MAR, how would I know that?

Told by whom?  And, what did he or she base this answer on?  Regarding you pantoprazole example, at my facility, this would be administered over 15 minutes.  And at my facility, at least in the children's hospital, we maintain a list of medications that can be administered IV push over ≤5 minutes.

As this will vary facility to facility, you best course of action is always to consult your pharmacist.

Best wishes.

ETA: Our EMAR also contains administration instructions with detailed administration information.

[lexieanders]

 

CalicoKitty

The only volume that I see is when it says to reconstitute the 40 mg dose with 1 vial of 10 mL NS. 

 

chare

Another nurse at the facility told me this information. All she would tell me is that she has given all these medications before, so that's how she knew. Good idea about the pharmacist. Thanks.

[LibraNurse27, BSN, RN]

Based on my experience in adult acute care pantoprazole 40mg IV diluted in 10ml NS is IV push over 1-2 minutes, but it should really be specified in the MAR. I agree to clarify with the ordering provider and/or the pharmacist. Some IV push meds have to be pushed slowly. Where I worked the MAR in the EHR told us IV push or IV piggyback, and over how long to infuse/push. If it doesn't specify, definitely double check ? Good question! 

[LeChien, BSN, RN]

What system do you use? In Epic at my facility they are listed as IVP and IVPB.

Like someone else said, usually the 40mg protonix diluted with 10ml saline is IVP.

If this is a recurring problem, I would bring it up to whoever is on your safety team/pharmacy team as I can only assume lack of specification will cause or has already caused medication errors.

[lexieanders]

LeChien

I believe the name of it is SSO Paragon.

[MunoRN, RN]

There should be some sort of drug reference available to you where you work, if it isn't otherwise defined by a facility policy then the Instructions For Use (IFU) would be the best source.  This is included in the FDA labelling which is publicly available.

[Golden_RN, MSN]

It should be clear in the MAR.  I recommend talking to supervisor & pharmacy.  This is a med error waiting to happen.

 

[Susie2310]

What did the physician's order say?