rules of injections

dorimar, BSN, RN · Jun 29, 2006

I have given drugs that another has drawn up. Sometimes it is reality. In code situations when they cant reach the iv line, etc. Everything is not always black and white, and I have to say I am a very black and white type of person. But, never say never.

beautifulb · Jun 29, 2006

In my 12 yrs. I have never done that, nor do I ever expect someone else to give what I have drawn up. Noone has ever asked me to either b/c it is just something that you don't do.

Altra, BSN, RN · Jun 29, 2006

been doing it a long time and will not bend--learned you draw what you shoot and only shoot what you have drawn! have pressure to shoot what others draw up--still refusing!!!!
Where do I find this guideline to show to "powers in charge"????? Have looked all over tx board website it's my license at stake(they don't have one) or my job HELP!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

I'm just curious what meds are being drawn up but not given by the person that drew up the meds? Is this an LTC situation as another poster described, in which 2 people are working to complete a med pass?

The only instance I can think of where this would occur in my setting is Fentanyl or another med in a vial that has to be broken open - obviously the entire contents will be drawn up and if 50mcg is given I can see a situation with a syringe with the remaining 50mcg being passed on to another nurse.

MackNJacks mom · Jun 29, 2006

OK guys....I think you are going a little to far with not giving meds the pharmacy drew up. As far as the example of the pharmacy sending up the wrong med..of course this happens!! The pharmacist are people like the rest of us!!! I think that was great that you caught the error, it is our job to double check, this is why they drill it in our heads. Where do you "draw" the line on what you "draw" up (no pun intended :) How can you be sure that bags of d545 c 20 k...really have 2o of k?? Would you only feel safe if you put it in the bag?? If so...what if the manufacturer of k made an error and labeled it incorrectly?? Are you going to manufacturer your own k to put in all of you IV?? Of course not, but you get my point. Lets be realistic about this...we are all human beings so of course mistakes happen..by Md's, pharmacists, manager and even Rn's. I don't intend to be sarcastic but I really think this is a bit extreme :)

I agree, but it is always our license on the line if something were to be given that was not intended. I think the line is drawn on high risk meds like lovenox, insulin,and narcotics, but we have to trust pharmacy.

christen13 · Jun 29, 2006

The only instance I can think of where this would occur in my setting is Fentanyl or another med in a vial that has to be broken open - obviously the entire contents will be drawn up and if 50mcg is given I can see a situation with a syringe with the remaining 50mcg being passed on to another nurse.

Fentanyl is one of the meds that I am talking about. Should we waste it, if you only use 25mcg?? Even when we know they will require another dose in one hour.....thats not practical and wastes time and money.

Altra, BSN, RN · Jun 29, 2006

Fentanyl is one of the meds that I am talking about. Should we waste it, if you only use 25mcg?? Even when we know they will require another dose in one hour.....thats not practical and wastes time and money.

Agree, Christen ... we do this all the time where I work (hang on to or pass on the syringe w/the remaining Fentanyl). I was trying to better understand the OP's situation.

TazziRN, RN · Jun 30, 2006

I have given drugs that another has drawn up. Sometimes it is reality. In code situations when they cant reach the iv line, etc. Everything is not always black and white, and I have to say I am a very black and white type of person. But, never say never.

In codes, though, the med nurse is there in the room with you and should be holding up the vial as she's handing you the syringe.

As for the Fentanyl example, if you're going to hang onto the rest of it and pass it on, the remainder should not be drawn up in a syringe but left in the vial and the vial passed on.

As for labelled syringes, I meant from the pharmacy, not labelled by another nurse.

And the LVNs who draw up meds for overworked RNs........ain't happenin' if I'm the RN.

SharonH, RN · Jun 30, 2006

The only instance I can think of where this would occur in my setting is Fentanyl or another med in a vial that has to be broken open - obviously the entire contents will be drawn up and if 50mcg is given I can see a situation with a syringe with the remaining 50mcg being passed on to another nurse.

Wait, are you talking about breaking open an ampule of Fentanyl, drawing it up, giving half the dose and passing on the remaining dose to another nurse? How does the nurse receiving the syringe of med verify that she is giving what you claim is in the syringe? Isn't she violating the NPA by giving unlabeled medicine and jeopardizing her license by not adhering to the 5 rights(drug,dose)? Isn't Fentanyl controlled in your facility? Is there not a policy that states that you have to use a substance when you obtain it or you must return it or waste it? I'm asking because I'm not sure. Or am I totally misunderstanding what you are saying? I think I am not understanding....

cariad · Jun 30, 2006

any unused medications should be wasted. they should never be kept for a second use or passed onto another nurse. if the order is for 25mcgs of anything and you use a larger dose to draw from then the rest should be wasted and the patient only gets charged for the 25mcgs as thats what was ordered and given.

Altra, BSN, RN · Jun 30, 2006

Wait, are you talking about breaking open an ampule of Fentanyl, drawing it up, giving half the dose and passing on the remaining dose to another nurse? How does the nurse receiving the syringe of med verify that she is giving what you claim is in the syringe? Isn't she violating the NPA by giving unlabeled medicine and jeopardizing her license by not adhering to the 5 rights(drug,dose)? Isn't Fentanyl controlled in your facility? Is there not a policy that states that you have to use a substance when you obtain it or you must return it or waste it? I'm asking because I'm not sure. Or am I totally misunderstanding what you are saying? I think I am not understanding....

You're right SharonH, that's what I'm talking about - the ampules of Fentanyl. I was curious about the OP's situation, as the Fentanyl situation was the only reason I could think of in my setting where more than the ordered dose of a drug would be drawn up - it's the only thing you can do with those glass ampules as obviously they have to be discarded into the sharps container immediately because they're a tiny version of a broken glass bottle. :uhoh3:

When giving Fentanyl, typically 50mcg ... yes, I hang on to the other 50mcg as it is fairly likely that I'll be giving it as an additional dose. If this is near the end of a shift, yes, it is common practice in my dept. to pass this on to the next nurse. We do the same with Morphine, Dilaudid, etc ... but these will still be in the original tubex, as there isn't the same need to draw up the entire contents as there is with the ampules.

I understand what you're saying about how would that nurse verify what is in the syringe. It is a valid point; however, how can you really verify what you're wasting with another nurse? I could hold up a tubex of 0.5mL of saline and say that I'm wasting my other 5mg of Morphine. There is some inherent level of trust among co-workers. If there isn't, then I guess it's really not possible to have 2 RNs waste meds together unless RN #1 is personally accompanied by RN #2 from the time the med is removed from the Pyxis or whatever storage, administered to the patient, and then wasted. I suppose this might be the *ideal* solution, but it's probably not realistic.

Still curious about the OP's situation, as the post seemed to imply that there are a lot of syringes of meds being drawn up and then administered by someone else.

imahobbit · Jun 30, 2006

WOW thanks so much for all the input!!!!!!! :lol2:

never dreamed so many out there. the situation is in a clinic setting where one nurse (who happens to be best friends with the office manager) will draw up ABX, immunizations anything and-----then ask for others to shoot some of them so patient gets all at once instead of multiple sticks. says this is better for the patient with less trauma. i feel is very dangerous and always refuse. so....boss says not team player.

thanks for validating my belief that all i have at the end of the day are my ethics and my name and sticking to what we were taught.

christen13 · Jun 30, 2006

I agree with MLSO. There is a high level of trust in our facility between the RNs....there has NEVER been a sitation where a pt was given the wrong med when another RN drew it up. I think it is very wasteful and unrealistic to waste 75mcg of fentanyl when you are only giving 25. Not to mention the PT is the one that pays for this........do you think they should pay for 4 ampules as opposed to 1?? Not me.

I would NEVER put a pt at risk and I have gone 8 years without a med error....I am very conciencios and am proud of my practice.

The REALITY is that this occurs...it is sooooo unrealistic to assume that RN's should not trust the pharmacy to draw meds up. We are part of a healthcare team...........we are not alone out there.......if you can't trust your pharmacy or coworkers....go somewhere you can