rules of injections

SharonH, RN · 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.

But you are putting patients at risk by giving unlabeled meds. Whether or not the patient should pay for 4 amps is really not your concern although I admire your advocacy on their behalf. It is also extremely poor nursing practice and I am surprised that your facilities do not have a policy against it.

christen13 · Jun 30, 2006

I am a STRONG advocate for my patients. I believe this is one of our primary responsibilies!! As far as putting my pt's at risk, I disagree with you. I have learned through exp that this is not putting them at risk....there are many situations that I would not give them meds drawn up by other RN's but in some I would and do.

TazziRN, RN · Jun 30, 2006

Hobbitt, we do double whammies on kids all the time in the ER with Rocephin; the second nurse watches the first one mix and draw it up.

Sharon, you put a pt at risk EVERY TIME you give a med that you did not draw up, or at least witness being drawn up. And that high level of trust you have? One of those coworkers could be a high-functioning addict. And even the most concientious nurse will make a med error at least once in his/her career.

SharonH, RN · Jun 30, 2006

Hobbitt, we do double whammies on kids all the time in the ER with Rocephin; the second nurse watches the first one mix and draw it up.
Sharon, you put a pt at risk EVERY TIME you give a med that you did not draw up, or at least witness being drawn up. And that high level of trust you have? One of those coworkers could be a high-functioning addict. And even the most concientious nurse will make a med error at least once in his/her career.

Tazzi, I think you got me mixed up with someone else. I'm in agreement with you.

veegeern, BSN, RN · Jun 30, 2006

I don't even like giving meds mixed by pharmacy. I had one instance a couple wks ago... primary nurse asked me to give Vanco on Dialysis, it came up fr pharm with a vanco label & the bar code to scan but the vial attached was zithromax!!!!! Even the opposite side of the bag said zithromax!!!! When an error this blatant happens, I hate to think of what may be in those hand labled syringes. E-mar would not have prevented this error as the med would have scanned as Vanco. Scary!

I find this interesting...A few weeks back, our pharmacy stopped putting OUR scanning labels on most of our IVPB. Now, we scan the manufacturer's label on the vial or bag. There are a few abx that come up pre-mixed in a NS bag, and those still have our in house barcode on them. The other thing that I find interesting is that our MD has to order that something be given on dialysis, otherwise it is held until the patient comes off (off subject, I know).

imahobbit · Jul 1, 2006

Hobbitt, we do double whammies on kids all the time in the ER with Rocephin; the second nurse watches the first one mix and draw it up.
Sharon, you put a pt at risk EVERY TIME you give a med that you did not draw up, or at least witness being drawn up. And that high level of trust you have? One of those coworkers could be a high-functioning addict. And even the most concientious nurse will make a med error at least once in his/her career.

Tazzi--she never asks anyone to watch--already has them in syringes and then asks you to shoot. (Wouldn't change my mind though) Several of you say is a trust issue--she also hands out samples, changes meds etc. without dr's order-don't trust her any farther than I could throw her--can only hope doc's stop her now.

NYCRN16 · Jul 1, 2006

I would never give an injection that I did not see personally drawn up in front of me that I didnt do myself. You have no idea what is in that syringe and its your license if its the wrong medication. I think its risky practive to pass vials back and forth between patients like others have mentioned earlier with the fentanyl because: If the pharmacy decided to audit your narcotics book with patient charts, you could get in serious trouble. For example, say patient Smith was ordered 2.5 mg of morphine and patient Jones was ordered the same dose (we have 5 mg morphine vials). I signed out patient Smith's medication and gave the other half of the vial to another nurse to give to her patient, they will wonder where the morphine for her patient Jones came from. If they figure out that the other half of that vial went to Jones from Smith's vial, the nurse that wasted Smith's vial has falsified a waste. We will sometimes hold the vial for the same patient if lets say we give 1 mg (of 2 mg of a vial) of Ativan, and we know that this dose is not going to be enough, we will have the doctor order the other mg and give the remainder of the vial. Therefore, we are signing out and using all the medication and are covered by an order. We are then not wasting any of that vial, or 1mg of another vial. If the patient does not require further dosing, than we will waste the other half as usual.

Edited to say: One of my biggest pet peeves is nurses who mix and hang thier own IVPB's and don't label them!! If I take report from them and notice it hanging, I tell them to put a label on it or its getting thrown out.

madwife2002, BSN, RN · Jul 1, 2006

I would never give an injection that I did not see personally drawn up in front of me that I didnt do myself. You have no idea what is in that syringe and its your license if its the wrong medication. I think its risky practive to pass vials back and forth between patients like others have mentioned earlier with the fentanyl because: If the pharmacy decided to audit your narcotics book with patient charts, you could get in serious trouble. For example, say patient Smith was ordered 2.5 mg of morphine and patient Jones was ordered the same dose (we have 5 mg morphine vials). I signed out patient Smith's medication and gave the other half of the vial to another nurse to give to her patient, they will wonder where the morphine for her patient Jones came from. If they figure out that the other half of that vial went to Jones from Smith's vial, the nurse that wasted Smith's vial has falsified a waste. We will sometimes hold the vial for the same patient if lets say we give 1 mg (of 2 mg of a vial) of Ativan, and we know that this dose is not going to be enough, we will have the doctor order the other mg and give the remainder of the vial. Therefore, we are signing out and using all the medication and are covered by an order. We are then not wasting any of that vial, or 1mg of another vial. If the patient does not require further dosing, than we will waste the other half as usual.
Edited to say: One of my biggest pet peeves is nurses who mix and hang thier own IVPB's and don't label them!! If I take report from them and notice it hanging, I tell them to put a label on it or its getting thrown out.

I couldnt agree more

madwife2002, BSN, RN · Jul 1, 2006

One of the nurses on the floor was really unorganised and wasnt coping well so as I wasnt busy I asked what i could do for her. She asked me to give out her pts meds, so I asked her for her mars-initially she couldnt find them and when she did I went to the pixis to draw the meds she said Oh no need to do that and started pulling pills out of her pocket. I have drawn them already here they are and piled them into my hand six pts medications all mixed up. I said I am not giving out those meds you do it yourself and I will do something else for you. Talk about a medication error waiting to happen.

Altra, BSN, RN · Jul 1, 2006

I think its risky practive to pass vials back and forth between patients like others have mentioned earlier with the fentanyl because: If the pharmacy decided to audit your narcotics book with patient charts, you could get in serious trouble. For example, say patient Smith was ordered 2.5 mg of morphine and patient Jones was ordered the same dose (we have 5 mg morphine vials). I signed out patient Smith's medication and gave the other half of the vial to another nurse to give to her patient, they will wonder where the morphine for her patient Jones came from. If they figure out that the other half of that vial went to Jones from Smith's vial, the nurse that wasted Smith's vial has falsified a waste. We will sometimes hold the vial for the same patient if lets say we give 1 mg (of 2 mg of a vial) of Ativan, and we know that this dose is not going to be enough, we will have the doctor order the other mg and give the remainder of the vial. Therefore, we are signing out and using all the medication and are covered by an order. We are then not wasting any of that vial, or 1mg of another vial. If the patient does not require further dosing, than we will waste the other half as usual.

Just to clarify ... when I pass on remaining meds to another nurse or have them passed on to me ... they are for the SAME patient. I do not give 1 mg of Ativan from a 2mg vial to patient X and then the remaining 1mg to patient Y.

teeituptom, BSN, RN · Jul 1, 2006

Just to clarify ... when I pass on remaining meds to another nurse or have them passed on to me ... they are for the SAME patient. I do not give 1 mg of Ativan from a 2mg vial to patient X and then the remaining 1mg to patient Y.

You have to clarify this,,,Hmmmmmm

Hoozdo, ADN · Jul 1, 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.

Agreed. I do it more than occasionally in ICU in a code situation or an emergency intubation. You gotta do what you gotta do to save the patient.