Splitting pills outside of nurse's scope of practice?

[thesundowner]

New at my hospital - nurses are no longer allowed to split pills. So, if we have a half dose to give, we have to call pharmacy and they have to split it for us/send it up to us (which takes approximately 100 hours because they are so swamped).

Do you split pills where you work?

[That Guy, BSN, RN, EMT-B]

Do they hold your hand while giving the pills too?

[whichone'spink, BSN, RN]

Whiskey Tango Foxtrot?!

[hiddencatRN, BSN, RN]

We can split pills, and they frequently send us parts of a mixed medication to mix on our own like we're chemists (we'll frequently get viscous lido, maalox and directions to add liquid benadryl to make magic mouthwash from scratch) but we can't have a bottle of amox to dispense doses from in our pyxis fridge. Go figure.

[anotherone, BSN, RN]

On our floor we recently found out we are no longer able to IVP metoprolol, labetalol, ativan, morphine, hydralazine.... the list goes on. Basically any medication that is usually needed quickly, we are now required to call an MD and have them push it for us, because a nurse isn't capable of watching the second hands on a clock to ensure that the medication is being given safely. In the words of our night float last night "how fast do I give it? They don't teach us this stuff in med school."

LOL. the mockery of nursing, and medicine I suppose. wow many many of our pts get iv lopressor and morphine, they are both a dime a dozen! sometimes half the pts on the unit are getting morphine or dilaudid every few ours ivp. what kind of floor is this?

[applewhitern, BSN, RN]

"Back in the day" we mixed all of our meds. Once upon a time we added our own potassium to fluids, etc., and mixed all of our ICU drips. That was before IV pumps calculated drip rates for you, so we had to have a calculator and figure out our own rates. Now all the nurse has to do is grab a pre-mix out of the med dispense, and punch in the med and weight in the IV pump. Of course I realize preventing med errors is the idea here, but not allowing the nurse to split pills is what I refer to as "the dumbing down" of the nursing profession.

[RNperdiem, RN]

Luckily we can still split our pills.

I suspect the pill splitting issue is part of the new focus on patient safety in preventing med errors.

I remember when I started in nursing in the 1990's, we kept concentrated potassium and sodium chlorides in vials to mix our own dialysate bags. After a few deadly mix-ups reported over the years, those disappeared.

No more mixing our own Morphine, epinepherine, insulin, or lasix drips. We even have these computerized pumps to run them on to reduce med errors if used correctly.

I wonder if the pharmacy was given any more techs to handle their increased workload. Sometimes I have to call more than once to get my IV drugs.

[classicdame, MSN, EdD]

would love to know where all this is originating.

[beckster_01, BSN, RN]

Haha we were pretty upset when this policy (which is apparently old) came out. We are cardiac/vascular surgery, 100% tele, with people in rapid AF left and right. We manage because some of these drugs (metoprolol) can be hung and most our patients are on dilaudid, which mysteriously was not on the list of no-no's. Apparently they are "working on a policy specifically for the cardiovascular center." But I am still pretty miffed at this squeeze on my scope of practice.

[sapphire18]

My facility would never dream of implementing this- we have no pharmacy at night, mix all our own drips, everything. Having to give 12.5mg of lopressor PO does get interesting, though, when you're on a unit without a pill splitter- those tiny pills are impossible to split by hand!

[sapphire18]

Beckster- I like how they let you push IV dilaudid but not morphine..makes sense =P

[GitanoRN, BSN, MSN, RN]

i have split pills for a gajillion years.

whoa! i didn't know you were that old ...okay so i been doing it for trigallion times

[AngelicDarkness]

I've been splitting my own pills because my pharmacy is over an hour away, so to send it back and forth would be a chore:) I can see the issue with it though - I questioned the pharmacy on whether a patient was receiving a proper dose of metroprolol when the Dr orders 3/4 of a tab and I'm splitting it. They didn't seem to have an issue with it, but I sure did.