Streamlining Medication Administration?

[JMomBaby]

Hello all, I have what might be considered a naive question for all of you experienced in NICU. Namely, how do you streamline medication administration?

What I mean by that: I am a newly graduated nurse. In clinicals there were essentially two different ways we gave medications. If your preceptor was your professor, you did the five rights of medication, then looked up all the details of the medication (purpose, drug class, contraindications, average dose...), did the math to calculate how many mililiters you needed and how long to push it (if an IV med) collected the med, repeated the five rights, etc. If, however, your preceptor happened to be a member of the unit staff, things went differently: you did the five rights and the math for IV meds and gave it asap. During one hectic med/surg clinical I was warned that "we have a lot of patients to get to and you don't have time to do all that (looking up information). I know it's safe so let's go give it." Okay...

So here's the thing: when you're a nurse on your own, especially starting out in NICU, and you're not all that familiar with the medications, as far as: what is contraindicated with each, average doses, etc. how do you streamline the medication administration process while still looking up enough information about your meds to do safe practice? I don't want to dawdle and look up a lot of unnecessary information, but it seems like to be safe you should know contraindications to giving the med, average dose for a pt your age and size, compatibility with other running meds and any "special instructions"... and that takes time, even taking a minute to look up a med takes up a lot of time if you have a lot of meds to look up.

So, experienced NICU nurses who were once newbies, how did you handle this?

[NicuGal, MSN, RN]

That preceptor is wrong. You should always look up meds that you are not familiar with, and when I precept that is what you would do. You need to know if you are within the guidelines, if you aren't you need to find out why, you need to know if that med can run with TPN or whatever else you have running thru that line, you need to know how long it goes over. I've worked for a long time and still look stuff up!

If you don't and a med error is made, you are at fault and you have no one to blame but yourself, and legal won't take the answer, well that is what my preceptor told me to do. The same goes for any procedure or policy you aren't familiar with, always look it up!

Keep thinking the way you think, always say to yourself "What would the reasonably prudent nurse do in this situation" :)

[umcRN, BSN, RN]

I write down all my meds due for the shift and look up all meds I don't know right from the bat if I have a few minutes before my first assessment is due. I also always look up compatibly of things I don't know. Better safe than sorry! Even in a code once the doc called for a drug I was unfamiliar with, still looked it up and verified it with another nurse who was there with me. Also, even meds that are sent from pharmacy can often be sent wrong - wrong route, wrong dose, wrong amount, so just because someone else drew it up and double checked it does not mean you can trust it! We have incident reports written against our pharmacy all the time

[JMomBaby]

I like the idea of looking up meds at the beginning of the shift or any time you have free time, and I agree the meds should be researched before administration :) Did you find it took you a long time to look-up and administer meds before you became "seasoned", and did you take heat from the experienced nurses? What was the best way you found to becone familiar with the usual NICU meds?

[EricJRN, MSN, RN]

One of the great things about NICU is that we never have eight patients who each weigh more than 200 pounds and each have twenty meds. We're usually able to focus on very intense but very precise care for a small number of babies. Another nice thing is that we give a pretty narrow range of meds in NICU when compared to other units, so you become familiar with the bread-and-butter stuff pretty quickly.

I just try to remember that it only takes one med to change a baby's life and the course of my career.

[umcRN, BSN, RN]

Like Eric said, we don't have too many patients, I generally look at the basics, why is the kid getting the med and is it the correct dose? Those two questions are usually enough for me. We use the NeoFax in my unit, I suggest getting one and writing your name all over it. That way you don't have to go far to look up your meds. I also have the "Ultimate NICU Survival Card" (http://www.survivalcard.com/Ultimate-NICU-Survival-Card-P56.aspx) it has dose ranges for the most common meds and can be kept on your badge for quick reference. You do find that eventually common meds become ingrained in your head. After a few shifts it really shouldn't take you that long to look up meds and I'm not sure why you would get "heat" from other nurses, they're your patients after all and they probably won't know you're behind unless you tell them. On that note - don't let yourself swirl, people look down on that and would rather have new grads ask for help than pretend they know everything/don't need help on a busy shift. Heck I had a crazy busy shift a few weeks ago, 6pm septic workup, code, transition to oscillator, a-line placement, the works and I had another patient, I had to ask someone to feed my other baby and no one said anything about it.

So, bottom line: look up your meds, don't be afraid to ask for help!

[JMomBaby]

Thanks guys, you give me confidance Looking forward to the excitement of learning- and I love that badge card!!!