Unit Dose

[Slightly]

Preparation of medication in NICU

We began using the unit dose system for preparation of medication about 2 years ago. Most of the drugs are prepared by the pharmacy, individually for every baby, in a syringe, in a double dose method. We connect the tubing and rinse it with half of the solution and give the rest in IV drip. We do not rinse the tubing after giving medicine through the drip. The pharmacy labels the syringes. The drugs we prepare in the department are done under laminar flow. Some drugs we inject into the rubber (in the IV set, like Caffein, Penbritine, Vit.K). Sometimes the pharmacy prepares drugs given PO, but mostly we do it in the department. The doctors write new prescriptions for unit dose every day and they are sent by fax to the pharmacy.

I would like to know how is it done elsewhere.

Is the unit dose system used?

Are all medications prepared in the pharmacy using the unit dose system?

What kind of medication is prepered in the pharmacy?

Do the medications from the pharmacy arrive in a syringe ready for injection?

Are the medications prepared in a double dose method or some other method?

Who writes the prescription for the unit dose for the pharmacy?

Are there daily prescriptions for permanent drugs?

How is the prescription sent: via courier, fax or computer?

Which drugs do the department make?

Are the drugs from the department made in laminar flow?

How do you medicate: injecting the rubber or the IV drip?

Do the tubes get rinsed with saline after giving medicine through the drip?

How do you write on the syringe with medication?

Is there inspection of two nurses for each drug?

Are you aware of research papers concerning the benefits of the unit dose method?

Are you aware of research papers to show a decrease in the infections rate in the

pre-mature nursery using the unit dose method?

Thank you for your cooperation

Lia, Israel

[NicuGal, MSN, RN]

Is the unit dose system used? Yes, we went completely to unit dose about a year ago.

Are all medications prepared in the pharmacy using the unit dose system? Yes, all our meds are prepared there.

What kind of medication is prepered in the pharmacy? All orals, injectables and drips, including IVF and HAL's, IL.

Do the medications from the pharmacy arrive in a syringe ready for injection? We have to prime our tubing if needed, otherwise all we need is the needless needle.

Are the medications prepared in a double dose method or some other method? We get a syringe for each dose.

Who writes the prescription for the unit dose for the pharmacy?

All meds have to be ordered in the docs orders, then we fax them to pharmacy where they are entered into a computer system. Docs and NNP's can write orders.

Are there daily prescriptions for permanent drugs? Not sure I understand this question. Each drug has to be written for, no standing orders.

How is the prescription sent: via courier, fax or computer? Fax or we walk it across the hall to our satellite pharmacy.

Which drugs do the department make? We make no meds in the unit unless it is an emergency and we can't wait 15 minutes for something.

Are the drugs from the department made in laminar flow? Yes.

How do you medicate: injecting the rubber or the IV drip? Depends on the drug...some are classified for push, others have to go over a set period of time.

Do the tubes get rinsed with saline after giving medicine through the drip? If the med is compatible with the main IVF we don't flush, we just let the main IVF push it thru, esp. on our fluid restricted kids. Other meds have to be flushed before and after to avoid crystals.

How do you write on the syringe with medication? Our pharmacy generates labels for each syringe.

Is there inspection of two nurses for each drug? Only certain meds have a double check that must be signed in the orders...ie insulin, vasopressor drips, sedation drips, digioxin. We have a computation sheet for everything else and those are co-signed and upon d/c the paper is pitched.

Are you aware of research papers concerning the benefits of the unit dose method? I'm sure there is some infection control ones out there.

Are you aware of research papers to show a decrease in the infections rate in the pre-mature nursery using the unit dose method? As above, but honestly, I haven't noticed a difference in infection rates.

[dawngloves, BSN, RN]

We use unit dosing for all our IV meds. Single doses.

PO meds like caffine, Lasix we get a bottle for each pt and we measure it out.

Orders are entered in the computer by the doc and we recieve it (sometimes!) at the designated time. It has a lable affixed to it by pharmacy with the dosaged, amount in syringe, baby's weight, time to give and of course, drug name.

I don't think infection is as much an issue as much as dosing error.

With IV meds we only have two nurses check narcs and Indocin. but I'll have someone double check my KCL with me no matter the route!

[Slightly]

really ?

We double check EVERY drug we give....and both nurses sign.

Don`t you think it is safer that way ?