Update: Dilaudid tx for Cancer pt

[weavrvirgorising]

Thanks to everyone who wrote last week. It has helped immensely, since I have had very little support within my hospice company, except for one other nurse. Last Monday, I respectfully requested removal from this client's case and asked for a replacement. It's very sad that I had to protect myself above the patient. The director said, Oh, that's ok....and nothing more. She will now be the one to do the mixing and drawing up of cheaper Dilaudid within the office. Since then I have not had the DON or Owner pull me aside to explain their case re: why it is supposedly 'ok' to draw up Dilaudid out of single dose vials, put in empty sterile IV bag without a hood, then mix Ketamine with it. Nobody's talking to me...so far. Anyway, because of your support, I have finally gone to the Montana Board of Nursing and again, received conformation of my worst fears. They encouraged me to use the Scope of Practice Decision-making model to assist in investigating the issue. The Executive Director was very concerned for my risks/liability as a nurse and also contacted the Pharmacy inspector, who agreed. They emailed me some key points. 1. If a Hospice pharmacist will not draw Dilaudid up and mix it without a hood, why is it ok for a nurse to do so. This confirmed that it is not within the scope of practice for a nurse, it is a pharmacist's function and could be illegal for a nurse in Pharmacy law. They also mentioned that there may be a certain arrangement within the pharmacy and hospice employer contract stating that it is ok for a RN to draw up meds. (If this is the case, my employer did not bother to ease my fears by verifying any contract agreement.) It was also mentioned that I should think about whether or not I have the knowledge and clinical competence to perform the act safely and if so, am I comfortable accepting the accountibility for the decision to do what has been asked of me. Contacting the Board of Nursing was great, I felt like I had the advocate and support of true professionals. Thanks again, hope this helps you someday too.