Medications

The category of Medications covers the 5 rights of medication administration. These include: 1) Right Medication, 2) Right Dose, 3) Right Time, 4) Right Route, and 5) Right Patient. It also addresses medications from administration to patient teaching.

Photo: "The Many Faces of AMSN Members," taken at a recent annual convention.

Question: Should IV push Lopressor be given on medical/surgical units where there is no cardiac monitoring?

Answer: Our review reveals that the best practice is to ensure the patient receiving metoprolol has a cardiac monitor in place...

Question: Questions About TPN Compatibility

Answer: Upon investigation we found that the A.S.P.E.N. Parenteral Nutrition Safety Consensus Recommendations (Ayers et al., 2014) discourages co-infusion of medications through TPN lines...

Question: What is the current practice for giving an IM injection across the lifespan? Should the nurse aspirate the syringe?...

Answer: Aspiration is the process of pulling back on the syringe plunger by applying negative pressure for 5-10 seconds after the needle has been inserted into tissue, but before administration of the medication (CDC, 2017; Sepah et al, 2017)...

What is the best Evidence Based Practice for safe assessment and care of epidurals?

Answer: The standards of care (2014) and practice guidelines (2013) published by the American Society of Anesthesiologists provide guidance about postoperative care for patients who have received general or regional anesthesia, as well as moderate or deep sedation...

Question: ...how does the RN know what is piggybacked vs. y-sited infused? Meaning - Heparin drip vs. antibiotic vs. potassium infusion.

Answer: Many facilities use referenced materials in order to develop guidelines to be used for clinical practice. It is important that the references are reviewed and approved by the pharmacy, most likely in a venue such as a Pharmacy and Therapeutics committee...

Question: Regarding high alert medications, ...what the recommendations are for which meds are considered high alert and require a medication double check?

Answer: Most facilities will institute at their own discretion, which medications will require a double check prior to administration. However, the Institute for Safe Medication Practices (ISMP) lists...

What are the med/surg units out there doing in regards to IV insulin practice? Are there any restrictions on IV insulin drips and IV bolus push?

Answer: ...members of the committee have provided their expertise in regards to IV Insulin administration on med-surg units...

Question: ...how to improve my Ortho unit's press ganey score on "Communication about medications" part.

Answer: ...we queried some of our member hospitals. Most of these provide handouts to their patients about their meds, including a detailed dosing schedule and calendar, with teaching, review, and reinforcement of the education provided...

Question: My hospital is currently analyzing our IV medication push policy...

Answer: I have summarized the responses from our members, and added my details for you, in order to have a record of this for your answer and our CPC minutes... Refer to the drug manufacturer recommendations and organizational guidelines (AHA, Infusion Nurses Society, etc.)...

Question: I am looking for information regarding the standard of care for monitoring patients on narcotic PCA on a med/surg unit.

Answer: Monitoring the patient receiving PCA therapy should be outlined in your organization's policy... Monitoring requirements can vary, based whether patient is opioid naïve or opioid tolerant, drug, drug concentration, dosage, PCA...

Question: I am looking for any documented research regarding the need for taking a blood pressure in a specified time frame before giving antihypertensive medication.

Answer: We found that most guidelines provided clear direction for valid BP measurement (equipment, procedure, validation of caregiver's procedure, etc.) but did not address when the BP should be monitored in relation to medication administration...

Question: I am looking for some best practices regarding Dilaudid (hydromorphone) administriation IM and IVP (not PCA) on medical surgical floor.

Answer: Our members reviewed your question and performed a brief literature search for best practices, as well as reviewed community standards for our member hospitals. Of the organizations we queried, most hospitals have...

Question: With The Joint Commission just here (making us hyper aware of our processes), we are looking at our Pharmaceutical Waste program and found that we need to tighten up disposal of narcotics...

Answer: We dispose of wasted narcotics in the sink (ex: portion of a dose to be wasted or fluid in a minibag, etc.) or the sharps container (syringe, PCA syringe, fentanyl patch, etc.)...

Question: Would any of you be willing to share how you intake medications and management them while a patient is admitted?

Answer: This question was answered by four different people. Their answers are as follows:...