Question: Should a medical telemetry unit be allowed to administer non-titrated IV drips such as Cardizem or Dopamine? If so what are the guidelines for administration?

Complete Question: Should a medical telemetry unit be allowed to administer non-titrated IV drips such as Cardizem or Dopamine? If so what are the guidelines for administration?

Several members of the Clinical Practice Committee reviewed and investigated an answer to this question.

Answer: There is very little in the literature that specifies where certain medications can be administered, only hospital specific guidelines. Our recommendation is that your hospital use an interprofessional team to develop a guideline for the administration of these medications.

Each facility or organization should have standard guidelines on the location of where these medications can be administered, how to administer these medications, and what follow-up care needs to be included in the monitoring of patients receiving these medications.

Many of the facilities that have been queried regarding this question have medication lists that provide guidance to the administration of all medicated drips. It may be helpful to reach out to the pharmacy department and verify what medications can be given as non-titrated or if patients need continuous monitoring during the infusion.

In conjunction with administering the medication, the monitoring will also vary dependent on the drug. Typical guidelines may include frequent vital signs to be measured (prior to administration, then every 5min x4, every 15min x4, every 30 min x2, every 1 hour x 4, and every 4 hours after that). Continuous telemetry may also be required.

The Institute for Safe Medication Practices recommends that healthcare organizations should consider the following suggestions to reduce the risk of IV drug administration errors:

  • Standardize dosing methods. Look for variable dosing methods for the same medication in your hospital and select a standard way to dose the drug for adults and a standard way to dose the drug for pediatric patients. Also examine the different dosing methods used in the organization for all drugs, and to the extent possible, standardize the dosing methods to promote familiarity. Health systems comprising multiple hospitals will also benefit from system-level standardization, as patients and nurses may transfer among the facilities. List the standard dosing methods on preprinted or electronic order sets in which applicable drugs appear.
  • Use fully functional smart pumps. Use of smart pumps that provide dosage error-reduction software will help avoid harmful mix-ups among various dosing methods for the drugs in the pump’s library. Other safety features include unchangeable dosing units once a drug is selected, weight limits, and clinical advisories. Smart pump alerts warn practitioners of impending medication errors and should not be overridden. If an alert is activated, it is crucial for the practitioner to investigate the warning and act accordingly. Organizations should conduct regular compliance rounds to ensure that the dose-checking capabilities are fully functional, as well as review available data from the error-reduction software to monitor appropriate staff interaction with the technology.
  • List dosing methods on MARs and labels. When possible, the dose of a medication should be displayed on the medication administration record (MAR) and the drug container label the same way the information will be needed to program the pump.
  • List dosing methods on orders. Prescribers should list the dosing method used along with the calculated dose of drugs at risk for error (e.g., pediatric drugs, chemotherapy).
  • Verify the dosing method. When applicable, pharmacists and nurses should verify both the dosing method used and the calculated dose before dispensing or administering a medication.
  • Verify pump settings during hand-offs. Verify all pump settings upon transfer of patients and at the beginning of each shift. Be sure the dosing method and total dose make sense for the patient given his or her weight, age, and condition.
  • Suspect an error. If a patient is not exhibiting the physiologic changes that would be expected given the infusion, consider the possibility of an error, and verify the pump settings.
  • Use simulation training. To heighten staff awareness about mix-ups with dosing methods, consider simulation training in which participants investigate a hypothetical case with a dosing error, uncover the error, and take corrective action. (ISMP, 2017)

REFERENCES

Institute for Safe Medication Practices. (2017). Lack of Standard Dosing Methods Contributes to IV Errors. Retrieved from: https://www.ismp.org/resources/lack-standard-dosing-methods-contributes-iv-errors

Updated January 2019)
(Published November 2014)