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nurses admixing at bedside

Does anyone have policy and procedure for nurses mixing IV drugs at the bedside and administering them? I am especially seeking input from LTC nurses.   Do you have a list of acceptable drugs?     Thanks

admixing drugs in Long Term Care
Most IV P&Ps in LTC   will have a procedure for admixing IV drugs.  
Since there is no pharmacy on site, this may be necessary for first doses and for drugs with short term stability, especially if there are multiple doses to be given each day. (A QD dose can usually be mixed and delivered, but the delivery costs would preclude the pharmacy mixing if multiple doses are needed.)
The list of drugs that can be mixed is usually a practical matter determined by the distance from the pharmacy, the number of routine deliveries per day the pharmacy provides to the facility, etc.
State nursing regs prohibit LPNs from mixing in some (not all) states, so this has to be considered as the majority of LTC staff is LPN.
We try to send the unstables in the ADDvantage system to minimize nursing issues. If you are in a state where LPNs cannot mix, this is considered "activating" the dose that the pharmacist prepared and can usually be done by an LPN.
Chapter 797 regs
Another factor influencing this is the Chapter 797 regulations from the US Pharmacopeia which provides strict guidelines for meds being compounded in a laminar airflow workbench. When working on the INS standards of practice, I learned that the word "admix" is no longer used and has been replaced by "compounding". These new guidelines are written for pharmacies and they are the only ones with any type of governmental oversight. So if nurses are compounding at the bedside, there is no agency that will be monitoring your actions, but you will need to work very closely with your pharmacy so they can make sure they are dispensing meds for you to compound in a manner that is within these regulations. INS standards of practice now states that compounding should not be done at the bedside and it is because of these new regulations. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

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