experience –
Pharmacy said no conventional practice said yesRating: (votes: 0) I felt stuck between a rock and a hard place-- with the pharmacy saying one thing and standard practice being another thing. WWYD? And if there was an adverse reaction, would I be blamed for it for going ahead and running those fluids together, or would it be understood that it was common practice so it was okay that I did it? What should I document if I decided to run them anyway? I would have stopped the primary IV, hung NS, and given the IVPB. But that's just me. Most incompatibilities are based on PH. NS is pretty safe because the patient is 75% NS. Starting another line seems excessive. Just because they regularly give the med that way doesn't make it wise. Blood seems to infuse fine with LR in a trauma setting, but the K in LR lyses the red blood cells in a transfusion. As always, your mileage may vary. Comment:
I also would have stopped the primary infusion, put up the Flagyl and just switched them back when the Flagyl was done. Better safe than sorry.
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I wonder what the reasoning was to not hang the 2 together? I know Flagyl is compatible with potassium and D5W. Not sure about the 1/2 NS though... maybe it has something to do with that?
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If pharmacy said no, well, then, no.
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Okay, so can you go through this step by step on what you would have done? Can you hang NS without and order?
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Quote from anon456Okay, so can you go through this step by step on what you would have done? Can you hang NS without and order?
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As a student, right now, you have no license to lose and you were smart to call the pharmacy and defer to your instructor. I feel that any nurse who calls the pharmacy to verify compatibility, and then does not do what they recommended, is taking an unnecessary chance. In this case, the patient's nurse made the call. But when you do get your license, I would definitely encourage you to do what the pharmacist says. Why take the chance....like another poster said, "better safe than sorry."
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Always follow hospital policy. If a mistake is made, and you didn't follow guidelines or P/P, the hospital will not back you. With our guidelines, if the 3 sources we use do not have compatibilty listed or unknown, we consider that a no go.
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Quote from anon456Okay, so can you go through this step by step on what you would have done? Can you hang NS without and order?
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Well you learn something new every day!I had no idea that NS with KCL wasn't compatible with Metrinidazole. I've run these two substances together many times.I'll be asking our pharmacy about this. Thanks for the heads-up.
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This wouldn't be as feasible for a nursing student, but as a nurse I try to have some rapport with the pharmacy personnel. Could it be that this is a new pharmacist? Sometimes pharmacy programs flag things that we do all the time. I would ask a different pharmacist or a pharmacist I trust. I would say, we do this a lot without a problem... can I get a second opinion? And go from there.
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Quote from iNurseUKWell you learn something new every day!I had no idea that NS with KCL wasn't compatible with Metrinidazole. I've run these two substances together many times.I'll be asking our pharmacy about this. Thanks for the heads-up.
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