From: Laurie Talarico, MS, RN, NP, Nursing Practice Coordinator
Re: Clarification of 3/29/11 BRN Website Alert "Preparation and Administration of Intravenous Solutions"
Date: April 14, 2011
The Board of Registration in Nursing (Board) has received multiple requests to clarify the alert " Preparation and Administration of Intravenous Solutions" posted on the Board's website on March 29, 2011.
Several healthcare organizations have inquired about nurses administering intravenous solutions that have, by organizational policies, been prepared in an area designed for admixture (e.g., when pharmacy compounds a sterile IV admixture under a laminar-airflow hood in a cleanroom). To ensure safe IV admixture, some medications may require the solution, once mixed, be spiked and primed at the time of compounding and are then placed in a sealed container.
Q: Can the intravenous solution be compounded in a pharmacy setting, labeled and sealed for procurement and administration by a nurse?
Q: Is it in accordance with accepted standards of nursing practice for one nurse to prepare (remove from sealed container and/or spike and prime) intravenous solutions for other nurses to retrieve and administer to a patient?
A: No. The nurse administering the intravenous solution must be able to validate the integrity of the intravenous solution throughout the entire medication administration process.
Q: Can a nurse hang an intravenous solution without additives that has been prepared (removed from sealed container and/or spiked and primed) for another nurse?
A: The nurse who prepares the intravenous solution with or without additives must administer only those intravenous solutions they procure, remove from the sealed container and prepare. Since the first step in preparing the intravenous solution is removal from a sealed container, the nurse would not be able to verify that any substance that has already been removed from its outer sealed container is, in fact, the "right" drug, consistent with the "Five Rights" of medication safety.
Q: During an emergency situation, can a nurse prepare (remove from sealed container and/or spike and prime) intravenous solutions for the immediate administration to a patient by another nurse?
A: Yes, during an emergency situation, nurses working in the same room attending to the same patient may prepare an intravenous solution together for immediate administration to a patient. At a minimum, both are responsible for communicating to each other regarding the medication order, validating the integrity of the medication, dosing pursuant to the order, administration orders, and documentation, pursuant to the policies of the organization.
Q: In an operating room or treatment room, can a nurse assist with preparing a medication that will be administered by another person?
A: Yes, in an operating room or treatment room nurses working in the same room, at the same time, attending to the same patient, may prepare a medication together for administration to a patient. At a minimum, both are responsible for communicating to each other regarding the medication order, validating the integrity of the medication, dosing pursuant to the order, administration orders, and documentation, pursuant to the policies of the organization.
Q: How can a nurse enhance safe medication practices within their healthcare organization?
A: Keep abreast of and follow accepted standards of nursing practice. Enhance patient safety by working with nurses in management roles to ensure your organization's policies and procedures reflect accepted standards of nursing practice.
This information is provided by the Division of Health Professions Licensure within the Department of Public Health.