IV Bags made on the floor

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Hello,

For those of you working in a hospital setting - I have a question for you. Do nurses make any IV piggybacks or continuous infusions bags on the floor? Or is everything prepared in pharmacy, and either tubed or delivered?

I just started working at a new hospital where a lot of meds are prepared by nurses on the floor. Even things like heparin bags and alteplase! The last hospital at which I worked would NEVER have allowed this - everything was prepared in pharmacy in a sterile environment.

Since I've only practiced at one hospital, I'm not sure if it is normal to have nurses both preparing and administering the meds? What do you do at your institution?

Btw - the new hospital is a huge academic teaching center (800+ beds).

Thanks in advance for your response!

I think a lot of it comes down to what you actually mean by "preparing." If they're doing what is normally done in a sterile hood (reconstituting vial, drawing from vial, injecting into bag) that would be a no-no. NY had a case (Sheffield v NYSED) where it was deemed that nurses were practicing pharmacy without a license for doing this.

If you can't hang it within an hour of mixing it, then it shouldn't be mixed on the floor!

Originally Posted by Cocogirl

Hello,

For those of you working in a hospital setting - I have a question for you. Do nurses make any IV piggybacks or continuous infusions bags on the floor? Or is everything prepared in pharmacy, and either tubed or delivered?

I just started working at a new hospital where a lot of meds are prepared by nurses on the floor. Even things like heparin bags and alteplase! The last hospital at which I worked would NEVER have allowed this - everything was prepared in pharmacy in a sterile environment.

Since I've only practiced at one hospital, I'm not sure if it is normal to have nurses both preparing and administering the meds? What do you do at your institution?

Btw - the new hospital is a huge academic teaching center (800+ beds).

Thanks in advance for your response!

When I first looked at this thread, I was like "Why would they make IV's on the floor?? That's so unsanitary!!! People walk there!!"

And then I came to my senses....

Sounds like a weak Department of Pharmacy to me. Some of the smaller hospitals with no access to 24-hour pharmacy services will do this, simply because they have no other option. If you have the option, then it boils down to a patient safety issue. You need to ask about a few things:

1) Is this a pharmacy issue (i.e., is there sufficient manpower in the department to fill every IV admixture within a reasonable time frame)?
2) Is this an institutional issue (i.e., this is the way it has always been done, so were not going to change)?
3) Is this a systematic bias against the pharmacy department?
4) Does the DoP care?

The first two are relatively easy to fix with the right people and clear objectives. The second two take time or a change in personnel and culture. Not so easy.

Originally Posted by PharmDstudent

If you can't hang it within an hour of mixing it, then it shouldn't be mixed on the floor!

That's it right there, an hour is the cutoff, anything longer than that needs to be prepared in the hood.

I've seen places that let nurses put together ADDVantage and Baxter Mini bags. As long as they follow proper technique, I don't have a problem with it.

Heparin?? Oh no, that story ends on the 10 o'clock news.

with 797 a lot of places don't even allow emergency pressor bags to be made on the floor.

Originally Posted by njac

with 797 a lot of places don't even allow emergency pressor bags to be made on the floor.

That kind of bothers me. We have pharmacists respond to all codes/rapid response situations at my institution, but we still are blocked (mainly by nursing) from mixing pressors on the floor. With the recent dopamine shortage, this is even more of an issue. I thought 797 didn't apply in emergency situations, is that an overinterpretation of the rules on their part, or am I just mistaken?

Still, this led to one of my all time favorite hospital moments. I had to sprint from a code to the pharmacy to mix a phenylephrine bag, and on the run back I got to jump over a slow-moving environmental guy dragging a garbage bag through the hallways. I felt like I was living the ER/Grey's/House dream.

Originally Posted by Praziquantel86

That kind of bothers me. We have pharmacists respond to all codes/rapid response situations at my institution, but we still are blocked (mainly by nursing) from mixing pressors on the floor. With the recent dopamine shortage, this is even more of an issue. I thought 797 didn't apply in emergency situations, is that an overinterpretation of the rules on their part, or am I just mistaken?

Still, this led to one of my all time favorite hospital moments. I had to sprint from a code to the pharmacy to mix a phenylephrine bag, and on the run back I got to jump over a slow-moving environmental guy dragging a garbage bag through the hallways. I felt like I was living the ER/Grey's/House dream.

I make drips at codes. But at my last hospital that was verboten.

I agree about 797 not applying in emergency situations - I believe the emergency bag is good for 12 or 24 hours so really as long as you change it ASAP with a real one from the pharmacy you're golden.

I work at a big hospital, and we make all IVs in the pharmacy (either in the central IV room or the satellites). Some units have room in their Pyxis machines for IV bags that we make, but the nurses never make them.

At codes, they technically have the stuff in the crash carts to make certain drips right then and there, but I still don't think they even do that. Usually the pharmacist just calls the satellite for me to make it and run it over.