There is a discussion thread from September 2019 on allnurses.com that really does a great job demonstrating the degree of variation in IV push medication preparation and administration practices. A simple question from a new graduate RN about how to give IV push medications opened a Pandora’s box of misinformation and unsafe advice from others in the discussion. In the absence of consistent, evidence-based policies, procedures, and information to guide nursing practice, we as a profession, seem to be filling in the gaps with opinions.
Of course, the reality with opinions is that everyone has one, and everyone else’s is wrong. There is nothing wrong with opinions that are well-informed. The problem is when opinions are based on misconceptions. If you think that it is appropriate to dilute every IV push medication, this is factually wrong. If you think that it is within the nursing scope of practice to manipulate/dilute IV push medications (at will), you are factually wrong. If you think that diluting an IV push medication improves the dose accuracy, you are factually wrong.
The other problem with opinion is that sometimes they are based on a single experience and we form a narrow opinion that is used broadly for all subsequent opportunities. Just because a patient complained of discomfort once with an IV push medication, does not mean that all patients will experience discomfort. If we believe that the medication is the always the issue and the way to fix this is to dilute, we are wrong.
Nurses will look for more than opinions to guide practice. Some of the nurses in the discussion noted that important directions for how to prepare and give IV push medications are not included in the medication administration record (MAR) at their hospital. Others advised that the nurse should take the time to learn each medication including preparation and rate of administration, using available references and the pharmacist expert. Many references lag behind current best practices.
The ISMP Safe Practice Guidelines for Adult IV Push Medications (2016) are the best source of well-informed opinions today for IV push medications. The Guidelines state to “Only dilute IV push medications when recommended by the manufacturer, supported by evidence in peer-reviewed biomedical literature, or in accordance with approved institutional guidelines.” The Guidelines recommend that “standardized, facility-approved IV push medication resources are readily available at the point of care to guide the safe practice of IV push medication administration. Resources should include any special considerations for the preparation and administration of IV push medications and for unique practice locations where medications may be administered IV push to ensure effective patient monitoring.” It is really important that organizations give clear expectations and instructions for the preparation and administration of IV push medications both on the MAR and in easily retrievable resources. Institutional guidelines may lag behind current literature and nurses can take an active role by collaborating with pharmacists and others in their institution to update the approved institutional guidelines.
Nurses don’t need to rely on word of mouth, singular opinions, misinformation, and past experiences for IV push medication preparation and administration. There are excellent guidelines and expert opinions to reduce the variation in practice and mitigate risk for our patients. In my humble opinion, let’s use the FACTS.