Hospitals unnecessarily diluting IV meds

More than 80% of healthcare employees dilute certain IV push medications, which is not always necessary, according to a new survey conducted by the Institute for Safe Medication Practices (ISMP). 

The practice sometimes results in the repackaging of prefilled syringes or other containers provided by the pharmacy, and leads to unlabeled or mislabeled syringes, potential contamination of sterile IV medications, dosing errors, and other types of drug-administration errors, according to the ISMPMedication Safety Alert – Acute Care June 19, 2014 issue.

Even when the pharmacy dispenses a prefilled syringe containing a patient-specific dose, as many as 20% or more of the survey respondents further dilute these medications; 12% often or always dilute these medications, and another 8% reported sometimes diluting the medications, according to the ISMP survey of 1,773 nurses, administrators, and nursing educators.

Opioids and antianxiety/antipsychotic medications were most frequently diluted. Almost half of all those surveyed said they often or always dilute antianxiety/antipsychotic medications prior to IV push administration.

As a result of the survey findings, ISMP provided nurses with several recommendations, including requiring pharmacy to prepare any IV push medications that must be diluted according to the manufacturer’s guidelines or hospital policy. “The syringe of diluted medication should be labeled for each patient with the patient’s name, drug name, strength, dose, directions for administration (e.g., slow IV push over 2 minutes), and expiration date/time,” ISMP wrote.

For drugs that may improve patient comfort or the accuracy of measuring the dose if diluted, pharmacists should research the safety of dilution in the absence of manufacturers’ recommendations, ISMP suggested. “If appropriate, seek approval for dilution from the pharmacy and therapeutics committee. For drugs that carry a high risk of extravasation and injury during IV administration, have the pharmacy and therapeutics committee determine if safer medication alternatives exist,” ISMP wrote.

If stability of the medication requires drug dilution immediately prior to IV push administration, nurses should be provided written directions via written or electronic guidelines or checklists that provide volumes and resulting concentrations.  

“Encourage nurses to always reference the hospital’s standard guidelines when diluting medications, and to call the pharmacy with questions (as commercial drug references may provide less specific recommendations than hospital guidelines),” ISMP wrote.