The Do’s and Don’ts of Pharm 2 Demo’s

I don’t care if you state all of the “Fundamental Skills” at the start of the demo. I want to see
you actually do them during the demo, otherwise it doesn’t count. (I.E. washing hands, aseptic
technique, etc.)

While reviewing doctor’s orders and meds, prepare a cheat sheet before entering patient’s
room.
 IV rate and solution
 What assessments will need to be done?
 Allergies?
 Anything else?

When assessing the patient:

 By identifying your patient and comparing ID band to the MAR, this acts as a part of the
first check for medication administration.
 Assess the IV site, the line, pump (for rate), and bag for solution type and expiry date.
When you are hanging a new infusion set (be it primary or secondary) or making any
changes to the primary or secondary line, start at the bag, follow the line down through
the pump, to the patient, and back up again. (Or start at the patient, go up to the bag,
and back down to the patient).This will help you to not forget anything.
 If you are conducting a pain assessment, don’t just use the pain scale. Do PQRST or
CODLSPA for your pain assessment. Don’t assume anything!!! Some patient’s might be
obvious with their pain and nausea, others might not share unless you ask.
 What other assessments are necessary for the medications you will be giving???

When preparing medications:

 Review your IV guidelines before taking any meds out of the med station . If it works best
for you, review one med and prepare it from start to finish, then review the next med
and prepare from start to finish. If you prefer, make a cheat note for each drug from the
IV guidelines to have available when preparing the meds. If you do it the second way,
you will not have to leave any meds unattended to go back to IV guidelines.
 Your IV guidelines will not tell you if two medications are compatible. For your
scenarios, there will be a compatibility chart at the med station.
 What you will find in the IV Guidelines are:
o The preferred method of injection
o The reconstitution instructions
o Administration instructions
o Compatibility with IV solutions (i.e. NS, D5W, with KCL, etc.)
o Stability/expiration after reconstituted
o Usual doses (should also be on your drug cards)
o Precautions, potential adverse reactions (should also be on your drug cards)
o Additional notes – things that might show a contraindication for your patient
 When are your 3 checks???? ALL THREE CHECKS OF THE DRUG AND DOSE NEED TO BE
DONE WHILE VISUALIZING THE AMPOULE OR VIAL AND THE SYRINGE WITH WHICH
YOU ARE DRAWING IT UP!!!!!
o 1. You check when taking it out of the med station. Looking to see that you have
the right medication and enough to fulfill the dose you will be giving.
o 2. You check while preparing the medication. Ensure that you have the right
supplies to prepare the med: i.e. a 1 mL syringe for 3 mg (10 mg/mL) of
morphine, versus, a 3 mL for 50 mg (50 mg/mL) of dimenhydrinate. Prepare your
label between 2 and 3.
o 3. You check the amount in your syringe against the label and the vial/ampoule,
before you dilute the medication in the minibag/minibag+ or with saline in a
syringe for administration. For example, if you are doing a 3 rd check that you
have 3 mg of morphine, it needs to be before you put it into the 3 mL of NS or
SW. Once it has been put in the minibag/minibag+ or mixed with NS or SW there
is no way to verify!
o If it is a narcotic requiring waste, the ‘witness’ nurse must be present during this
third check (while able to see the ampoule/vial and the syringe with the correct
volume) in order to verify the dose given and therefore verify the dose to be
wasted. Once the dose has been wasted, you are relying on your label to verify
at the bedside that it is the right drug and dose before administration.
o Once you have the narcotic taken out of the med cart, do not let it out of your
sight.
 Don’t prepare meds on top of the MAR. If you get it wet, it can ruin it and you will have
to recopy it. This is time consuming and frustrating for the other nursing staff.
 If preparing two medications when one is a narcotic and the other is not, I suggest
preparing the non-narcotic first. This way you are not leaving a controlled substance
unattended while preparing the other. I would rather see you prepare and label a mini-
bag of dimenhydrinate and then prepare a syringe of morphine. Think of it this way…the
dimenhydrinate, once set up in the patient’s room to infuse, you do not need to stand
there and watch it go through. But, the morphine, you need to be with/see at all times
until administration is complete.
 Have all of your syringes for injections ready before leaving the med room. The NS flush
is considered a part of the medication, and all medications should be ready before
leaving the med room. So have your flushes ready too!!
 NS and SW vials are single use only. We re-use here to save on supplies, but in the
facilities, you will never re-use these!
 Take the least amount of garbage to the patient’s room. For example, take out the
secondary med line from the package, clamp, and get the ‘alligator clip’ on before
leaving the med room. The patient room garbage can is very small. Leave those garbage
cans for their use.
Administering the Medications:
 Get your working area organized. If you are going to need the table to place the flush,
med, flush, then move the table where you can access it. Over bed tables are meant to
go over-the-bed. If you are giving an injection, get yourself comfortable. With morphine,
there is 4 minutes for the med and another 4 minutes for the flush. Eight minutes is a
very long time when you are bending over in an uncomfortable position.
 You will have already checked the patients ID with the MAR during your pre-med
assessment. Now you need to compare the MAR to the patient’s ID bracelet and ask the
right questions to act as another check for the “Right Patient”. Do this prior to each
medication administration.
 This last check will include the patient, the MAR, and the label on the medication to be
administered. The correct route is also confirmed, and the right time will also be
checked just prior to administering. By this point, your patient will be very
uncomfortable with pain and probably having some emesis, because of that, the right
reason will be obvious.
 Think of your administration sites that need to be ‘cleaned’ prior to administering meds
like a sterile field for dressing change. If you turn your back to it, you can no longer be
sure it is sterile. The way to avoid this is getting the med ready first, cleanse the injection
port, and then administer. Same goes for hanging a secondary med set. Prepare the bag,
clean injection port, attach the secondary med line into the injection port, and prime the
line with the solution from the primary bag.

Documentation:
 Don’t forget to sign for your meds as soon as you have given them.
 Don’t forget to put your secondary med bag on the column “Meds”, labelled with a
letter (starting with ‘A’) and then write out on the back of I&O.