| a) Limit the concentration in stock to 25 mg/mL |
| 1 |
4% |
| 2 |
4% |
| 3 |
10% |
| 4 |
15% |
| NA |
5% |
| No |
25% |
we were already doing this
Not available on formulary
we are looking at changing this practice
Plan to discontinue the 50mg vial
Recently removed 50 mg/ml from formulart
l
Biggest issue is great sedation, burns both IM and IV. Little issue with tissue damage.
this is the case on our floor, don't know about other floors
Pending P&T Approval
We plan to do this. Great idea!
GOING TO IMPLEMENT
staff would just draw up 2 vials
Implementing now
we do not stock promethazine
Do not use Promethazine
only 25mg/ml for iv 50mg/ml for im
After your article we have put this into place
Changed after review of newsletter
not currently
Home Care-we don't keep stock meds
50 mg is for 1M
Considering recommendation at this time
Plan to remove
if they want 50 mg they have to call the pharmacy for a piggy back
Better compliance would be achieved with starting dose if concentration were limited to max starting does, not above.
All answers are based on use
Not sure
That would be ideal.
Submission to P&T committee pending
plan to review for implementation
is under review
We have 50mg vials Marked for IM only
Proposed change in policy
Home Infusion
Since this alert was published our P & T committee has not met. Recommendations will be made to either remove it from formulary or put all of these restrictions on it.
In GI Center yes
Usually give 12.5 mg IV
We are taking this issue to the Pharmacy and Therapeutics Committee for further action.
I work in the PACU and we use this drug frequently and have excellent results with it and its use with no adverse effects described in these questions.
carry 25mg vials - have more than one vial in stock
seems reasonable
50 mg/ml concentration is shown on ADDC screen as "for IM only"
Good idea.
we keep it locked now in the narc dispensor
in omnicell
sometimes 50 mg/ml
Responses are based on my 25 years of bedside care. I am not working in the hospital setting any longer because of an accident.
Home Health Agency-do not stock meds
doesn't change pH
VIals are labled 50mg for IM only
just changed from 50mg/ml
Stock 50mg in emergency room pyxis
After receiving the alert of phenergan our facility has banned IV phenergan use and made a protocol to substitute phenergan 12.5 IV to 25 mg IM and 25 mg IV to 25 mg IM. Prior to this alert there were no measures listed below here recommended.
Already doing
i don't know what our pharmacy carry's
Not sure.
Won't help.
medication not administered here
@ ppmp/not on crash cart
used in outpatient surgery for all answers.
I usually start out with 12.5mg
for each of the following, we did not have any restrictions on dilution/admnistration until we read your article. the following reflects our current practice after we made the changes to make administration safer.
floor stock
Will refer to P&T to remove 50 mg
HCA has recently adopted ISMPs recommendation. While we are in the process of implenting them, they are not all implemented at this time.
Don't know
the facility still has 50 mg
unknown
Unsure
Prior to removal from formulary
hosp committee looking at use
Not yet.
50mg was removed from all automated machines with the exception of ER and Surgery. Plans to remove them are in place.
IV teraphy not used in our facility
I think
Unsure
Trying to eliminate
Pyxis machines contain 25mg/ml; the 50mg /ml is available from pharmacy
Adverse Drug Committee reviewed and completed survey as group MD's, Pharmacists and nurses
Don't know
Is the chance of adverse reaction dose related?
Maximo
Omarion
only carry 25 mg
|
| b) Limit the starting dose to 6.25 to 12.5 mg IV |
| 1 |
6% |
| 2 |
8% |
| 3 |
17% |
| 4 |
19% |
| NA |
7% |
| No |
64% |
Not a present time but are addressing with the medical staff.
Not available on formulary
Often 25 mg given in 1000 ml bag
Pediatric hospital
we are looking at changing this practice
Evaluating the ability to police this type of policy
Default dose is 12.5 mg - MD can choose 6.25 or 25 or type in another dose
In OR only
Our orders come from anesthesiologists
Have worked at other facilities that ban it IV and think it should be banned completely unless medically necessary because nothing else works
Mostly, but not all follow
Is there data demonstrating a decreased risk with this recommendation?
Pending P&T Approval
We plan to do this.
Very importan for the"sedation issues" connected with the drug.
Most doses are 12.5mg
Instituted to also limit the development of CNS side effects which was a significant issue in our institution
Evaluating now
Do not have IV therapy
most MD's follow this, not required
6.25 for pt's over 65
Will present to P&T Committee
facility not helping pharmacy to accomplish
We do not allow the IV use.
will you recommend a dose cut off for patient >65 years old and younger than 65 years old? Or can have option of 6.25mg, then repeat one dose in 15min if first dose not effective
the md's won't do it.
No longer given
Sent notice to MD's
in our Emerency Department...
Usually 12.5-25
Already do this
12.5 mg is ordered
Most patients will respond well to 12.5mg, I think that 6.25 is probably too low of a dose for adults.
is under review
Would this does even be effective?
usually 12.5 mg but occas 25mg
Our start dose is usually 12.5
just implemented
Home Infusion
No formal policy
12.5 Start
some mds reluctant to start with low dose
If promethazine is going to control nausea 12.5 ml usually does it
In most cases, but not all yet
depends, most physicans order smaller doses for older pts, otherwise 25mg usually ordered.
Not given in PACU/Given in OR
No- too limiting
Most of the time we give 6.25 mg, if someone is actively vomiting we give 12.5mg IV
not for all, but for most - some still use 25mg
12.5 - 25mg dose max.
Usually given in conjunction with Demerol. Dose depends on patient's weight and pain scale.
all my administrationas have not been over 12.5mg per admission
12.5mg is our MAX IV dose -- 25mg MAX IM dose
Should not give IV
when previously used
typical dose = 12.5mg
doesn't change pH
Start at 12.5 mg
almost always,but pt dependent
For the following: not a set standard but usually done
12.5
Already doing
Is a recommendation
does 6.25mg do anything
Not sure.
Still creates a problem.
reviewing at this time
Rarely 12.5
I have found 6.25 mg to be much better and just as effective as higher does of phenergan, especially in the elderly.
a/a
depends on provider
Moving to 6.25 mg only
universal compliance would be difficult
12.5mg for pt>55 or < 60kg
Will revise pre-printed orders
We recommend
25 mg is oftne given and not diluted
some drs do
Plan to take all suggestions to Pharmacy/Nursing Subcommittee
Not yet
Max dose 25mg
This is not a manufacturer recommended strategy to minimize risk of extravasation.
this is always done
Depends on patient
ED & other OP areas may often initiate with 25mg dose
For only 2-3 wks and the physicians are overriding 6.25 saying higher doses are required
Don't know
Limit to 25mg IV via Central Line
majority of doses are 12.5mg
Jamil
Layton
|
| c) Dilute the drug in 10 to 20 mL of normal saline |
| 2 |
5% |
| 3 |
9% |
| 4 |
16% |
| NA |
7% |
| No |
45% |
Writing a policy as well.
We will be starting to do this.
we were already doing this
Not available on formulary
we are looking at doing this for 25 mg doses
Plan to do so.
We indicate to dilute in nursing admin. insructions
Except in OR
nurse preference
previous hospital I did have this manditory
10 cc dilution is the usual inpatent practice, outpatient clinic prepars minibags
Again, is there data demonstrating a decreased risk?
UNSURE
UNSURE
Not current facility policy. Many individual nurses were already doing this measure.
We do this or via a running line
Just started 8/23/06
We dilute in 10 ml; some of our nurses feel that this is not especially effective.
most RN's do this anyway
After the article this was put into place
Changed after review of newsletter
if not being administered into an existing IV line
Instructions on MAR, have not evaluated if staff doing it.
for doses larger than 25mg only
Considering recommendation at this time
Not yet
Mostly
Working on implementing
I do not required
Minimum of 20 ml NS
drug is diluted in 3ml normal saline
Currently evaluating these recommendations
med surg mixes in 50 ml
This should be required. 10mls should be the minimum amount. In my experience, diluting to 10ccs is the best, most appropriate way to administer promiethazine. If nurses can realize the severity of tissue damage from promethazine, they will ALWAYS dilute it. I just makes sense!
not everyone knows to do this
We have now recommended this
I do regardless
we are required to dilute in 20ml NS
even still veins are getting phlebitis
Pyxis Alerts Nurses that IV drug must be Diluted
just implemented
Home Infusion
except in specialty areas, need improvement
from personal experience, i know this medication is extremely irritating and painful. diluting the drug with 5ml is helpful but still irritating.
but I do not know if everyone knows this
No formal policy
not policy so varies greatly among staff...after reading the ISMP report I think this needs to be "required" if giving IV unless piggyback is used
I do this but research doesn't support this as a way of reducing reactions
I just wrote a Clinical Practice Guideline based on the information and suggestions in the article. Our Medical Director likes it with some minor changes-it still has to go through our Med. Exec. Committee and Gov. Board for approval then we can start using it officially. Right now we are unofficially using most of the suggestions.
policy in 5-10ml
we've req'd 5ml till now.
have posted signage instruction to dilute in 10 -20ml normal saline. Compliance is improving.
may be recommended but didn't know it.
But we are teaching that trhis month
Under consideration
don't know if it's recommended by facility, but most caregivers do dilute before administration due to the burning sensation felt during IV push.
yes - this works effectively
Individual nurses may infact do this without written policy or procedure
We have not done this yet as we give 6.25mg and once and a while 12.5 mg IV
Good idea.
our policy is to dilute in a minimum of 50cc ns(mini bag)
NO, but will investigate ptobablitity of instituting
we will only do it by mini-bag
RNs are not allowed to dilute meds on unit, must come up diluted from pharmacy. Promethazine is retrieved in 25mg ampules from the automated dispensing cabinets on the unit.
sometimes- noty all nurses dilute this medication
however, not a full 10-20cc dilution, just that it must be diluted
This would allow a vigilant nurse to stop injection with any complaint.
it was taught to me that way on my ward when entering as a new ly liscensed nurse
Nurses in ED dilute in 10ml and give slow push
some do/some don't
not in our institution formulary but taught in general orientation to the unit by nursing
policy changes pending
Infusion pharmacies prepare the meds that we admisinister to pts in their homes
Dilution does not minimize phelibitis risk
We have been doing this for 10 or more years. I have never had another patient experience any untoward effects since. Additionally, we infuse it over 30 minutes.
doesn't change pH
I believe it is safer to dilute this further than 10-20 ml
Usually given slowly with fluid increase. Sometimes added to IVF remaining.
this is my practice
vials are available for nurses to dilute
In some areas we do
or ivp with running iv
If not adding to running line
suggested on emar screen
Recommended
recommended dilution of 5-10 mg
Do people follow recommendations is athe questions fo r all of these.
some nurses dilute, some do not
don't feel nursing will take the time to dilute
I always do.
Doesn't prevent the damage.
reviewing at this time
Always
Not consistently
Not always done
No policy but most of us do this.
a/a
We dilute in 10 cc NS
anesth. does it this way
not mandatory but dilution used by some
I do but many nurses are unaware
I have been thought to dilute it in 10-20 mls of ns
Moving to 50 mL preferred
many nurses are currently diluting ivp
universal compliance would be difficult
Pyxis has a "speed bump" suggesting dilution.
some of our nurses do this
diluted on nsg. units only
We dilute in 10 ml
Not all RN's do this though
Just approved at 9/06 P&T
I always dilute in
We dilute in 5ml ns
I always did as a practitioner and i teach this in the Pharmacology class and to my clinical grouips, however it is not see in practice
Our pharmacy recommends diluting Zofran in 5-10ml NS for iv push over 2-5 minutes
I currently follow this practice
individual RNs sometimes do this
not good for peds
Protocol is being developed
sometimes done; sometimes not
It is a personal preference
Tried this, still had patietn go to surgery due to seriour tissue damage
today all doses are diluted, prior to your article so long as it was pushed through a running IV it was allowed
in process of adding to order set
Don't know
I think my institution gives the promethazine as an IV bolus
I do but no policy
I always use ample flush with a saline lock
I do this all time.
it is not mandatory
Blaine
Jordon
|
| d) Prepare the drug in minibags containing normal saline |
| 1 |
18% |
| 2 |
12% |
| 3 |
22% |
| 4 |
16% |
| NA |
8% |
| No |
82% |
have done this for many years
Not available on formulary
often given in 1000ml bag.
Too much volume for kids
this could allow nurses to hang bag and then leave the room, they wouldn't be there to stop infusion quickly if pain is expreienced.
See above.
Evaluating
extravasation is more likely if not watched -- in PB, nurses are more likely to walk away
No need if always diluted in a 10 to 20ml syringe volume.
use a mini infuser- syringe pump
like to avoid this option
Volume be a problem
this will create too much turn around time for drug administration
This recommendation would likely take too long for our patients with nausea
for doses higher than 25 mg
will revise admin. IV guidelines
Working on implementing
given slowly and diluted
for ivpb infusion
Currently evaluating these recommendations
Not a bad idea, however, that would probably increase the administration time, in that case it would take longer to act in patients that are severly nauseated. We need quick action in that situation.
To be discussed at P&T meeting
No experience with this approach
time effective?
Nurse's choice
If it is an LPN administering the med
too much time; used too much
Home Infusion
dilute in syringe for syringe pump admin.
Limited pharmacy hours
Just put out education.
do sometimes
in process of impliementation
Have asked nurses to call pharm for minibags however pharm is not cooperative
also under consideration
when mixed in a Piggyback
not necessary if you dilute in 10cc and give in saline line
Individual nurses may infact do this without written policy or procedure
Again we use the smallest dose
RN prepares at time of admin.
We always administer this med in a 50cc ns minibag or larger fluid amount and I am not aware of any problems with this form of administration using this method
As above
See comment for letter C
see comment to previous question
we dilute in a 50 ml bag of NS and infuse on the pump over 20 minutes
What is the length of stability for this admixture? May not be possible for hospitals that require all admixing in a central pharmacy
i,ve not seen this in my practice of 6 months on this unit
We must dilute in 10 ml syringe of normal saline and infuse into a running iv, but we do not add it to a minibag for infusion
The nurses in ICU and on the floor do this
mix in 20cc syringe for syringe pump
not practical in er settings
same as (c)
PT CASE DEPENDANT.
Recommend IVPB when possible
In certain areas this would be beneficial, such as the floor.
doesn't change pH
Not convenient in ambulatory setting
push easier to monitor
Do not use
recommedation being written to do this in outpatient areas
only with specific orders
some nurses may dilute, most do not
Our immediant action was to remove promethazine from our pyxis & make all orders for promethazine available as a piggyback.
only give IV in mini bags
"
we are still reviewing to see what we will do. This is a possibility
reviewing at this time
a/a
dilute in 50 cc on other depart.
Moving to 50 mL preferred
Pediatric facility
would cause delays in treatment
we still allow IV push via PICC line only when the pharmacist explicitly labels the drug that way. We are a home care agency and 99% of our patients have PICC lines.
new
Pharmacy does not do this, however during my hospital orientation it was recommended that we use this technique. Yet nurses are not allowed to mix medications in IV bags!
What a great idea! It's almost stupid-proof!
some of our nurses do this on their own
as above
Give in a pump
Most doses prn, impractical
Stability?
Not yet
Not feasible
not a bad idea, but not necessary
Impractiable due to increase labor time involved and JCAHO mandate on no mixing on the nursing units.
This would loose some of the improtance of monitoring the drug during infusion
not good for pediatric pts
Turn around time for an antinausea drug used infrequently is not optimal
Compatibility data exists but impractical, would require 250 ml diluent for each 25 mg dose too much fluid for the usual frequency.
I have never used promethazine as a drip
Floor nurses do
Too time consuming
for doses larger than 12.5 mg we are implementing this practice
Don't know
10 or 20ml syringes via B-D360 infuser pump
Syringe with 10ml or more NS
Minibags would have to be prepared in pharmacy. This would significantly delay a medication that usually needs to be administered quickly after symptoms are reported. This would adversely affect patient satisfaction and nursing satisfaction. We would consider purchasing premix bags if they were available.
Kellen
Samuel
|
| e) Do not allow administration via hand or wrist veins |
| 1 |
12% |
| 2 |
9% |
| 3 |
22% |
| 4 |
19% |
| NA |
7% |
| No |
83% |
Will be including these recommendations in new policy
added this to our safety info for labels and MAR/Automated disp cabinets
indicated in nursing admin instructions
most all surgical patients with risk for N&V have hand or wrist IV's
Nurses educated, practice not monitored
We are a pediatric hospital and overall use is low.
Probably a difficult policy to follow. If med is ordered and only IV site available is in the hand, it is likely that a nurse would not think twice about administering the med.
Not yet, but will implement
strongly recommended
Have asked nursing to review policy
recently encountered incident when this was not followed
sometimes there is no other vein available
This recommendation would eliminate promethazine usage in the vast majority of our patients
I ma not sure of what is being done on the floors, but we have stared inservicing the nurses
Not yet
what if they only have that access
sometimes it is all you have!
But encourage
Working on implementing
Currently evaluating these recommendations
1st choices for OB or OR sites
it is recommended not to vs not allowed
Possibly make it "CENTRAL LINE USE ONLY"
Would rule out many pts getting
I look for a good blood return
We discourage but don't prohibit
Not always possible
helps but even large veins get phlebitis
Proposed change in policy
locations of sites cannot be so confining
sometimes this is the only site available
Home Infusion
only access at times
sometimes, these are the only available/accessable sites.
Just put out education.
May be all that is available
After assuring patentcy and administering slowly diluted in a port farthest from the site we are administering it into a hand/wrist. Our Anesthesia dept. does not like us to use anti cubital veins on a regular basis.
sometimes that's all you have
under consideration
difficult to enforce
Posted reminders to use large veings
Will recommend during education but not always a choice
Going to be implemented
proper dilution eliminates adverse effects even in distal sites
We have not yet, we give at a high port and mainly use 6.25 mg IV
Need to investigate further.
As above
we recommend doing IM or use another drug
it is given any any accessible vein
All legal cases review show hand or wrist sites with problems
this is a new recommendation to me and of sound premise
Not sure if this is carried out by everyone
These areas are the primary IV sites in our facility.
plan on removing this drug from the formulary
Not always an option
May change
somtimes we do not have a choice
sometimes this is the ONLY IV site patients have
insure patency with flash back
Would severely limit our ability to give this drug.
peripheral IV site limitations
This has worked for a long time
Encouraged not to
Adding that suggestion to education
The IV is check prior to giving
Placed as a warning on label-but it could be ignored by a nurse.
some of these sites work well
most of our iv sites are hand or wrist sites.
unknown
Won't get compliance
we use PIV's but slow push
reviewing at this time
a/a
universal compliance would be difficult
new
In process of implementing this strategy
Patient IV sites vary
We use low concentrators
We try to avoid
just dilute it properly
sometimes this is the only access, a good running IV is the key.
Need to include in protocol
recommend against
Controversial, not consistent with best practices "extravasation" precautions, if you extravasate when IV access is higher up the limb and significant extravasation and tissue damage occurs you stand too loose more of the limb effected.
Not realistic
"whenever possible"
ha, almost all patinets have poor iv access at some point
Don't know
Is the risk of adverse reaction greater in a more peripheral site?
20 ga or larger cathlon
good point
Herbert
Quinten
|
| f) Give the drug through a central venous site only |
| 1 |
26% |
| 2 |
19% |
| 3 |
23% |
| 4 |
12% |
| NA |
8% |
| No |
89% |
not practical
see above
this is not realistic
most of our patients have central lines
Again, difficult policy to enforce.
This would be great but if given via CL only there are other meds that would be better suited anyways.
We use a central line if there is one
Fine if pt has a central line
Have asked nursing to review policy
not cost-effective if existing IV line established
most patient do not have central access
Not available
most patients do not have a central line, especially patients in the ED
This recommendation would eliminate promethazine usage in the vast majority of our patients
should we put central lines in our total knee patients?
Working on implementing
I think this is too drastic and would force the nurse to go against policy or the MD
Currently evaluating these recommendations
Should be the way to infuse promethazine
Not realistic
No experience with this approach
Not always possible
excellent
Not all patients have TLC
Proposed change in policy
not available for all pts
this would put pts at risk
Home Infusion
not all patients who may benefit from this drug have central venous access.
CV catheter if available
outpts do not have central lines; we give it so frequently for sedated procedures
probably not practical and increases risk of infection...I would prefer to give promethazine as suppository or IM
Just put out education.
difficult to enforce
Many ots request phenergan. Not all need central lines. Puts us between rock & hard place; we know pt would be better off w/alternative drug however pt (usually chronic pain and/or addicted pts) demand phenergan
Again, will recommend but not always a choice
Not feasible most of the time
how many pts actually get central lines? not enough.
this is rediculous and extreme
Not realistic. Bad idea.
I work on a Labor and Delivery unit. We rarely have patients with central venous sites and would therefore not be able to use promethazine.
it is given any any accessible iv access
Ideal situation
Not a practical recommendation as most patients in ER would not have a CVC
i have given through peripheral iv's and picc's
This isn't practical in the Ed or for occasional nausea in Med-surg area.
very few cvc's
PT CASE DEPENDANT
should be administered through CVL's only with proper precautions
We rarely have central venous access at our facility
As much as this drug is used, it is unrealistic to admin. thru central venous lines only
central line risks
no central venous sites used in this facility
Not sure.
Won't get compliance. Have tried.
if one is available, use 1st
most of our patients do not have central lines
reviewing at this time
a/a
what if pt 's do not have central line
NOT PRACTICLE
difficult to hard wire
I work L&D most of our L&D patients do not have central lines.
Pyxis speed bump suggests central line if possible. Not everyone has a central line!
Not always possible
Not all patients have central lines
I have had patient me they could feel the burn in a central line - not given by me but others - I always dilute this drug
if we're to do this though I believe it would be better to take IV off as an accepted route
Not resasonable
rarely have central vein access
Not all patients have a central line
Catheter tip can migrate..
Too limited
Hard to do; not all pts have central lines.
Not realistic
Don't know
Not practical
25 mg.
don't always have a central line
Alberto
Earnest
completely non-practical
|
| g) Inject the drug through a running IV line |
| 1 |
3% |
| 2 |
6% |
| 3 |
15% |
| 4 |
26% |
| NA |
7% |
| No |
52% |
Inconsistent practices amongst RNs
Planning to change policy
common practice
UNSURE
UNSURE
Or in 10-20 mls of fluid
When available
it will be done only if there is a IV line available
We sometimes do this
recommended not required
Working on implementing
Depends on what is running
After PRN on Picc running
If IVF are infusing.
Currently evaluating these recommendations
If running IV line exists
will it form precipitate? would it always be compatible?
Better changes of knowing catheter is in vein and more diluted.
I do, but not sure what hospital recommends
doesn't seem to matter
rate of push is the issue
this should be a must
Home Infusion
all may not do this though
helpful but still recommend diluting it.
Nursing resists
not known by everyone
Sometimes with a running IV;sometimes with just a lock.
I have seen serious nerve damage when all precautions were taken: dilution with Saline, given thru running IV slowly. Not nearly enough attention has been given to this drug. The texts talk about infiltration and arterial administration. Injuries are not limited to those situations. Physicians still order it like water. With so many other choices available, I think the partenterall route ought to be stopped. I would refuse it if it were ordered for me.
Just put out education.
is given through saline lock also
too many saline locks
some pt's have saline locks.
this is essential for painfree admin
Individual nurses may infact do this without written policy or procedure
Good idea.
run in minibag or larger diluent amount only. NO IV PUSHES of this med!
most of the time pt's have IV's running but not always
Would allow for more dilution
This still does not prevent from a lg bolus of the medication reaching the patient
somethings do not mix and only checking with pharmacy first
With dilution of drug itself
Usually
Assure compatibiltiy of running IV line
still should be diluted
doesn't change pH
when possilbe
but not required
or flush with 10cc ns
Personal practice but many don't do.
fluid limitations
This is our usual practice, will add to education piece and policy
when an iv line i running
this is what i do if they have IV fluid
Some of my coworkers feel this is enough, no need to further dilute, while there is increased risk with INT, this recommendation alone may confuse some to think it is enough
still with dilution in the syringe
Cannot get compliance. Use is too widespread. Message is not sticking.
we are still reviewing to see what we will do. This is a possibility
reviewing at this time
a/a
this is our policy but it is rarely carried out
inject over 10-15minutes
diffucult to hard wire
Our CHF patients are saline locked.
Not all pts have "running IV"
this only helpt if the drug is diluted. I often would increase my IV rate if not contraindicated for the patient even with diluted drug
not at all uncommon to give direct IVP
I currently follow this practice
Depends on the rate or you may have to manually adjust flow.
Minibags would accomplish this
Inconsistencies noticed, will be addressed in protocol
we recommend for
We have explored use of burretrols, expensive, time consumptive to set up, requires change every 48 hours in our facility.
At times
Still goes through full concentration
Trying to limit all IV
Ideal
"whenever possible"
if it is diluted in 10-20ml of NS, I think that would be adequate
checking for compatibility
Zackery
Grady
I can not answer this question completely - in L&D yes, in Acute Care areas or ER I do not know
|
| h) Inject the drug through a running IV line at the port furthest from the patient’s vein |
| 1 |
5% |
| 2 |
7% |
| 3 |
17% |
| 4 |
26% |
| NA |
9% |
| No |
67% |
cannot enforce
Inconsistent practices amongst RNs
added to safety info for labels,MAR,automated disp cabinets
common practice
UNSURE
UNSURE
By practice, not policy.
the wording to this may be difficult to understand without further explanation/example
good idea
When available
it will be done only if there is a IV line available
single port tubing in use
Encourage
Due to pump design, if on IVF.
Currently evaluating these recommendations
Personal practice
Already do this
is under review-potential problem: the nurse may not stand by the bedside until all medication is infused. possible physical incompatibility with medication given at a lower port previously i.e.; heparin iv push.
Often already an intervention
do, but not sure what hospital recommends
We don't do IV's at our level of care
I have suggested to the staff in my unit to do this
Proposed change in policy
depends on how fast and how diluted
Home Infusion
same as above
not known by everyone
We try
Do not know how each staff member does administer it but think this would help.
Same
will be doing so
difficult to enforce
If the patient has a running IV
this is helpful but not necessary
Individual nurses may infact do this without written policy or procedure
Good idea.
nurses always give IV pushes in port closest to patient
If you put all of it into the port furtherst and do not dilute it you still bolus the patient
i will do this as long as first checking for compatability
still should be diluted
strongly recommended, not policy
doesn't change pH
when possible
All our IV's are usually 18 guages would this help insure a patent site? (OB unit)
What about drug compatibilities?
as above
placed as a label comment on the drug-could be ignored by a nurse
this is what i do
sometimes depending on which nurse gives it.
Varies
we are still reviewing to see what we will do. This is a possibility
reviewing at this time
a/a
Will incorporate
universal compliance would be difficult
When possible
this only helpf if you increase the rate of the fluids and dilute the drug - Nurses do do that but it just takes a little longer to hit the vien
Since reading your article, I myself have implented this in my practice
I currently follow this practice
not sure
Not yet
Not always done, need protocol
we recommend for
Good suggestion
"whenever possible"
Will
Perry
there is no nursing guidelines that state the must do this that I am aware of - in L&D several nurses verbalized that this is their practice
most commonly one iv access
|
| i) Administer the drug slowly over 10-15 minutes |
| 1 |
7% |
| 2 |
11% |
| 3 |
19% |
| 4 |
22% |
| NA |
6% |
| No |
68% |
Inconsistent practices amonst RNs
will have probs w/nursingcompliance due to time involved-most nurses don't want to spend 10-15min for ivpush
plan to do so.
usually over 3 minutes
Again, this long of an infusion would require the minibag that could be hung and left unattended
Recommending, but is not policy yet
Does this reduce risk?
30 Minutes
Over at least 5 min
Yes on inpatients, no in the OR
Over 5 min
Resistance encountered from nursing due to time involved and staffing issues.
Modified: over 5-10min
Was recommended after reading your article
Would only work if we convert to mini bag
only if no IV fluid is being administered and the medication is diluted in a piggyback
Current procedure
nurse is diluting the drug in 10-20ml of NS, then giving it as IV over at least 2 min, nurse do not have time to wait for 10-15min
Considering recommendation at this time
Not yet
we push over 1-2 minutes
Working on implementing
Nurses rarely have
2 to 5 mins.
administered over 3 minutes
Currently evaluating these recommendations
I do 5 min
IMPRACTICAL UNLESS IVPB ON PUMP
Nauseated patients want a quick fix. Promethazine is great for that.
is under review
Too much time for a drug given frequently
I give over 7-10 min, -- not sure what hospital recommends
We don't inject this slowly
We have now recommended this
not really possible with how busy we are!
too much time when used frequently
Do you have the nursing time?
Home Infusion
Dilute
Am sure some staff in a hurry give way too fast.
can't turn over pts fast enough waiting 10-15 min for admin of phenergan
again, IM or suppository would be more practical...wh takes care of the other paeintts while I'm at the bedside for 15 min?
Same
longer than our current recommed
using minibags-- IVP won't work
Not reasonable to expect floor RN w/7-8pts to do this. Would be better to ban IV admin or mandate minibags
Will educate to this
Will come with above implementation
not when given IVP
that is a long time unless it's mixed for IVPB administration.
not necessary if proper dilution
if in minibag ok, if IVP not advisable
5-10 minutes more realistic.
if not in a mini bag
not very realistic for IV push
Who has time to do this in real practice?
maybe 5 minutes by ivpush but noone stands there for 10-15 minutes
Important but not practical for busy nurses
i wish we had the portable 10-15 minute syringe pumps
Written in our policy but I know the ED nurses don't follow this.
over 20 min
still should be diluted
over 5 minutes
policy change pending
NURSING PRACTICE DEPENDANT
Recommend over 3-5 minutes
However, you see fewer problems when administered over 30 min. I gave it over 20 min for ~10 years and had a handful of patients with side effects.
It should be given slowly, but for an IV push this time frame may be too long. However,this would probably would be a good time frame for a piggyback.
doesn't change pH
dose dependent
I generally do over 5 minutes
We are in the process of implementing this policy
We compromised with bedside RNs. The drug is given, diluted w/NS in a large, patent vein over 5 minutes.
flush or running iv
Time intensive
drip more time saving for RN
More like 5 minutes
currently changing policy to reflect
We dilute, and push over 3-5 minutes
25 mg/min.
unless in a minibag, our nurses don't have that kind of time.
I always do.
In minibag yes, who has time otherwise
Will still see damage. Nurses ignoring patient's pain, as they expect it.
in PIVs
this is the most important factor...I have had pt with very tiny veins and they tolerated slowwww pushes...thanked me for not burning their veins like other nurses who "push" their meds fast
reviewing at this time
Slow IVP 1-2 min
a/a
administer over 20 minutes
universal compliance would be difficult
We do not require this on our PICC only adminsitration guidelines
new
Much easier if it's a piggyback, not a push.
No time for that
Not sure
We use 2 to 5 minutes
We recommend 3-5 min infusion
Nursing will resist due to time involved and staffing issues.
this is possible if diluted - it is hard to give over time if only 1ml
again individual RNs do this
Recommendations state 3-5minutes at this time
no pushes over 5 minutes
Requires more time to be spent administering medication, less time available to address other patient care needs.
FDA PI approved for 25mg over 1 minute
in process of adding to order set
Who has time to do this.
Seth
Abram
|
| j) Require the person administering the drug to remain with the patient to assess the IV site during the entire injection/infusion |
| 1 |
7% |
| 2 |
8% |
| 3 |
19% |
| 4 |
25% |
| NA |
8% |
| No |
59% |
not practical
common practice
check for blood return throughout the infusion
More the reason to allow in a syringe instead of minibag
would be difficult given nursing shortage
if pushing it - the individual would need to be at the bedside
nurse are diluting the drug and give as IV push over at least 2 min. RN remain with patient while pushing the med
Unknown
not possible, especially on rregular Rn units (none ICU)
Would be time consuming in a busy ER
Not possible
Working on implementing
This is not always feasible in an emergency room setting
Currently evaluating these recommendations
Not enough time
IMPRACTICAL
They should be there anyway.
over 3 to 5 minutes
nurses already stay
Already the case for pushes. Not feasible if minibags used. What nurse has 30 minutes for this several times per shift.
We still push it
Home Infusion-PIV only
wouldn't be feasable for 15-20 minute infusions
not realistic for med-surg nurses who have a load of 6+ patients
Nursing resists
Some staff add syringe to IV pump as a piggyback and program it to run in over so many minutes.
sedating nurse present throughout procedure
see i
PACU Nurse-stays with the patient for other reasons also not just Phenergan adm.
impractical with IVPB administration
See question i comments
Will recommend
ok if giving IVP, wouldn't work with IVPB
this happens if given slow IV
Staff too busy. Will return in 15 min.
staffing situation would not make this feasable
evaluate at least every 15 minutes
but only for the 5 minutes required for admionistration
Is currently being done but nursing knowledge about this drug is sadly lacking. I know of many cases where the patient complained and the nurse explained away their signs and symptoms
not good practical clinical advise as i have more to do in an allotted amount of time for med pass and every mnute counts
only give IVPush-slowly
When hung as an IVPB over 10 - 15 minutes the nurse is unable to stay in the room
not practical in er settigs
strongly recommended, not policy
should be CVL-administered only; observation of CVL site is not useful in detection of infiltration
done routinely on any IVP med
unless it is a minibag infusion - then cannot stay with patient for 30 min infusion time
We provided assessment and action guidelines.
should be if ivp with running iv or flush
if given push
Since we administer by direct injection only, instead of using minibags, the nurse is with the patient during the entire administration.
If IV push, the nurse is there the entire time
how else could you do it
who has time for that
this will only work if giving as a push, which should be done over 5 minutes minimum
Will not cause them to administer more slowly. May have opposite effect.
reviewing at this time
No one should admin a drug they are not trained for.
a/a
time mgmt issue
it'sa little bit difficult to leave when you're pushing the drug thru a syringe
NOT PRACTICLE
This will mostly be administered in our PACU where nurses will not be at the bedside but are within voice range; when used on nursing units, we feel a call bell is sufficient). Plus, pulls nursing staff away from other issues were may be of higher priority. Provided the dosage, dilution, rate and site recommendations are followed, we hope this will not be necessary.
predicting poor compliance
if the drug is push, the nurse would be there during administration
Pending
No standing orders
Not always practical
In PACU we are at bedside
in my area,it is given iv push over about a minute, diluted, so the rn is at the pt side throughout
again nursing will resist due to staffing issues
This could be done if drug is given push, but is impractical if minibag is used.
Yes, since we are administering IV push
This may not occur with minibag infusions
no minibag, only RIVA
If IV Push
5-10 min
Don't know
applicable only when RN is pushing the med
When possible
Given IVP, but not IVPB
Not practical if given as infusion
Alexis
Jarrod
|
| k) Standing orders for promethazine IV reflect the current safety requirements |
| 1 |
4% |
| 2 |
5% |
| 3 |
16% |
| 4 |
22% |
| NA |
20% |
| No |
58% |
but warnings are present in EMR/e-MAR
Will change with new policy.
MAR will reflect this information
Pending
working on it but requirements implemented are in effect now
PLAN TO IMPLEMENT
UNSURE
UNSURE
Don't use standing orders
Working on
no standing order in my hospital
THis is in our IV policy on who can admin & how to administer
we don't have standing orders for this drug
Working on getting these changed after reading your article
unknown
Will present to P & T committee
Unknown
Soon
Working on implementing
Currently evaluating these recommendations
building new order sets in progress
Home Infusion
would like more info sent to me
No standing orders yet working
Have not change PPO
We do not use standing orders.
no standing orders
We don't have standing orders.
no standing orders
No standing orders at my facility
No standing orders
No standing orders at our facility.
These have been our standing orders for years
Order sheets = No. IV Guidelines = Yes
no standing orders
No standing orders
first I have heard of safety requirements
Prohibit standing orders for IV promethazine, far too dangerous
push diluted over two minutes
we use titrate orders
No standing orders
no standing order
We do not use standing orders
Promethazine was not part of any current standing orders
for nurses that have never been taught good iv rx, which must be increasing
No standing orders
Will add the dilute and push times to the order
reviewing at this time
In progress
IV Push
Do not have as a standing order
a/a
workingon CPOE changes currently
NO STANDING ORDERS
new
We have no standing orders for promethazine.
Pending
not supported by the medical staff
I don't agree with a total ban. I would like to see administration via mini-bags
Not yet
No standing orders
We have no standing orders
We are revising all order sets
any rn giving the drug should know to dilute it and administer slowly--unsure about standing orders, because we give it only when specifically ordered
We have voted to implement this recommendation
Not all of them
we don't have standing orders for this drug
Trying to change
in process
No standing orders
Not sure
Do not have standing orders
Brant
Mathew
|
| l) Patients are advised to report burning or pain |
| 1 |
1% |
| 2 |
1% |
| 3 |
8% |
| 4 |
19% |
| NA |
6% |
| No |
34% |
Will change with new policy
probably not being done
plan to do so
Nursing staff inservice, practice not monitored
Not possible for all patients
working on new policy
UNSURE
UNSURE
RN's prompted to monitor iv site
Recommended after reading your article
I don't know what RN tells pt.
This can be common without further problems developing
Working on implementing
Will education nursing
KEY!!!
Not always
Currently evaluating these recommendations
I always do pt. teaching prior to dosing
They will anyway...what makes a difference is when nurses pay attention and stop infusing, as opposed to saying, "it might burn a little, but it will stop." Nurses need to listen to their patients and stop infusing when they say it hurts!
Yes. Include pts in care!
Home Infusion
seldom
Just educated.
most caregivers advise pts to report burning/pain with administration.
We call pt's after surgery to assess all concerns
ideally
But unfortunately nurses don't listen
Pain scale follow-up mandatory.
we have just developed an educational program for nurses based on your last ISMP
but seen as a normal reaction to medication by nurses
Burning or pain indicate that some damage has already been done
i have always made the inquiry of pain
ssevere
strongly recommended, not policy
But the nurse doesn't stop
usually always burns, have never seen a reaction.
Does the nurse listen?
Phenergan burns even when diluted on many pts
pain yes, burning no because I have heard nurses tell patients that this drug does burn and is expected
i had no idea that it caused severe tissue damage our pharmacy now has us mix the med in 50cc of NS, however some don't do it. More warnings and info
but nurse would know and should advise the patient while at bedside giving thw rx
Will incorporate that specific phrase
rn's responsibility
label comment on drug-could be ignored by nurse
this is standard on any Iv medication
Staff are ignoring this complaint.
reviewing at this time
a/a
as with all IV meds
in post op setting not very helpful
At present not specific to this drug
anticipate poor RN and pt compliance
Not policy. Just standard of care.
Not sure
done by some RNs
Not consistent. Information includes "burning may occur"
always done
No standing order
Personal preference
Not consistenly followed
in process of adding to order set
Common sense but how about the patients who can not communicate?
Ulysses
Armani
unknown what nurses advise patients of
|
| m) An alert appears on MARs reminding staff of safety precautions |
| 1 |
3% |
| 2 |
4% |
| 3 |
14% |
| 4 |
20% |
| NA |
10% |
| No |
63% |
We do not have electronic MARs
Beginning this next week
we do not use mars
JUST IMPLEMENTED
working on new policy
Not able to with current system,
are in process of
The order would indicate the route is IM
Considering recommendation at this time
Plan to implement
Will be soon
MARS not used in ER
Not until electronic MA
Mostly
Alerts on MARS are often overlooked. Nurses have Alert fatigue because too many things are put on the MAR
Can add
Currently evaluating these recommendations
PRINT OUT
in progress
Too Many alerts results in ignoring them
Home Infusion
a must
not sure
MAR's not used in all areas where this is given
dodn't use MAR (OP setting)
RE: Proper dilution
no pre-made MAR in ED. I'm unfamiliar with practice outside of ED
Not on MARs. Not realistic.
however has program that makes you choose to withdrawl saline from pyxis for iv route
Or prohibit IV injection
not to my knowledge
Dilute well
a tag to dilute the medication with 10-20ml saline should appear
not unless recently initiated
warning comes up on automated dose cabinet
do not use mars at our facility
for informing nurses that are not aware and/or never taught
Currently adding this to emar screen
We do teach about the dangers of tissue necrosis.
don't work with MARs
unknown
we are still reviewing to see what we will do. This is a possibility
protonx says push over 2 minutes slowly...why cant phenergan say push over 5 minutes..thats how long I stand there...
not currently using MARs
Alerts are all over for every drug
unknown
we do not have mar's
a/a
Don't know. Haven't used lately
only to push over 15 seconds
In L&D we write our own MARS as pts are not on our floor for very long.
Online formulary
We do not use MARS in PACU
Not on Mar on IV
Not yet
Don't know
Home infusion
unsure if the hospital does this
Space on the MAR is limited.
We are considering this recommendation
Don't know
in process of implementing
Nurse written paper MARS
J
Darian
until recently (past 2 months) the use of an alert was sporadic but this does not reach those areas that take supplies from ADM's
|
| n) An alert appears on automated dispensing cabinet screens reminding staff of safety precautions |
| 1 |
4% |
| 2 |
3% |
| 3 |
15% |
| 4 |
21% |
| NA |
18% |
| No |
62% |
Will do this as soon as we determine how.
may help
No automatic dispensing cabinets
JUST IMPLEMENTED
working on new policy
Acudose systems do not have alerts
Will prob add- unfortunately wiht our machines the maessage doesn't appear until after you hear the "boing" of the drawer opening. We keep trying to educate the nurse to look at the sreen after the draw opens- not bend to get the drug. So these in general haven't been that helpful. We have tried to put messages that they have to answer questions. I think we will consider this for the ED, which unlike the rest of the hospital may admin diluted IV push over 5 min.
Added warning after reading your article
Will address.
Reminder that promethazine injection is not for IV use
Considering recommendation at this time
Plan to implement
Not avalable accurately
Better place for an alert than the MAR
Though placed with NS vials.
Currently evaluating these recommendations
this option is not available
see above
Home Infusion
a must
No automated cabinet
Not at this time
not sure
re concentration only
dilution reminders only
Other ways to inform RN's.
we will be putting one in
not to my knowledge
It reminds nurses to dilute in minibag
to further dilute
it doesn't currently appear in my organization but should
No automated dispensing cabiets
dON'T HAVE AUTOMATIC DISPENSING CABINETS
Working with IT.
for imforming nurses that are not aware or never taught
Pyxis not in use.
Will do with updated system
Good practice, sometimes the alerts are so many they are not seen
annoying however
we are still reviewing to see what we will do. This is a possibility
note placed where product
Work in ED
Do not have auto dispense
a/a & don' t have auto dispensing machines
alert posted in nurse break room
Don't know - haven't used lately
NO AUTO DISPENSING UNITS
Some RNs don't read alerts.
Alert sticker is affixed to each vial; recommending dilution and rate
In process
Will proceed with doing so
Alert fatigue; to many already
Not in cabinet
Not yet
Do not use
N/A
Home infusion
Also a problem with extrapramidal symptoms with the elderly
When remove from Pyxis, it asks if pt is greater than 2 years of age
We are considering this recommendation
Not in cabinet
in process of implementing
Will not appear when nurse override access
Mohamed
Shaun
|
| o) Remove promethazine from the formulary |
| 1 |
44% |
| 2 |
19% |
| 3 |
16% |
| 4 |
5% |
| NA |
8% |
| No |
90% |
not realistic
we would need to start using droperidol again, which we always liked better than promethazine anyway
This is being discussed
Considering
We had these safety procedures in & almost never used. After the compazine recall, we felt forced to use. NOw we still use a significant amt- evn though we are discouraging it.
Currently being contemplated
Pending -evaluating at this time
This is a complete overreaction!
Remove the injectable form of the drug
Current practice
Easier said than done ... and, it has its place in therapy
Are you kidding?
This medication has benefit if given according to safety precautions. Many other meds also have issues (ie chemo) but we don't remove them.
Currently evaluating these recommendations
or central line only
Should be
Cost issues
NOT ENOUGH OTHER CHOICES
medical staff is considering
Sometimes this is the best drug
This drug is VERY effective when zofran and tigan are not
yes, please
Phenergan is needed on formulary
IV & IM might be nice but a hard sell
Home Infusion
Effective IM
cost wise it is inexpensive compared to Zofran
This is to be discussed at our next PTN meeting in Oct - largely as a result of your information
Unfortunately, pricing has an effect
but it's in our plans
ABSOLUTELY NOT!!!
Bad idea! Would hurt patients more.
very much agree
Best of all worlds!!
promethazine is a fine drug and effective i say put the protocols in place and replace iv with pill routes whenever possible
I'd love to
it is effective
physicians still able to order non-formulary drugs
In 19+ years, have never seen a reaction
Too valuable a medication to remove
Considering.
r/t expense - prefer zofran, but still too expensive
effective, inexpensive
we have gone thru P&T and medical staff and IV promethazine is NOT used no matter where in the hospital
Considered, however Medical staff would reject
We have other drugs that are much safer-Why use this one from ancient times???
We are removing it from preprinted order sets.
we are pending the next P&T meeting later this month
this med has it's value
Staff MDs and nurses are too comfortable with this drug, are not hearing the concerns. It needs to be removed from IV practice completely.
no...it helps too many peoples...its how the nurses deliver thats the main problem
not likely at this time
We are exploring this route, with summer holidays haven't got to it yet
absolutely not! it's the best drug we use for ponv
a/a
considering
Vast majority of cases were from inappropriate dosages/rates of infusion - we will be using exclusively 6.25 mg by infusion with the precautions recommended. We feel that removing this drug from use is an exaggered response + would eliminate a valuable drug for the treatment of post-op nausea and vomiting. Alternate drugs carry risks also - dexamethasone (avascular necrosis), droperidol (QT warning/black box), ondansetron (5HT3s; QT prolongation), dimenhydrinate (EPS, anticholinergic)
use I.M. only
meeting resistance
Our admission orders state promethazine should be tried only after Zofran fails. (The #3 drug is Reglan.)
We had 5 cases of extravasation in one year and removed the drug from formulary
Considering
Promethazine is widely used in L&D
i certainly hope they won't--it is a good drug and quite safe if administered properly
Just not realistic. Promethazine is inexpensive and very effective. Physicians would strongly resist this recommendation.
This drug is effective for the right patient when diluted
Cost
This is a very effective drug which should be used safely, not removed.
Recommendations to P&T for alternate
Cost impact can be substantial, Reduces available antiemetic options for the patient.
Trying to remove
Hard to do; it's a good drug
Drug is too effective when used properly to take away
I have used phenergan for 4 years in my hospitalist practice and I have never had an adverse reaction due to infiltration of the drug. Is this really a frequent event to cause such a response or are we overreacting?
No, this is a good drug.
med is very effective
Arturo
Dakota
Several case reports do not necessitate formulary removal
|
| p) Ban IV use of promethazine |
| 1 |
46% |
| 2 |
15% |
| 3 |
14% |
| 4 |
6% |
| NA |
8% |
| No |
89% |
not realistic
not
under discussion
did remove 50mg/ml strength
Just voted to do this in P&T
See ans to #9. We are discouraging its use due to sedation issues. After the long comapzine backorder. IT would be hard to totally eliminate- in case that happens again. Zofran works grat- but the financil impact was great. I think phenergan could be reserved with guidelines for these type of occasions.for
Currently being contemplated; action by FDA would help greatly
This is a complete overreaction!
Are you kidding?
I have never seen a severe reaction in 10 years of practice
See above
Currently evaluating these recommendations
or central line only PFV IM
Could be used correctly; strict guide
A GOOD IDEA I THINK
Sometimes this is the best drug
After $600k liability costs compromise was "b" above
Home Infusion
considering via P&T
I have used it for voer 30 years with no adverse events
works so well it would be a shame to resort to this
under consideration
but in our future plans
ABSOLUTELY NOT!!! Phenergan is a safe and effective drug if given correctly Please do not eliminate
Bad idea! Would hurt patients more.
just train nurses better on administration- we always dilute meds if it is always listed to be diluted before administration
very much agree
GIVE IM ONLY!!
Best of all worlds!!
If the medication is available MD's will still order it and RN's/LPN's will still give it. Such a pity.
no some of my patients require fast acting in the acute setting
Still a very effective antiemetic
we no longer use iv phenergan
IM use is just as painful
it is effective and quick acting
Only allowed in rare instances
plan on implementing this in the near future
the only solution
Should only be given IV via a central line with confirmation of patency with blood aspiration or radiologic confirmation.
I would hate to see this happen. It has been beneficial for many of our patients and I haven't seen an adverse reaction when given IV over 19 years of practice.
could be used in central catheters
Does IM cause tissue problems as well?
Again, it is too valuable a medication to remove from use
I was just at a hospital taking a friend for admittance and told the nursing station she had pain at her iv site and would need a new site before getting her promethazine and she came in with 10cc of rx with ns and said "proudly" when asked if she was going to flush it after starting a new iv, was going to try the old and did not need to flush as they just started a new policy for diluting it in 10cc of ns!!! I advised she needed a new iv before any other rx or fluids and need for flush after any rx if no running iv fluids!
effective, inexpensive
There are too many other drugs that could be tried.
We annually administer over 4,000 doses IV and have not had any problems. Despite this, education is helpful
most of our patient's won't or can't use rectal route
This should be removed from IV use, it is too dangerous and there are other alternatives that are much safer.
Best option. Unable to get compliance with any other safety options in my facility. Seeing horrible outcomes.
not likely at this time
Would highly
If I can't have it removed, we will look at this option next
absolutely not! its a great drug!!!!!!
a/a
i would use for times one dose only..not around the clock or Q6 PRN
considering
WHICH DRUG NEXT?
we are currently working on this
Still have listed for IM use
Considering
In 12 years, I have administered many, many doses of IV Promethazine, slow (over 2 min) and diluted, with absolutely no adverse occurence! All iv hand or wrist veins)!
We encourage IM administration for post-op & hyperemesis patients
i hope not--see above
Used frequently only occasional problem.
Cost
Not sure.
We may restrict inj Phenergan to IM route of administration only.
Trying to remove
It's really needed
Ladarius
Allen
|
q) Use alternative rescue antiemetics
Specify:
ondansetron, etc.
?Zofran
5-HT3 antagonist
Age group related
alternate route, compazine, ondansetron
antiemetic protocol
anzamet
Anzamet, Zofran or Kytril
anzamet, zofran, reglan
Anzement or Zofran
Anzemet
Anzemet - Zofran
Anzemet & Zofran IV available.
anzemet for iv/reglan/decadron
anzemet, compazine
anzemet, kytril, zofran
anzemet, reglan
anzemet, reglan, zofran
Anzemet, Zofran
Anzemet, Zofran, Compazine, DHE
anzemet, zofran, kytril
Anzemet,, Tigan
anzemet/zofran
anzimet
Cason
change the route of promethazine
Compaine or Zofran or Kytol
compazine
compazine is now available again
Compazine or Anzemet
compazine, 5HT3's
Compazine, Anzenet
compazine, Dexamethasone, Reglan, Kytril
compazine, inapsine, anzemet, zofran
Compazine, Kytril, Reglan
compazine, ondansetron
compazine, reglan
compazine, reglan, zofran
Compazine, Tigan, Zofran
Compazine, Tigan; Anzanet, Zofran
compazine, zoffran
compazine, zofran
compazine, zofran, ativan
compazine, zofran, ativan, benedryl, kytril
Compazine, Zofran, etc. I hope you are not passing the data to drug companies, that would be unprofessional.
Compazine, Zofran, Kytril, Reglan
compazine, zofran, pepcid, tigan
Compazine,Tigan,Reglan,Zofran
compazine/droperidol/zofran
compazine/zofran
Comzine or Zofran; dependen on underlying | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |