Disposal Of Live Attenuated Vaccines

Live vaccines contain viable microorganisms which must be killed before the material can safely be disposed of. Materials of this type are to be returned to the pharmacy when it becomes unusable because of deterioration, the expiration dating has been exceeded, etc. The Pharmacy will autoclave such vaccines before discarding. Examples of Live Attenuated Vaccines are measles, mumps, polio, and rubella. When there is any doubt whether an item is a live vaccine, return it to the Pharmacy. Do not discard or destroy it on the Nursing Unit or in the Clinic.

Total Parenteral Nutrition (TPN) Orders

1. A TPN order must be written for each 24 hours of patient feeding.

2. Orders must be received in the pharmacy no later than 4:00 P.M. daily. Late orders will be placed in a lower priority than other medication orders. If the next TPN bottle is not available when needed on the Nursing Unit, a Dextrose 10% Solution will need to be hung until the order is available.

3. The Pharmacy will provide each TPN fluid in a sequential number series with the number appearing on the label of the container. Before hanging a TPN the nurse is to compare the label data to the most recent physician’s order. Discrepancies or questions are to be directed to the Pharmacy before the TPN is hung.

4. All TPN solutions will be sent to the nursing unit at 7:00 P.M. and are to be hung at 8:00 P.M. This includes the initial fluid order.

5. No additional ingredients are to be added without first contacting the Pharmacy.

6. Normal expiration dating for a TPN fluid is 36 hours from the time of preparation.

7. TPN orders are not considered to qualify for a "STAT," "NOW," or "EMERGENCY" designation. A Dextrose 5% Solution is to be hung when a new subclavian line is put into place until a chest X-ray verifies the placement of the catheter in the vena cava. When positioning has been verified, hang a Dextrose 10% Solution until 8:00 P.M. when the first unit of TPN fluid is delivered.

8. No TPN order will be prepared if the order is incomplete or questionable until all information is clarified by a physician.

9. The Pharmacy is to communicate to the nurse any changes in orders that the physician may make directly with the Pharmacist. The nurse should make an annotation to the original TPN order and the physician is to initial the changes as soon as possible.

I.V. Push Policy

1. Registered nurses may administer I.V. bolus doses of any emergency drug of other standard I.V. drug while in the presence and under the supervision of a physician.

2. Registered nurses may administer I.V. bolus doses of certain standard I.V. drugs on written orders when the physician is not present.

1. Any drug administered must be on the approved hospital list.

2. Certification of the competency of the nurse to administer I.V. bolus medication is subject to the Department of Nursing.

3. A general listing of drugs approved for consideration for inclusion on a nursing unit list can be found in the appendix of this formulary. Any additions of drugs to the over-all list will be submitted and approved by the Pharmacy Committee.

4. Certain drugs will only be administered by IV bolus unless a specific therapeutic reason exists to administer the drug by piggyback or continuous infusion. These drugs are listed in the appendix of this formulary.

Medication Administration Times

A joint nursing-pharmacy committee has developed and the Pharmacy and Therapeutics Committee has approved Standard Medication Administration times for the Hospital. Every effort shall be made to conform to these administration times for all patients. A schedule for converting patients to the times no matter what time the first dose is administered has been developed and is posted on each nursing division with the medication administration times. A chart of the medication administration times is listed in the Appendix of this book.