The survey was completed by 1,773 respondents, 97 percent of whom were registered nurses, between April and June 2014.
Here are three key findings from the survey:
• Even when the pharmacy dispenses a prefilled syringe containing a patient-specific dose, as many as 20 percent or more respondents further dilute these medications, with 12 percent reporting that they often or always dilute these medications.
• For opioids, more than a quarter of respondents reported “always” diluting the drug before administration
• Almost half of all respondents reported they often or always dilute anti-anxiety/antipsychotic medications prior to IV push administration
According to the ISMP, these actions lead to unlabeled or mislabeled syringes, potential contamination of sterile IV medications, dosing errors and other drug administration errors. The ISMP recommends the following to avoid potential medication errors:
1. Conduct a nursing survey to learn the extent and variability of dilution of adult IV push medications.
2. For drugs that may improve patient comfort or the accuracy of measuring the dose if diluted, have pharmacy research the safety of dilution in the absence of manufacturers’ recommendations.
3. When possible, require pharmacy to prepare any IV push medications that must be diluted according to the manufacturer’s guidelines or hospital policy.
4. If stability requires drug dilution immediately prior to IV push administration, provide exact directions for dilution to nurses.
5. If the nursing survey in your organization identifies episodes of dilution not supported by the official drug labeling or other reliable sources, conduct educational programs to help nurses see the risks associated with these practices.
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