Open Forum

At my practices, we have a new provider/MD. He is stating that RNs/LPNs have assisted him before by drawing up the medication for him, and then he would administer to the patient. He may or may not witness the drawing up or the preparation, but he is "comfortable" allowing a properly trained nurse to draw up his injectable medications. 

Are there clear and hard guidelines for this? I know all nurses would not dare administer a medication that they did not draw up, but can nurses prepare for provider who is willing to administer a pre-prepared injectable medication?

------------------------------
Kenzo Sanga, MSN, RN
Director of Outpatient Clinical Education
Phoenix, AZ
480-788-6406
------------------------------

Hi Kenzo,

This actually came up recently during our implementation of a new covid vaccine clinic protocol in our pediatric specialty clinics. Due to the nature of the Covid vaccine being a multi-dose vial, and being administering infrequently in a multi-clinic building, it is not possible to have each nurse draw up their own vaccine dose without throwing away 4 to 5 doses from every vial. The doses are drawn up by a trained nurse in a central location, labeled and picked up by MAs or nurses as needed in their clinics.  This initially received a lot of push back from our nurses who were also uncomfortable giving medications they had not drawn up. But after talking through the safety measures in place and strong system of differentiating and labeling the different strength doses, it was accepted as safe and the process is going well. I feel that nurses are more sensitive to this matter after this year's events in the news with the RN administering the fatal med resulting in a patient death. But... historically, as a pediatric ICU nurse, almost all of my scheduled medications were pre-drawn and labeled for weight based dosing by pharmacy technicians in a central hospital pharmacy and dispersed into our individual patient rooms' med drawers. This is common practice in pediatrics as we rarely give whole vials or bags of any given med. I would think with the proper safety techniques in place, maybe even having the nurse draw up the meds in the room while the provider is prepping or bringing the vial with them along with the syringe, would help ensure the provider can verify the syringe is the correct medication. Our RNs in our pediatric rheumatology practice also assist with joint injections and I believe they often prep the meds in the room before the provider comes in for the injection. In this case the vials are available on hand and can be verified by the provider. 

Long story short, I wouldn't say its off the table, but you would definitely want to implement med safety steps. Knowing that the potential for error exists regardless of who is drawing up vs administering the vaccine (and nurses likely receive more training on safely drawing up medications than many MDs), med safety should always be top of mind ensuring safe practices are in place - minimizing distractions in the med zone, real time charting or barcode scanning when possible, double checking high alert medications and using clear labeling for look alike/sound alike meds. 

------------------------------
Brandy Williamson BSN RN CPN
Ambulatory Nursing Manager
Children's Healthcare-Atlanta
Atlanta GA
(404)785-8978
brandy.williamson@choa.org
------------------------------

Original Message:
Sent: 07-05-2022 16:28
From: Kenzo Sanga
Subject: Nurse preparing injectable medication, but provider administering

At my practices, we have a new provider/MD. He is stating that RNs/LPNs have assisted him before by drawing up the medication for him, and then he would administer to the patient. He may or may not witness the drawing up or the preparation, but he is "comfortable" allowing a properly trained nurse to draw up his injectable medications. 

Are there clear and hard guidelines for this? I know all nurses would not dare administer a medication that they did not draw up, but can nurses prepare for provider who is willing to administer a pre-prepared injectable medication?

------------------------------
Kenzo Sanga, MSN, RN
Director of Outpatient Clinical Education
Phoenix, AZ
480-788-6406
------------------------------

Original Message:
Sent: 7/5/2022 5:04:00 PM
From: Brandy Williamson
Subject: RE: Nurse preparing injectable medication, but provider administering

Hi Kenzo,

This actually came up recently during our implementation of a new covid vaccine clinic protocol in our pediatric specialty clinics. Due to the nature of the Covid vaccine being a multi-dose vial, and being administering infrequently in a multi-clinic building, it is not possible to have each nurse draw up their own vaccine dose without throwing away 4 to 5 doses from every vial. The doses are drawn up by a trained nurse in a central location, labeled and picked up by MAs or nurses as needed in their clinics.  This initially received a lot of push back from our nurses who were also uncomfortable giving medications they had not drawn up. But after talking through the safety measures in place and strong system of differentiating and labeling the different strength doses, it was accepted as safe and the process is going well. I feel that nurses are more sensitive to this matter after this year's events in the news with the RN administering the fatal med resulting in a patient death. But... historically, as a pediatric ICU nurse, almost all of my scheduled medications were pre-drawn and labeled for weight based dosing by pharmacy technicians in a central hospital pharmacy and dispersed into our individual patient rooms' med drawers. This is common practice in pediatrics as we rarely give whole vials or bags of any given med. I would think with the proper safety techniques in place, maybe even having the nurse draw up the meds in the room while the provider is prepping or bringing the vial with them along with the syringe, would help ensure the provider can verify the syringe is the correct medication. Our RNs in our pediatric rheumatology practice also assist with joint injections and I believe they often prep the meds in the room before the provider comes in for the injection. In this case the vials are available on hand and can be verified by the provider. 

Long story short, I wouldn't say its off the table, but you would definitely want to implement med safety steps. Knowing that the potential for error exists regardless of who is drawing up vs administering the vaccine (and nurses likely receive more training on safely drawing up medications than many MDs), med safety should always be top of mind ensuring safe practices are in place - minimizing distractions in the med zone, real time charting or barcode scanning when possible, double checking high alert medications and using clear labeling for look alike/sound alike meds. 

------------------------------
Brandy Williamson BSN RN CPN
Ambulatory Nursing Manager
Children's Healthcare-Atlanta
Atlanta GA
(404)785-8978
brandy.williamson@choa.org
------------------------------

Original Message:
Sent: 07-05-2022 16:28
From: Kenzo Sanga
Subject: Nurse preparing injectable medication, but provider administering

At my practices, we have a new provider/MD. He is stating that RNs/LPNs have assisted him before by drawing up the medication for him, and then he would administer to the patient. He may or may not witness the drawing up or the preparation, but he is "comfortable" allowing a properly trained nurse to draw up his injectable medications. 

Are there clear and hard guidelines for this? I know all nurses would not dare administer a medication that they did not draw up, but can nurses prepare for provider who is willing to administer a pre-prepared injectable medication?

------------------------------
Kenzo Sanga, MSN, RN
Director of Outpatient Clinical Education
Phoenix, AZ
480-788-6406
------------------------------

Original Message:
Sent: 7/8/2022 12:35:00 PM
From: Ceresa Ward
Subject: RE: Nurse preparing injectable medication, but provider administering

I have a related question. How is documentation of administration of those medications handled? Does the provider document that they administered or does the nurse document the medication and indicate the provider who will administer it?

We have similar situations where the nurses draw up, label and secure medications for providers to administer for various joint injections. The nurses are typically not present to witness when the provider administers the medication.  

 

Ceresa J. Ward, MSN, RN

Director, Ambulatory Patient Care Services

UPMB 0108 DC121.00

University of Missouri Health Care

One Hospital Drive, Columbia, MO 65212

E: wardc@health.missouri.edu  O: 573-884-7957

C: 573-268-6879  FAX: 573-884- 3187

 

 

 

Original Message:
Sent: 7/5/2022 5:04:00 PM
From: Brandy Williamson
Subject: RE: Nurse preparing injectable medication, but provider administering

Hi Kenzo,

This actually came up recently during our implementation of a new covid vaccine clinic protocol in our pediatric specialty clinics. Due to the nature of the Covid vaccine being a multi-dose vial, and being administering infrequently in a multi-clinic building, it is not possible to have each nurse draw up their own vaccine dose without throwing away 4 to 5 doses from every vial. The doses are drawn up by a trained nurse in a central location, labeled and picked up by MAs or nurses as needed in their clinics.  This initially received a lot of push back from our nurses who were also uncomfortable giving medications they had not drawn up. But after talking through the safety measures in place and strong system of differentiating and labeling the different strength doses, it was accepted as safe and the process is going well. I feel that nurses are more sensitive to this matter after this year's events in the news with the RN administering the fatal med resulting in a patient death. But... historically, as a pediatric ICU nurse, almost all of my scheduled medications were pre-drawn and labeled for weight based dosing by pharmacy technicians in a central hospital pharmacy and dispersed into our individual patient rooms' med drawers. This is common practice in pediatrics as we rarely give whole vials or bags of any given med. I would think with the proper safety techniques in place, maybe even having the nurse draw up the meds in the room while the provider is prepping or bringing the vial with them along with the syringe, would help ensure the provider can verify the syringe is the correct medication. Our RNs in our pediatric rheumatology practice also assist with joint injections and I believe they often prep the meds in the room before the provider comes in for the injection. In this case the vials are available on hand and can be verified by the provider. 

Long story short, I wouldn't say its off the table, but you would definitely want to implement med safety steps. Knowing that the potential for error exists regardless of who is drawing up vs administering the vaccine (and nurses likely receive more training on safely drawing up medications than many MDs), med safety should always be top of mind ensuring safe practices are in place - minimizing distractions in the med zone, real time charting or barcode scanning when possible, double checking high alert medications and using clear labeling for look alike/sound alike meds. 

------------------------------
Brandy Williamson BSN RN CPN
Ambulatory Nursing Manager
Children's Healthcare-Atlanta
Atlanta GA
(404)785-8978
brandy.williamson@choa.org
------------------------------

Original Message:
Sent: 07-05-2022 16:28
From: Kenzo Sanga
Subject: Nurse preparing injectable medication, but provider administering

At my practices, we have a new provider/MD. He is stating that RNs/LPNs have assisted him before by drawing up the medication for him, and then he would administer to the patient. He may or may not witness the drawing up or the preparation, but he is "comfortable" allowing a properly trained nurse to draw up his injectable medications. 

Are there clear and hard guidelines for this? I know all nurses would not dare administer a medication that they did not draw up, but can nurses prepare for provider who is willing to administer a pre-prepared injectable medication?

------------------------------
Kenzo Sanga, MSN, RN
Director of Outpatient Clinical Education
Phoenix, AZ
480-788-6406
------------------------------

Ceresa,

I think it will also depend on how you're currently documenting medication administration within the ambulatory setting. Is it free text or are you using a MAR? 

When I was in a procedural area and the providers were unable to enter orders (sterile procedure, too much variation to have standing orders or for them to enter them prior to the procedure) the providers would enter the medication, dose, and route in their procedure note. I still see this in the ambulatory setting where there isn't a MAR and the provider will have a note stating that "**mL of 2% lidocaine was injected into ***". It's probably a smart text within our EHR and they just have to fill in the blanks! 

The procedural area I was in eventually moved to having the provider administered medications entered into our MAR. We entered the order and signed it as a verbal order (again, physician in sterile procedure and too much variation to enter ahead of time or use standing orders), and then when we (nursing staff) signed the medication administration we could document that it was administered by the provider. This provided easier access for reporting for our pharmacy team and allowed the inpatient staff to still see the medication administration. Keep in mind that since this was a procedural area, the nursing staff were present the entire time so we knew the dose/route/medicine and could witness the administration. Tying this all back in to the original topic, the nursing staff were usually the ones who had to mix and draw up the medicine and ensure it was handed off to the sterile field properly. We'd validate my syringe was right, the containers stayed on the counter until the patient left the room, I'd show my vial and labeled syringe to the scrub and they'd make sure their syringe label matched (my NTG was going into their NTG syringe). 

If you aren't using a MAR with your EHR, I'd at least make sure the providers are in the practice of dictating or documenting what was administered, the dose, route, and location.

------------------------------
Andrea Kelly MSN,RN,NPD-BC
Director, Population Health
Vidant Medical Group
Greenville NC
(252)847-3930
------------------------------

Original Message:
Sent: 07-08-2022 12:35
From: Ceresa Ward
Subject: Nurse preparing injectable medication, but provider administering

I have a related question. How is documentation of administration of those medications handled? Does the provider document that they administered or does the nurse document the medication and indicate the provider who will administer it?

We have similar situations where the nurses draw up, label and secure medications for providers to administer for various joint injections. The nurses are typically not present to witness when the provider administers the medication.  

 

Ceresa J. Ward, MSN, RN

Director, Ambulatory Patient Care Services

UPMB 0108 DC121.00

University of Missouri Health Care

One Hospital Drive, Columbia, MO 65212

E: wardc@health.missouri.edu  O: 573-884-7957

C: 573-268-6879  FAX: 573-884- 3187

 

 

 

Original Message:
Sent: 7/5/2022 5:04:00 PM
From: Brandy Williamson
Subject: RE: Nurse preparing injectable medication, but provider administering

Hi Kenzo,

This actually came up recently during our implementation of a new covid vaccine clinic protocol in our pediatric specialty clinics. Due to the nature of the Covid vaccine being a multi-dose vial, and being administering infrequently in a multi-clinic building, it is not possible to have each nurse draw up their own vaccine dose without throwing away 4 to 5 doses from every vial. The doses are drawn up by a trained nurse in a central location, labeled and picked up by MAs or nurses as needed in their clinics.  This initially received a lot of push back from our nurses who were also uncomfortable giving medications they had not drawn up. But after talking through the safety measures in place and strong system of differentiating and labeling the different strength doses, it was accepted as safe and the process is going well. I feel that nurses are more sensitive to this matter after this year's events in the news with the RN administering the fatal med resulting in a patient death. But... historically, as a pediatric ICU nurse, almost all of my scheduled medications were pre-drawn and labeled for weight based dosing by pharmacy technicians in a central hospital pharmacy and dispersed into our individual patient rooms' med drawers. This is common practice in pediatrics as we rarely give whole vials or bags of any given med. I would think with the proper safety techniques in place, maybe even having the nurse draw up the meds in the room while the provider is prepping or bringing the vial with them along with the syringe, would help ensure the provider can verify the syringe is the correct medication. Our RNs in our pediatric rheumatology practice also assist with joint injections and I believe they often prep the meds in the room before the provider comes in for the injection. In this case the vials are available on hand and can be verified by the provider. 

Long story short, I wouldn't say its off the table, but you would definitely want to implement med safety steps. Knowing that the potential for error exists regardless of who is drawing up vs administering the vaccine (and nurses likely receive more training on safely drawing up medications than many MDs), med safety should always be top of mind ensuring safe practices are in place - minimizing distractions in the med zone, real time charting or barcode scanning when possible, double checking high alert medications and using clear labeling for look alike/sound alike meds. 

------------------------------
Brandy Williamson BSN RN CPN
Ambulatory Nursing Manager
Children's Healthcare-Atlanta
Atlanta GA
(404)785-8978
brandy.williamson@choa.org

Original Message:
Sent: 07-05-2022 16:28
From: Kenzo Sanga
Subject: Nurse preparing injectable medication, but provider administering

At my practices, we have a new provider/MD. He is stating that RNs/LPNs have assisted him before by drawing up the medication for him, and then he would administer to the patient. He may or may not witness the drawing up or the preparation, but he is "comfortable" allowing a properly trained nurse to draw up his injectable medications. 

Are there clear and hard guidelines for this? I know all nurses would not dare administer a medication that they did not draw up, but can nurses prepare for provider who is willing to administer a pre-prepared injectable medication?

------------------------------
Kenzo Sanga, MSN, RN
Director of Outpatient Clinical Education
Phoenix, AZ
480-788-6406
------------------------------

Kenzo,

Especially in our Orthopedics clinic, every day, providers give intra-articular injections drawn up by the nurses.  As RNs, we are trained to never given an injection of any kind that we didn't draw up ourselves.  The physicians, however, have a trust in the nurses' knowledge and skill, making them comfortable giving injections they didn't draw up.  We don't have a policy against this practice.  I'm eager to see what others report.  Thanks for your post.

------------------------------
Patricia Parrish-Deese, MSN, RN, NE-BC
Ambulatory Nurse Manager - Quality and Safety
Augusta University Medical Center
Augusta, Georgia
706-829-3863
------------------------------

Original Message:
Sent: 07-05-2022 16:28
From: Kenzo Sanga
Subject: Nurse preparing injectable medication, but provider administering

At my practices, we have a new provider/MD. He is stating that RNs/LPNs have assisted him before by drawing up the medication for him, and then he would administer to the patient. He may or may not witness the drawing up or the preparation, but he is "comfortable" allowing a properly trained nurse to draw up his injectable medications. 

Are there clear and hard guidelines for this? I know all nurses would not dare administer a medication that they did not draw up, but can nurses prepare for provider who is willing to administer a pre-prepared injectable medication?

------------------------------
Kenzo Sanga, MSN, RN
Director of Outpatient Clinical Education
Phoenix, AZ
480-788-6406
------------------------------

I remember my first day as a nurse. I'm less than four hours on the clock as a new grad nurse in an ED, and my preceptor and I had received orders to go give morphine to a patient with renal colic. I had not trained on our medication system yet, and my preceptor drew up the medicine and handed it to me and told me to go give it. I was trying to do the right thing (Is she testing me?) and told her we weren't supposed to give medicine that we didn't draw up. Picture the exorcist scene where the head spins around. Her head whipped around and I got a quick lesson from her in "Don't ever....". She ended up giving the medicine (since I also hadn't been validated to push IV medicines yet). (By no means am I implying that this was a healthy encounter, and this was a long time ago and there have been great strides in preceptor practices and not "eating our young".)

All of that to say- even in nursing there are situations where we do give medications we didn't draw up. We use our safety habits and validate and verify where we can. Can I see the bottle you used to validate the dose/concentration? Did I validate the amount in the container that I'm going to administer? Is the syringe labeled with medicine and strength? Do I know the person who drew it up and know they are competent (or do they have the required training even if I don't know them)? For example, we had a similar situation as Brandy. During our large scale vaccination campaign we had pharmacists in another location drawing up the doses. I didn't know them, but know they have the required training to competently perform that job. In a code situation someone is assigned to the medication administration role, but someone else may be at the cart preparing the medications.

Patricia mentioned another great point. It isn't routine practice for nursing staff to administer something we didn't draw up, but for providers this is day to day. If they're in a sterile procedure and need a medication drawn up to inject, someone else has mixed or drawn that up (lidocaine, steroids, antibiotics, Botox, etc...). I did check our state medical board site (I'm in North Carolina) and it doesn't mention anything against this practice, so long as the person being delegated to is competent and the practice is "established by custom".

------------------------------
Andrea Kelly MSN,RN,NPD-BC
Director, Population Health
Vidant Medical Group
Greenville NC
(252)847-3930
------------------------------

Original Message:
Sent: 07-05-2022 16:28
From: Kenzo Sanga
Subject: Nurse preparing injectable medication, but provider administering

At my practices, we have a new provider/MD. He is stating that RNs/LPNs have assisted him before by drawing up the medication for him, and then he would administer to the patient. He may or may not witness the drawing up or the preparation, but he is "comfortable" allowing a properly trained nurse to draw up his injectable medications. 

Are there clear and hard guidelines for this? I know all nurses would not dare administer a medication that they did not draw up, but can nurses prepare for provider who is willing to administer a pre-prepared injectable medication?

------------------------------
Kenzo Sanga, MSN, RN
Director of Outpatient Clinical Education
Phoenix, AZ
480-788-6406
------------------------------

@Andrea Kelly agree with all of this. I think of healthcare, and especially Nursing, as a team sport. We cant do every step of every job (our providers cant either) and we need to be able to trust our teammates to do their parts as well (with proper training and competencies) and its important that as many safety measures are in place to set everyone up for success and safe care. ​

------------------------------
Brandy Williamson BSN RN CPN
Ambulatory Nursing Manager
Children's Healthcare-Atlanta
Atlanta GA
(404)785-8978
brandy.williamson@choa.org
------------------------------

Original Message:
Sent: 07-06-2022 08:34
From: Andrea Kelly
Subject: Nurse preparing injectable medication, but provider administering

I remember my first day as a nurse. I'm less than four hours on the clock as a new grad nurse in an ED, and my preceptor and I had received orders to go give morphine to a patient with renal colic. I had not trained on our medication system yet, and my preceptor drew up the medicine and handed it to me and told me to go give it. I was trying to do the right thing (Is she testing me?) and told her we weren't supposed to give medicine that we didn't draw up. Picture the exorcist scene where the head spins around. Her head whipped around and I got a quick lesson from her in "Don't ever....". She ended up giving the medicine (since I also hadn't been validated to push IV medicines yet). (By no means am I implying that this was a healthy encounter, and this was a long time ago and there have been great strides in preceptor practices and not "eating our young".)

All of that to say- even in nursing there are situations where we do give medications we didn't draw up. We use our safety habits and validate and verify where we can. Can I see the bottle you used to validate the dose/concentration? Did I validate the amount in the container that I'm going to administer? Is the syringe labeled with medicine and strength? Do I know the person who drew it up and know they are competent (or do they have the required training even if I don't know them)? For example, we had a similar situation as Brandy. During our large scale vaccination campaign we had pharmacists in another location drawing up the doses. I didn't know them, but know they have the required training to competently perform that job. In a code situation someone is assigned to the medication administration role, but someone else may be at the cart preparing the medications.

Patricia mentioned another great point. It isn't routine practice for nursing staff to administer something we didn't draw up, but for providers this is day to day. If they're in a sterile procedure and need a medication drawn up to inject, someone else has mixed or drawn that up (lidocaine, steroids, antibiotics, Botox, etc...). I did check our state medical board site (I'm in North Carolina) and it doesn't mention anything against this practice, so long as the person being delegated to is competent and the practice is "established by custom".

------------------------------
Andrea Kelly MSN,RN,NPD-BC
Director, Population Health
Vidant Medical Group
Greenville NC
(252)847-3930

Original Message:
Sent: 07-05-2022 16:28
From: Kenzo Sanga
Subject: Nurse preparing injectable medication, but provider administering

At my practices, we have a new provider/MD. He is stating that RNs/LPNs have assisted him before by drawing up the medication for him, and then he would administer to the patient. He may or may not witness the drawing up or the preparation, but he is "comfortable" allowing a properly trained nurse to draw up his injectable medications. 

Are there clear and hard guidelines for this? I know all nurses would not dare administer a medication that they did not draw up, but can nurses prepare for provider who is willing to administer a pre-prepared injectable medication?

------------------------------
Kenzo Sanga, MSN, RN
Director of Outpatient Clinical Education
Phoenix, AZ
480-788-6406
------------------------------

Good Morning! We function just as Brandy mentioned with our COVID vaccines, our trained pharmacy staff dilute, draw up and label the COVID vaccines for our primary care and pediatric clinic. I also understand the nervousness on these sort of things but we also have to be good stewards, wasting so many COVID vaccines would be absurd. As Brandy mentioned our staff accepted this process after some solid teaching and ensuring that specific protocols were in place. What's a tad funny is that they will draw up Lidocaine for a provider to administer during procedures all day long and it never bothered them (I suppose all the hype over the vaccine caused them to be weary). If you ensure that protocols are in place and everyone has been properly trained things should go well :-)

------------------------------
Krystal Lewis RN
Chickasaw Nation
Ardmore OK
(580)220-7720
------------------------------

Original Message:
Sent: 07-05-2022 16:28
From: Kenzo Sanga
Subject: Nurse preparing injectable medication, but provider administering

At my practices, we have a new provider/MD. He is stating that RNs/LPNs have assisted him before by drawing up the medication for him, and then he would administer to the patient. He may or may not witness the drawing up or the preparation, but he is "comfortable" allowing a properly trained nurse to draw up his injectable medications. 

Are there clear and hard guidelines for this? I know all nurses would not dare administer a medication that they did not draw up, but can nurses prepare for provider who is willing to administer a pre-prepared injectable medication?

------------------------------
Kenzo Sanga, MSN, RN
Director of Outpatient Clinical Education
Phoenix, AZ
480-788-6406
------------------------------

Hello All,
We have clinical competencies for our Medical Assistants/LPNs/RNs that are required to be completed upon hire and yearly. For our medication administration competency we do require staff preparing medication for an injection administered by a provider they are required to label the syringe with name, strength & volume of medication drawn up for administration.

------------------------------
Tina Malec MSN RN-BC CPHIMS
WellSpan
York PA
717-812-4993
------------------------------

Original Message:
Sent: 07-05-2022 16:28
From: Kenzo Sanga
Subject: Nurse preparing injectable medication, but provider administering

At my practices, we have a new provider/MD. He is stating that RNs/LPNs have assisted him before by drawing up the medication for him, and then he would administer to the patient. He may or may not witness the drawing up or the preparation, but he is "comfortable" allowing a properly trained nurse to draw up his injectable medications. 

Are there clear and hard guidelines for this? I know all nurses would not dare administer a medication that they did not draw up, but can nurses prepare for provider who is willing to administer a pre-prepared injectable medication?

------------------------------
Kenzo Sanga, MSN, RN
Director of Outpatient Clinical Education
Phoenix, AZ
480-788-6406
------------------------------

Hi Kenzo

We currently have our nurses draw up for our providers but it is usually for a procedure such as joint inj or I&D. it's drawn up, the syringe is labeled with the content and dosage and the vial remains with the syringe. If it involves an anesthetic component, then this is not a function that or MAs do. Per CA regs, MAs are not allowed to draw up any anesthetic even if the intent is not to administer. 

besides that, I enforce the policy outlining that our clinical support staff (MAs, LVNs &RNs) are not to administer anything that they did not prepare.

------------------------------
Kristyl McCray MSN RN-BC
RN Clinical Director, Education & Prof. Practice
PIH Health Physicians
Whittier CA
(562)698-0811
------------------------------

Original Message:
Sent: 07-05-2022 16:28
From: Kenzo Sanga
Subject: Nurse preparing injectable medication, but provider administering

At my practices, we have a new provider/MD. He is stating that RNs/LPNs have assisted him before by drawing up the medication for him, and then he would administer to the patient. He may or may not witness the drawing up or the preparation, but he is "comfortable" allowing a properly trained nurse to draw up his injectable medications. 

Are there clear and hard guidelines for this? I know all nurses would not dare administer a medication that they did not draw up, but can nurses prepare for provider who is willing to administer a pre-prepared injectable medication?

------------------------------
Kenzo Sanga, MSN, RN
Director of Outpatient Clinical Education
Phoenix, AZ
480-788-6406
------------------------------

Original Message:
Sent: 7/7/2022 2:21:00 PM
From: Kristyl McCray
Subject: RE: Nurse preparing injectable medication, but provider administering

Hi Kenzo

We currently have our nurses draw up for our providers but it is usually for a procedure such as joint inj or I&D. it's drawn up, the syringe is labeled with the content and dosage and the vial remains with the syringe. If it involves an anesthetic component, then this is not a function that or MAs do. Per CA regs, MAs are not allowed to draw up any anesthetic even if the intent is not to administer. 

besides that, I enforce the policy outlining that our clinical support staff (MAs, LVNs &RNs) are not to administer anything that they did not prepare.

------------------------------
Kristyl McCray MSN RN-BC
RN Clinical Director, Education & Prof. Practice
PIH Health Physicians
Whittier CA
(562)698-0811
------------------------------

Original Message:
Sent: 07-05-2022 16:28
From: Kenzo Sanga
Subject: Nurse preparing injectable medication, but provider administering

At my practices, we have a new provider/MD. He is stating that RNs/LPNs have assisted him before by drawing up the medication for him, and then he would administer to the patient. He may or may not witness the drawing up or the preparation, but he is "comfortable" allowing a properly trained nurse to draw up his injectable medications. 

Are there clear and hard guidelines for this? I know all nurses would not dare administer a medication that they did not draw up, but can nurses prepare for provider who is willing to administer a pre-prepared injectable medication?

------------------------------
Kenzo Sanga, MSN, RN
Director of Outpatient Clinical Education
Phoenix, AZ
480-788-6406
------------------------------