Our current policy is to stock saline syringes for flush in bedside

carts in each patient's room.  Our unit is locked and our staffing is

never greater than 1:2.



We are now being told that we must have these flushes locked as saline

is considered a "drug".  Doing so will make it more difficult for the

nursing staff.



How is this issue handled in your ICU's?  Is the bedside cart locked?

Do you keep these outside of the rooms?



Any light that you can shed would be greatly appreciated.



Thanks!



Susan Davis Gerhardt, MSN, RN

Administrative Director, Surgical Trauma ICU

University Hospital

4502 Medical Drive

San Antonio, TX  78229













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[Non-text portions of this message have been removed]

We keep our saline flushes in the bedside carts in the rooms and when

the RN is not in the room the carts are locked.  (it's a simple

alpha-code lock - same in every room!)







Amy Kreeger RN MS FNP CCRN



Clinical Educator and Subject Matter Expert

Exempla Good Samaritan Medical Center

200 Exempla Circle

Lafayette, Colorado 80026

Office: 303-689-6996

Pager:  303-897-3166

Fax: 303-689-5147

kreegera@...

We have needed to do the same thing. Yes by Joint Commission standards -

saline is a drug! We keep our's locked.



Roberta





Roberta Basol RN, MA, NE-BC

Director; Intensive/Surgical Care and Clinical Practice

ext. 54110

pager 89-0364

So if saline is a drug, do you have an order for all saline flushes?

Yes, we do require an order.



Roberta







Roberta Basol RN, MA, NE-BC

Director; Intensive/Surgical Care and Clinical Practice

ext. 54110

pager 89-0364



-----Original Message-----

From: NIHMBL@yahoogroups.com [mailto:NIHMBL@yahoogroups.com] On Behalf

Of Susan Gerhardt

Sent: Monday, July 13, 2009 4:37 PM

To: NIHMBL@yahoogroups.com

Subject: RE: [NIHMBL] Saline Flushes in ICU

















So if saline is a drug, do you have an order for all saline flushes?











[Non-text portions of this message have been removed]

Is it a generic order placed at the start of each new line?  Do you have

an order for each line?

One order to flush all SL q shift.







________________________________



From: NIHMBL@yahoogroups.com [mailto:NIHMBL@yahoogroups.com] On Behalf

Of Susan Gerhardt

Sent: Wednesday, July 15, 2009 5:59 AM

To: NIHMBL@yahoogroups.com

Subject: RE: [NIHMBL] Saline Flushes in ICU











Is it a generic order placed at the start of each new line? Do you have

an order for each line?











[Non-text portions of this message have been removed]

yes



  ________________________________



From: NIHMBL@yahoogroups.com [mailto:NIHMBL@yahoogroups.com] On Behalf

Of Susan Gerhardt

Sent: Monday, July 13, 2009 4:37 PM

To: NIHMBL@yahoogroups.com

Subject: RE: [NIHMBL] Saline Flushes in ICU







So if saline is a drug, do you have an order for all saline flushes?











[

We have no supplies or flushes in the pt room. All is kept in the supply/med

room. It has taken about 6 months for staff to get used to this (supplies only)

since all sharps and flushes were removed 18 months ago

We also keep our saline flushes locked in our Pyxis in a supply/med room. Make

work more challenging for the nurses and rest assured, they'll come up with

work-arounds. We have trouble with the nurses taking out what they think they'll

need for the shift for their patients and keep them in their pockets all day.

What's not used is returned to Pyxis. I haven't been able to change this one.

It's just not convenient to keep them locked outside the room...standards or

not.



Susie Kampfert MSN RN CCRN

Metro Health Hospital

Wyoming, MI

Susan,



I do interim management and for the past several years we have always kept

Saline locked for the reasons you state below. However, at my current assignment

in PA out quality director (who is also a Joint Commission surveyor on the side)

said that most recently saline syringes have been considered a "medical supply"

and not a drug or medication so we are not locking them up at my current

hospital. Hope this helps.



J. Foulk

We just had our survey with only 6 directs and 14 indirects. NS flushes

were considered medication since they are used to flush a line and were

considered no different than the NS IV fluid.







________________________________



From: NIHMBL@yahoogroups.com [mailto:NIHMBL@yahoogroups.com] On Behalf

Of jbird@...

Sent: Tuesday, June 30, 2009 6:27 PM

To: NIHMBL@yahoogroups.com

Cc: Susan Gerhardt

Subject: Re: [NIHMBL] Saline Flushes in ICU

















Susan,



I do interim management and for the past several years we have always

kept Saline locked for the reasons you state below. However, at my

current assignment in PA out quality director (who is also a Joint

Commission surveyor on the side) said that most recently saline syringes

have been considered a "medical supply" and not a drug or medication so

we are not locking them up at my current hospital. Hope this helps.



J. Foulk











[Non-text portions of this message have been removed]

Yes, we also consider the saline flushes "medical supplies" per JC guidelines

and do not lock up in our patient room supply areas.  We do also have locked

supply rooms on the unit that contain our maintenance IV fluids.  Carrie



--- In NIHMBL@yahoogroups.com, <jbird@...> wrote:

>

> Susan,

>

> I do interim management and for the past several years we have always kept

Saline locked for the reasons you state below. However, at my current assignment

in PA out quality director (who is also a Joint Commission surveyor on the side)

said that most recently saline syringes have been considered a "medical supply"

and not a drug or medication so we are not locking them up at my current

hospital. Hope this helps.

>

> J. Foulk

>

We also keep saline flushed behind locked doors with the IV fluids.  We just had

our Joint Commission visit about 8 months ago and they were still quoting that

they were medications.  We already had them locked up so it was not an issue.



Darla

Thank you all for your responses; they are much appreciated!



I do find it interesting that several places have gotten feedback from

TJC that the pre-filled NS syringes are a medical "device" and not a

drug.  More of you said that it was a drug and thus they were not kept

in a patient room and were instead locked in a med room.



I am looking into a locking cart for each room now as having to run for

a flush just isn't doable in our unit.  I am quite sure that I will be

over budget for the rest of the year!



Thanks!



Susan Davis Gerhardt, MSN, RN

Surgical Trauma ICU

I understand that if you use a locking cart in the room it has to be

secured. A cart on wheels does not meet JC standards if meds are in the

cart.



Roberta





Roberta Basol RN, MA, NE-BC

Director; Intensive/Surgical Care and Clinical Practice

ext. 54110

pager 89-0364

We have had to rearrange our IV stock and flushes as well as they are

now considered medications.  Our IV bags now are in a locked storage

room across the hall from our unit which is a huge burden to our staff.

We keep the flushes either in our locked medication dispensing system or

locked in patient drawers in the computer cart.  We had to do many

rounds and audits to get compliance from the staff.







[Non-text portions of this message have been removed]

We keep our flushes in the locked med room.

We keep them in the room in a locked drawer. The nurses have a universal key on

their badge.

Terrie Fontenot RN,BSN,CCRN