California Scope for RNs regarding Zofran and Morphine

OP
akflightmedic

akflightmedic

Forum Deputy Chief
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Ok for anyone who is interested. I finally got a phone call from the CA Board of Nursing.

The lady who called me sounded very geriatric and as we chatted for nearly 30 minutes, she did mention she had been a RN for over 50 years!!!

Anyways, we reviewed the statutes, some definitions, what the BON does, and then of course this very specific practice question as it relates to BON and RNs in CA.

First, there is NO rule anywhere that in anyway prohibits the mixing of compatible medications. None. There is NO rule. Especially one which specifically names Zofran and Morphine.

*There is NO rule. This is NOT illegal in CA and this does NOT jeopardize your license.

As copied and pasted earlier in this thread, there is a rule which says RNs will not compound drugs. Morphine and Zofran mixing is NOT compounding.

Second, she stated that about 3-5 years ago “or maybe longer”, she recalls this similar question/issue making the rounds. During that time, it was discovered many facilities have their own interpretations and set practice guidelines around that. So yes, individual facilities may ban this practice, however that is THEIR decision based on their own reasoning. And subsequently, no one really revisits or challenges this silliness. Click this link if you care to know more about an experiment which highlighted organizational dysfunction. https://www.google.com/.../five-monkeys-experiment...

Anyways....the myth has permeated so many facilities for so long and been spread like wildfire that it now seems to be “fact”.

Finally, the Board of Pharmacy has absolute final authority in CA with regards to compounding and what the definition means. While they do not dictate the scope of practice for RNs in CA, they heavily influence it by their decisions, recommendations, etc.

The BON made it very clear to me that they do not lay out what RNs can and cannot do, but then kind of implied they do. Lol. She followed up with there are way too many cooks in the kitchen and they are all using different recipes.

Also, the Board of Pharmacy could potentially have different interpretations of rules and regs in different regions. All dependent upon who is in charge of that region. She again said this is longstanding issue.

So this minor issue of mixing morphine and Zofran is NOT illegal or banned by BON.

However it could be banned by certain facilities who chose that OR it could be banned by whichever Board of Pharmacy person is in charge.

How’s that for a fine example of the craziness we call California??
 
OP
akflightmedic

akflightmedic

Forum Deputy Chief
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As for the customer service experience, they replied to my initial email within 2 days and set a time/date for a call back. I replied that due to working some night shifts and that I was on East Coast could they make sure they do not call prior to 2pm their time. They replied and agreed. They did not call on the specified date or the following day. Then we hit the weekend, so I sent a follow up email.

They then called that day and we chatted as noted in the post above. She was very nice, pleasant, and took her time explaining everything.
 

Comfort Care

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That's non-sense. Is "compounding" specifically for syringes? In the ICU we often y-site many sedatives/opioids together and pressors as well, we verify compatibility, and our database states Y-SITE or SYRINGE. Whether it be on peripherals or CVCs. How else would we give the B-52 shot? , 3 syringes IM, no way.
 

MackTheKnife

BSN, RN-BC, EMT-P, TCRN, CEN
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forgive my ignorance, but why would you want to? I understand why you would give them individually, but what benefit do you get to combine them into a single dose?
Because it's easier to draw 2 compatible drugs into one syringe and only have to flush once. Saves time and effort.
 

MackTheKnife

BSN, RN-BC, EMT-P, TCRN, CEN
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Agreed, I saw that....but there is no definition of compounding provided by the CA BON. So I went to the FDA site...and according to their definition, combining zofran and morphine is not "compounding". Do you interpret otherwise?


Compounding is generally a practice in which a licensed pharmacist, a licensed physician, or, in the case of an outsourcing facility, a person under the supervision of a licensed pharmacist, combines, mixes, or alters ingredients of a drug to create a medication tailored to the needs of an individual patient. Although compounded drugs can serve an important medical need for certain patients, they also present a riskExternal Link Disclaimer to patients.

FDA’s compounding program aims to protect patients from unsafe, ineffective and poor quality compounded drugs, while preserving access to lawfully-marketed compounded drugs for patients who have a medical need for them.



What is compounding?​

Drug compounding is often regarded as the process of combining, mixing, or altering ingredients to create a medication tailored to the needs of an individual patient. Compounding includes the combining of two or more drugs. Compounded drugs are not FDA-approved.

Why do some patients need compounded drugs?​

A drug may be compounded for a patient who cannot be treated with an FDA-approved medication, such as a patient who has an allergy to a certain dye and needs a medication to be made without it, or an elderly patient or a child who cannot swallow a tablet or capsule and needs a medicine in a liquid dosage form. Practitioners in hospitals, clinics, and other health care facilities sometimes provide compounded drugs to patients when an FDA-approved drug is not medically appropriate to treat them.
Awesome!
 

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