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According to the Institute for Safe Medication Practices (ISMP), as noted in the My American Nurse Journal by Catherine Spader, RN, some nurses still use unsafe or outdated intravenous push administration practices (American Nurse Journal, 2020, p. 25),[1] despite guidelines being easy to access.  An example given is using commercially pre-packaged 0.9% normal saline syringes made for flushing lines to mix and dilute medication for I.V push, along with unnecessary dilation of certain medications.  A survey conducted in 2019 noted that one of the most common dilution errors among 70% of respondents was with I.V push opioids (pg. 26).

A noted obstacle to best practice is having a lack of standardization. It is harder for nurses to adopt changing unsafe practices because drug manuals still publish recommendations such as diluting medications, like I.V. morphine with sterile water and other discrepancies.  These unsafe practices are still being taught in some nursing schools, and best practice is not standardized.

Some tips for I.V. best practices recommended by the Institute for Safe Medication Practices (ISMP) includes:

  • Develop interdisciplinary I.V. push medication processes with access to current practice
  • Standardize terminology and specifics and standardize where the information can be quickly located
  • Post a standard “ready reference” on each medication dispensing unit, which includes a list of medications that should and should not be diluted
  • Work with the pharmacy to create a “virtual kit” where medications and the appropriate diluent appear at the time in the automated medication dispensing system.
  • Ensure necessary supplies are accessible, such as syringe labels and reusable holders
  • Incorporate ISMP best practices into nursing policies and practice

(American Nurse Journal, pg. 28)

To read more about the Institute for Safe Medication Practices recommendation and the need for more standardized I.V. push administration, please see the American Nurse Journal linked below.

Spader, C. (2020). American Nurse Journal. Standardizing I.V. push administration: bridging education and practice, 15(9), p. 26-30.  Retrieved from