NUR 508 Module 7 Interprofessional Collaboration Paper example

Four Tables, One Syringe: Negotiating the End of Bedside Dilution of IV Push Medications in an Emergency Department

[Student Name]

Southern New Hampshire University

NUR 508: Role Development and Transformation of the MSN Professional Nurse

Module Seven Interprofessional Collaboration Paper

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Four Tables, One Syringe: Negotiating the End of Bedside Dilution of IV Push Medications in an Emergency Department

The Problem and the Guideline

In a composite 45-bed emergency department, nurses routinely draw up IV push medications such as hydromorphone, ondansetron and metoprolol and then add saline to the syringe to dilute them, often without a label on the diluted syringe. In the past year, three reported events involved a wrong dose from a diluted syringe, including one patient who received ten times the intended hydromorphone concentration. National safe practice guidelines for adult IV push medications recommend using ready-to-administer products when available, diluting at the bedside only when the manufacturer, evidence or a specific patient need requires it, and labeling any syringe not administered immediately (Institute for Safe Medication Practices [ISMP], 2015).

Ms. Harlan, a composite MSN-prepared medication safety nurse, was asked by the medication safety committee to lead the change. She has no authority over pharmacy, physicians or supply chain. Her only tool is the ability to bring the right people to the table and keep them there until an agreement serves each of them.

Positions and Interests

Ms. Harlan met with each group individually before any joint meeting. Negotiation research distinguishes the positions parties state from the interests underneath them and recommends working from interests (Fisher et al., 2011). The table below summarizes what she learned.

Table 1

Positions and Interests of Each Group

The Negotiation

At the first joint meeting, Ms. Harlan presented the three events without naming the nurses involved, the guideline and the list of interests, and asked the group to agree on one shared goal: every IV push dose in the department is the correct concentration and is given at the right rate. Everyone agreed to that goal, even while their positions differed.

The second meeting generated options. Nurses' interest in pushing slowly could be met by teaching and timing tools rather than dilution, since a drug can be given slowly without adding saline. Pharmacy agreed to review the cost of prefilled syringes for the five drugs most often diluted, weighing it against the cost of errors and nurse time. The physician director asked that pain medications remain available without delay. Supply chain proposed stocking a backup concentration for each prefilled product and a clear procedure during shortages. Ms. Harlan kept a written list of each option and which interest it served.

At the third meeting, pharmacy reported that prefilled syringes for four of the five drugs would add a modest amount to the annual budget, offset in part by reduced waste. The fifth drug had no prefilled product, so pharmacy offered to prepare it in the sterile compounding area in a ready-to-administer concentration.

The Agreement

The group agreed that the department would stock prefilled syringes for four high-use drugs and pharmacy-prepared syringes for the fifth; that bedside dilution would be allowed only for drugs on a short list where the manufacturer or evidence recommends it, with a required label; that nurses would receive a 15-minute education session and a pocket card on push rates; that supply chain would maintain a backup plan for shortages; and that the medication safety committee would review event reports and nurse feedback at three and six months. Each group signed off on the elements that affected it. The agreement was written in one page, in plain language, and posted in the medication room so that every nurse, physician and pharmacist could see what had been decided and who was responsible for each part. Ms. Harlan kept responsibility for tracking the three-month and six-month reviews and reporting the results back to all four groups together.

Interprofessional Competencies in Action

The national framework for interprofessional collaborative practice groups its competencies into four areas, covering shared values and ethics, an understanding of one another's roles, communication across professions, and effective teamwork (Interprofessional Education Collaborative [IPEC], 2023), and the negotiation shows each of them. Ms. Harlan grounded the discussion in a shared value, patient safety, rather than nursing's preference. She acknowledged the roles of each profession, asking pharmacy to decide what pharmacy controls rather than deciding for them. She communicated in each group's language, presenting cost to pharmacy and flow to physicians. And she built a temporary team with a shared goal and a written agreement, which is what distinguishes collaboration from a series of requests.

What Nearly Went Wrong

The negotiation was not smooth. At the second meeting, a senior nurse said that pharmacy did not understand emergency work, and the pharmacy manager responded that nurses were creating the errors. Ms. Harlan paused the discussion, restated the shared goal, and asked each person to name one thing the other group did that made the department safer. The exchange lowered the temperature and later became a reference point: when the pharmacy manager agreed to prepare the fifth drug, she said it was because the nurses had acknowledged pharmacy's double checks. Handling that moment, rather than avoiding it, was part of the work.

What the MSN Role Contributed

No single profession could have made this change alone. Pharmacy could not change nursing practice, nurses could not buy products, and physicians could not solve supply problems. The medication safety nurse's contribution was not technical knowledge any one group lacked, but the ability to frame a shared goal, separate positions from interests, keep track of options and turn a conversation into a written agreement. That is the kind of system-level influence the MSN prepares nurses to exercise.

Conclusion

Ending bedside dilution of IV push medications required agreement from four groups with different interests. By meeting each group first, separating positions from interests, building options that met several interests at once and securing a specific written agreement, a medication safety nurse without formal authority achieved a change that follows national guidelines and protects patients. The case shows interprofessional collaboration as active negotiation rather than attendance at meetings.

References

Fisher, R., Ury, W., & Patton, B. (2011). Getting to yes: Negotiating agreement without giving in (3rd ed.). Penguin Books.

Institute for Safe Medication Practices. (2015). ISMP safe practice guidelines for adult IV push medications. https://www.ismp.org

Interprofessional Education Collaborative. (2023). IPEC core competencies for interprofessional collaborative practice: Version 3. https://www.ipecollaborative.org