What is the difference between stat and bolus (intravenous administration of a large dose) medication administration in a medical context?

Stat vs. Bolus Medication Administration

"Stat" refers to the urgency/timing of when a medication should be given (immediately), while "bolus" describes the method of administration (a concentrated dose given rapidly over a short period, typically intravenously).

Key Distinctions

Stat Administration

• Stat is a timing directive meaning the medication must be administered immediately, typically within 5-15 minutes of the order 1
• Can apply to any route of administration (oral, IV, intramuscular, subcutaneous) 1
• Does not specify how the drug is physically delivered, only when it should be given 1

Bolus Administration

• Bolus is a method of delivery describing rapid administration of a concentrated medication dose over a brief period (typically 1-5 minutes for IV medications) 1, 2
• Provides the most rapid onset and shortest duration of action but requires technical skill and monitoring 1
• Specifically refers to the physical technique of giving a larger volume or dose at once rather than continuously 1

Clinical Context and Examples

When Terms Overlap

• A medication can be ordered "stat bolus" - meaning give it immediately (stat) via rapid IV push (bolus) 1, 2
• For opioid-naïve patients, IV morphine can be given as 2 mg bolus doses every 15 minutes as needed, and these could be ordered "stat" if pain is severe 1
• For patients on continuous hydromorphone infusion, breakthrough pain can be treated with bolus doses equal to 2× the hourly infusion rate every 15 minutes - these boluses could be given "stat" for acute pain 1, 2

When Terms Are Distinct

• Stat without bolus: An oral medication ordered "stat" would be given immediately but absorbed over 30 minutes to 2 hours, not as a bolus 1
• Bolus without stat: Scheduled bolus doses of enteral nutrition (200-400 mL over 15-60 minutes, 4-6 times daily) are boluses but not stat orders 1, 3

Critical Safety Considerations

Bolus Administration Risks

• Rapid IV bolus can cause serious adverse effects including chest wall rigidity (with fentanyl at doses as low as 1 mcg/kg), reflex bradycardia, or dangerous hypertension 4, 5
• Bolus medications must be administered slowly over the recommended time (e.g., fentanyl over several minutes, not seconds) to prevent complications 4
• Medication errors are significantly more likely when bolus drugs are given, particularly when injecting faster than recommended rates 6

Common Pitfall to Avoid

• Do not confuse urgency with technique: A "stat" order does not automatically mean give as a rapid bolus - always verify the appropriate administration rate for the specific medication 1, 6
• For example, prochlorperazine given as a 2-minute bolus versus 15-minute infusion showed no difference in efficacy or akathisia rates, but the administration method (bolus vs. infusion) was distinct from the timing urgency 7

Practical Algorithm for Decision-Making

Step 1: Identify the Urgency

• Is this stat? → Administer within 5-15 minutes 1
• Is this scheduled? → Give at the prescribed time 1, 3

Step 2: Identify the Route and Method

• IV bolus? → Rapid concentrated dose over 1-5 minutes with appropriate monitoring 1, 2, 4
• IV infusion? → Continuous or intermittent delivery over longer period (15 minutes to hours) 1
• Enteral bolus? → 200-400 mL over 15-60 minutes via feeding tube 1, 3
• Other routes? → Follow standard administration guidelines for that route 1

Step 3: Verify Safety Parameters

• Confirm appropriate administration rate for the specific drug 4, 6
• Ensure monitoring equipment and reversal agents are available for high-risk bolus medications 1, 4
• Document rationale for any comfort medication dose during critical care 1