Administration of IV Infusion_edited 3 Dec 2008
Transcript of Administration of IV Infusion_edited 3 Dec 2008
NATIONAL NURSING AUDIT MINISTRY OF HEALTH MALAYSIA
ELEMENT 5: CONTINUUM OF CARE
5.2 5.2 ADMINISTRATION OF INTRAVENOUSADMINISTRATION OF INTRAVENOUS (I.V) INFUSION(I.V) INFUSION
1. INTRODUCTION
Intravenous infusion through peripheral venous access is the most
common procedure performed on patients. Care of patient with
intravenous infusion is now an integral part of the majority of nurses’
professional practice. It can range from caring for an individual with a
peripheral cannula in situ, to nursing a patient requiring multiple
parenteral drugs/infusions in the critical care environment. Whatever
the route, peripheral or central, infusion therapy is not without risk
(Scales 1999).
2. OBJECTIVES
2.1. To ensure nurses administer all intravenous infusions as
prescribed.
2.2. To ensure that patients do not develop IV infusion
misadventures during the therapy.
2.2. To ensure nurses exhibit the caring component when
administering the IV infusion.
3. STANDARD
3.1. Nurses administer the intravenous infusion according to regime
3.2. Nurses exhibit the caring component during the administration of
IV infusion.
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3.3. Nurses document accurately and completely the IV fluid infused.
4. CRITERIA
Structure Process Outcome
1. Each patient has current
legal written prescription
2. There is a Nursing
Operating Procedure
(NOP)/manual procedure
for administration of
intravenous infusion.
3. The nurse has knowledge
on care and
maintenance
of I.V. infusion.
1. Greet patient.
2. Identify right patient
3. Verify prescription
4. Prepare schedule for
I.V.
regime.
5. Prepare and check IV
solution.
6. Explain and inform
patient.
7. Assess infusion site for
Thrombophlebitis;
(swelling, redness, warm,
pain) and
dislodgement
8. Listen and responds
promptly and
politely to patient’s
questions.
9. Regulate flow rate as
prescribed.
10. Check for patency of
line.
11. Document fluid infused in
intake-output chart.
12. Monitor patient’s
response and document
13. Take appropriate measure
if adverse reaction
identified
1. Patient receives the IV regime as
prescribed.
2. Patient receives safe administration of intravenous infusion during hospital stay
3. IV infusion misadventures are detected early and appropriate measures taken timely
4. Patient is informed of his infusion regime.
5. Documentation is accurate and complete.
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5.
TECHNICAL DOCUMENTATION SOFT SKILL
identify patient
accordingly
verify prescription.
assess patient prior to
administration of
Intravenous infusion
administer IV infusion
according to schedule
document
assessment
findings
document IV fluid
infused – name of
fluid, date, time and
amount
document adverse
reactions identified
document
appropriate
measures taken if
adverse reactions
identified
greet patient
explain and inform
patient
responds promptly
and politely to
patient’s questions.
exhibit caring
component when
attending to patient
6. AUDIT GUIDE FOR ADMINISTRATION OF INTRAVENOUS
INFUSION
6.1. INCLUSION CRITERIA
All patients on intravenous infusions.
6.2. EXCLUSION CRITERIA
Patients
receiving blood transfusion.
on controlled analgesia (P.C.A.)
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with central venous lines (CVL)
6.3. INSTRUMENT
Audit form (E5 AF 5.2) – every line must have one audit
form.
6.4. Methodology
6.4.1 Direct observation of I.V. line and gathering of
information from documents.
6.4.2 Setting : All wards
6.4.3 Population : Patient with I.V. infusion.
6.4.4 Sample Design
- Convenient Sampling
6.4.5 Sample Size
- 200 for each Specialist hospital, to be equally
divided to each discipline and 100 for non
specialist hospital.
6.5. Time Frame
One month
7. DEFINITION OF OPERATIONAL TERMS
7.1. Written prescription – any legal orders of I.V. regime must
be endorsed in the patient’s case notes.
7.2. Schedule for I.V. regime – a 24-hour plan that informs the
fluid type and time frame for prescribed infusion [Bottle in
progress must indicate time commence and time
complete].
7.3. Checks I.V. solution
7.3.1. right solution
7.3.2. expiry date
7.3.3. contains no sediments / particles
7.3.4. no change in colour
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7.3.5. dry infusion – fluid level in IV bottle is below
spike / less than half in chamber
7.4. Patency of line – refers to uninterrupted flow with no signs
of tissue infiltration / thrombophlebitis / air bubbles or blood
clot along line.
7.5. Condition of cannula – securely anchored, no kinking and no
retraction.
7.6. Right flow rate : ± 2 to 5 drops per minute is acceptable.
7.7. Right amount infused : ± 50 mls. is acceptable for the
bottle checked. [Air vent must be open].
7.8. Assessment of patient infusion site for pain, thrombophlebitis and
dislodgement
7.9. Infusion errors include any one of the following :
7.9.1. schedule for I.V. regime not concurrent with the
latest
prescription.
7.9.2. no indication of time commenced and time
completed
on bottle in progress.
7.9.3. failed to check for type of solution / expiry
date /
presence of sediments and particles / change in
colour.
7.8.4 failure to maintain patency of line due to tissue
infiltration / thrombophlebitis / air bubbles or
blood clot
along line.
7.8.5 dry infusion
7.8.6 cannula not properly anchored, in other words
cannula
must be securely anchored, not kinked and no
cannula
retraction.
7.8.7 incorrect flow rate.
7.8.9 incorrect amount infused
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7.8.10 improper / incomplete documentation - no
schedule
available incomplete / incorrect / no latest
documentation in I/O chart [I/O chart must be
complete with name and registration number of
patient].
* If any one of the above errors is identified, it is
considered as infusion error.
8. Audit Form
NATIONAL NURSING AUDIT MINISTRY OF HEALTH
MALAYSIA
VERSION 1/08
ELEMENT 5: CONTINUUM OF CARE
TOPIC : 5.2 ADMINISTRATION OF
INTRAVENOUS INFUSION
DATE : 1.11.2008
DOCUMENT NO : E5 AF 5.2 PAGE No. 1/3
Standard:
1. Nurses administer the intravenous infusion according to regime
2. Nurses exhibit the caring component during the administration of IV
infusion.
Objectives:
2.1. To ensure nurses administer all intravenous infusions as
prescribed.
2.2. To ensure that patients do not develop IV infusion
misadventures during the therapy.
2.3. To ensure nurse exhibit the caring component when
administering the IV infusion.
Date of Audit:………………………………………….
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Locality:………………………………………………….
Auditors :
Auditors : 1. …………………………………………….
2………………………………………………
N.B. Instructions for Auditors
1. Tick [] at appropriate column
2. Item 4 is not rated if no specific nursing measures require
S/NO ITEM SOURCE OF INFORMATION
YES
NO
N/A
1. Schedule for I/V regime available. Check for I.V. schedule.
2. The nurse explains to patient/carer
prior to procedure.
Ask patient/carer
3. The nurse is responsive to the need
for patient’s comfort.
Observe nurse
4. Schedule for I .V. regime is concurrent with latest prescription.
Check prescription / validate with the I.V. regime .
5. Infusion in progress :
5.1 Is concurrent with prescribed
regime.
Check I.V bottle to validate correct solution.
5.2 Has indicator of time
commence and complete on
IV bottle.
Check label on IV bottle.The time is to be written on the label only.
5.3 Is valid (Not expired) Check expiry date on IV bottle.
5.4 Is clear :
a. no change in color
Check solution for any change in color.
b. no sediments / particles
Check solution for any sediments / particles.
5.5 Is infused as scheduled. Check flow rate.
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6 Fluid balance in IV bottle correspond to regime.
Check balance in IV bottle.
7 Fluid level in IV bottle is above
spike / more than half in chamber.
Check fluid level in IV bottle.
8. Line patent. Inspect line and site of infusion.
9. Cannula properly anchored. Inspect IV line.
10. Accuracy and completeness of documentation.
Check documents.
AUDIT REPORT AUDIT REPORT
(please [√] the appropriate box)
Conformance Non- Conformance
REMARKS
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Auditor 1 (name and signature): ………………………………………….
…………………………………………..
Auditor 2 (name and signature): ………………………………………….
………………………………….
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