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.

National Nursing Audit, Ministry of Health Malaysia : Version 1 / September 2008, Bahagian Kejururawatan , Kementerian Kesihatan Malaysia Page 1

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.


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.)


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


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


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:………………………………………….


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.


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


Auditor 1 (name and signature): ………………………………………….

…………………………………………..

Auditor 2 (name and signature): ………………………………………….

………………………………….


Documents

Administration of IV Infusion_edited 3 Dec 2008