Medication Administration: IV Fluids, PIVC, And Deteriorating Patients

This process is an essential stage of medication administration to decrease the risk of potential harm to the patient. The process of double checking medication should be performed by 2 authorised health care professionals (Registered Nurse or Enrolled Nurse). The CDU nursing student should be a third party when checking medications.

Medications that require checking by 2 authorised heath care professionals (within the scope of medication administration for CDU nursing students) are as below:

• Medication administered as an additive to an IV infusion bag, burette or syringe driver
• Medication administered by direct IV injection
• Medications administered by intramuscular or subcutaneous
• Medications given to babies and children
• Controlled drugs

Upon completion of this unit, students will be able to:

1. Design, implement and evaluate contextually relevant plans of holistic nursing care that are underpinned by the integration of related bodies of knowledge and skills in problem solving and evidence-based decision making in the acute and mental health setting.
2. Minimize risk of harm to patients through both clinical reasoning and individual performance.
3. Apply relevant ethical, legal, cultural and professional practice principles to the provision of nursing care in both the acute and mental health settings.
4. Demonstrate effective communication at a professional standard, in both oral and written format, in the acute and mental health environment.
5. Demonstrate the ability to work as part of a team and in a self-directed manner in the acute and mental health settings.
6. Critically reflect on performance, taking feedback from others into account, and identify opportunities for further personal and/or professional development.

Demonstrates positive and productive working relationships with colleagues

• Uses knowledge of other health care team roles to develop collegial networks
• Demonstrates a collaborative approach to practice
• Identifies appropriate educational resources (including other health professionals)
• Prioritises safety problems

Participates as an active member of the healthcare team to achieve optimum health outcomes

• Collaborates with the health care team and patient/client to achieve optimal outcomes
• Contributes appropriately in team meetings
• Maintains effective communication with clinical supervisors and peers
• Works collaboratively and respectfully with support staff

Administering IV Fluids in a Hospital Environment

Under the supervision, I will be able to learn about the administration of IV fluids in a hospital environment, in accordance with the NMBA standards of 6 rights of safe and quality practice (6.1). According to Queensland government medication safety initiatives, the administration of intravenous fluid (IV fluid) should include the identification of the patient, the lack of obstruction of intravenous access, the fluid type, rate, settings of the pump (Marschall et al., 2014). There are various complications that require the IV fluid to be administered such as reduced peripheral perfusion, turgor in tissue, deep breathing, thirst, dehydration and the fall in sodium level not above 1 mmol/L/hr. Effective management includes critically analyzing the solutions or administration sets, use relevant infusion rates i.e., 20-50 ml/hour, analysis of complications that might occur with the IV fluid therapy, such as infection at the localized site, CR-BSI (i.e., catheter-related bloodstream infection), overloading of the fluids, infiltration, hematoma, etc ("Intravascular device management", 2015).

Keywords:

Intravenous fluid, administration, saline lock, guidelines and procedures, critical analysis, NMBA standards.

NMBA standard (s) objective links to:

(1.6) maintains accurate, comprehensive and timely documentation of assessments, planning, decision-making, actions, and evaluations.

(2.6) uses delegation, supervision, coordination, consultation, and referrals in professional relationships to achieve improved health outcomes.

(3.4) accepts accountability for decisions, actions, behaviors and responsibilities inherent in their role, and for the actions of others to whom they have delegated responsibilities.

(4.2) uses a range of assessment techniques to systematically collect relevant and accurate information and data to inform practice.

(4.4) assesses the resources available to inform planning.

(6.1) provides comprehensive safe, quality practice to achieve agreed goals and outcomes that are responsive to the nursing needs of people (nursingmidwiferyboard.gov.au, 2018).

(6.5) practices in accordance with relevant policies, guidelines, standards, regulations and legislation

Resources:

• Instructor
• Practice guidelines
• Venous assessment tool (VAT)
• NICE guidelines to administer fluids (Intravenous Fluid Therapy: Intravenous Fluid Therapy in Adults in Hospital).

Objective 2: Drug administration via PIVC  

Under the supervision, I will be able to safely and competently administer a drug via a cannula (PIVC) and to learn that how long a cannula can stay in situ, in accordance with the NMBA standards of 1 rights of critical thinking and analysis practice (1.1). According to Queensland government I-Care intervention bundle initiative, reviewing of PIVC should be carried out every 8 hours atevery access. The site should be inspected hourly in case of infusions, poor PIVC securement might cause complications such as high risk of phlebitis, contamination, occlusion, infiltration and in some cases dislodgement (Wallis et al., 2014). Effective management such as the use of short extension set, sterile dressing, a regular check on insertion site and safe removal of cannula should be carried out by replacing dressing every 7 days and removal if not in use after 72 hours using an aseptic technique. The PIVC should be effectively prevented using procedures including hand hygiene and PPE, intravenous access ports cleaning using 70% alcohol.

Effective Management of PIVC

Keywords:

Alcohol swab, intravenous access, PIVC, hand hygiene, catheter, cannula, I-care intervention.

NMBA standard (s) objective links to:

(1.1) accesses, analyses, and uses the best available evidence, that includes research findings, for safe, quality practice

(1.2) develops practice through reflection on experiences, knowledge, actions, feelings, and beliefs to identify how these shape practice

(2.7) actively fosters a culture of safety and learning that includes engaging with health professionals and others, to share knowledge and practice that supports person-centred care

(2.8) participates in and/or leads collaborative practice,

(3.5) seeks and responds to practice review and feedback

(4.2) uses a range of assessment techniques to systematically collect relevant and accurate information and data to inform practice

(5.3) documents, evaluates and modifies plans accordingly to facilitate the agreed outcomes

(6.6) uses the appropriate processes to identify and report potential and actual risk related system issues and where practice may be below the expected standards.

• Instructor
• NSQHS Standard 3 – Guidelines and procedures to prevent and control infections.
• Australian guidelines to prevent and control healthcare infections
• Guideline for surveillance of infection
• Guidelines for Hand hygiene
• PIVC assessment: point of care to tool

Objective 3: Recognition and Response to a deteriorating patient using the QADDS assessment form

Objective:

Under the supervision, I will be able to safely and competently recognise a deteriorating patient using the QADDS assessment form and the criteria for a metcall response, in accordance with the NMBA standards of 4 rights of comprehensive and systematic assessments (4.2). According to Queensland government safety and quality in health care initiative, a deteriorating patient might show complications such as low level of consciousness, depression, respiratory anxiety or hypotension. The effective management involves the recording the score of pain and sedation before and after analgesia administration, monitoring the vital signs regularly, documentation of signs such as blood pressure, pulse and, O? saturation in the QADDS assessment form (Scott, Considine & Botti, 2015). Safely recognise the criteria for a metcall response basd on the patients condition. Safely implement the basic training of MET system i.e., Medical Emergency Team for the immediate repsonse after carefully analysing whetehr the patient have met the MET criteria. Accurately analyze the condition of the deteriorating patient to decide the MET call requirement under the supervision and within the legal framework and policies of the hospital. 

Keywords:

MET, QADDS assessment form, consciousness, depression, respiratory anxiety or hypotension, legal framework and policies.

NMBA standard (s) objective links to:

(2.7) actively fosters a culture of safety and learning that includes engaging with health professionals and others, to share knowledge and practice that supports person-centred care

(2.8) participates in and/or leads collaborative practice, and

Recognition and Response to a Deteriorating Patient

(3.2) provides the information and education required to enhance people’s control over health

(3.7) identifies and promotes the integral role of nursing practice and the profession in influencing better health outcomes for people.

(4.1) conducts assessments that are holistic as well as culturally appropriate

(4.2) uses a range of assessment techniques to systematically collect relevant and accurate information and data to inform practice

(4.3) works in partnership to determine factors that affect, or potentially affect, the health and wellbeing of people and populations to determine priorities for action and/ or for referral, and

(5.2) collaboratively constructs nursing practice plans until contingencies, options priorities, goals, actions, outcomes and timeframes are agreed with the relevant persons

(6.4) provides effective timely direction and supervision to ensure that delegated practice is safe and correct

Resources:

• Instructor
• Open Disclosure Program
• Assessment tools: acute clinical record tools

Objective 4: Assessing patient for dyspnea

Objective:

Under the supervision, I will be able to safely and competently perform a respiratory assessment on a patient experiencing shortness of breath, in accordance with the NMBA standards of 6 rights of safe and quality practice (6.5). According to Queensland government safety and quality in health care initiative, carefully observe the physical signs of the patients experiencing shortness of breath, using a number scale to demonstrate the condition of the patient. Effective management consists of carefully asking questions related to their current conditions and asking them to provide answers in yes or no, assessing the observations recorded for any difference compared to reported ratings, safely putting the patient in a comfortable position and use of appropriate signs under the supervision when the patient is uncomfortable. Accurately demonstrating the signs learned to infer the respiratory assessment on a patient and careful documentation of appearing symptoms such as speaking difficulty, flare nasal, difficulty in movement of muscles of the chest, any sign of pain or increased heart rate as well distressed behavior and scale the breathing rate ranging from 0 to 10 based on the physical examination (Queensland Health, 2016).

Keywords:

Dyspnea, supervision, flare nasal, distressed behavior

NMBA standard (s) objective links to:

1.1 accesses, analyses, and uses the best available evidence, that includes research findings, for safe, quality practice

1.2 develops practice through reflection on experiences, knowledge, actions, feelings and beliefs to identify how these shape practice

2.5 advocates on behalf of people in a manner that respects the person’s autonomy and legal capacity

3.7 identifies and promotes the integral role of nursing practice and the profession in influencing better health outcomes for people.

4.3 works in partnership to determine factors that affect, or potentially affect, the health and wellbeing of people and populations to determine priorities for action and/ or for referral,

5.1 uses assessment data and best available evidence to develop a plan

5.2 collaboratively constructs nursing practice plans until contingencies, options priorities, goals, actions, outcomes and timeframes are agreed with the relevant persons

6.1 provides comprehensive safe, quality practice to achieve agreed goals and outcomes that are responsive to the nursing needs of people

6.5 practises in accordance with relevant policies, guidelines, standards, regulations and legislation.

Resources:

• Instructor
• Patient Observations (Vital Signs) Policy
• Clinical knowledge network

References:

Awad, S., Dharmavaram, S., Wearn, C., Dube, M., & Lobo, D. (2012). Effects of an intraoperative infusion of 4% succinylated gelatinQueensland Health. (2016). Allied health nutrition & dietetics skill set electives pre-requisite units for Certificate IV in Allied Health Assistance:. Retrieved from https://www.health.qld.gov.au/__data/assets/pdf_file/0027/650619/LG-nutrition-dietetics-pt1.pdf

Baker, K., DeSanto-Madeya, S., & Banzett, R. (2017). Routine dyspnea assessment and documentation: Nurses’ experience yields wide acceptance. BMC Nursing, 16(1). doi: 10.1186/s12912-016-0196-9

Acute behavioural disturbance management (including acute sedation) in Queensland Health Authorised Mental Health Services (adults). (2017). Retrieved from https://www.health.qld.gov.au/__data/assets/pdf_file/0025/665314/qh-gdl-452.pdf

Scott, B., Considine, J., & Botti, M. (2015). Unreported clinical deterioration in emergency department patients: A point prevalence study. Australasian Emergency Nursing Journal, 18(1), 33-41. doi: 10.1016/j.aenj.2014.09.002

Mestre, G., Berbel, C., Tortajada, P., Alarcia, M., Coca, R., & Fernández, M. et al. (2013). Successful multifaceted intervention aimed to reduce short peripheral venous catheter-related adverse events: A quasi-experimental cohort study. American Journal Of Infection Control, 41(6), 520-526. doi: 10.1016/j.ajic.2012.07.014

Wallis, M., McGrail, M., Webster, J., Marsh, N., Gowardman, J., Playford, E., & Rickard, C. (2014). Risk Factors for Peripheral Intravenous Catheter Failure: A Multivariate Analysis of Data from a Randomized Controlled Trial. Infection Control & Hospital Epidemiology, 35(01), 63-68. doi: 10.1086/674398

Intravascular device management. (2015). Retrieved from https://www.health.qld.gov.au/__data/assets/pdf_file/0025/444490/icare-pivc-guideline.pdf

Marschall, J., Mermel, L., Fakih, M., Hadaway, L., Kallen, A., & O’Grady, N. et al. (2014). Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals: 2014 Update. Infection Control & Hospital Epidemiology, 35(S2), S89-S107. doi: 10.1017/s0899823x00193870

NICE issues draft standards for safe IV fluid therapy. (2014). Pharmacoeconomics & Outcomes News, 699(1), 2-2. doi: 10.1007/s40274-014-1125-3