10 Golden rules for administering drugs safely Administer the right drug. Administer the right drug to the right patient. Administer the right dose. Administer the right dose by the right route. Administer the right drug at the right time. Document each drug you administer. Teach the patient about the drugs he is receiving. Take a complete patient drug history. Find out if the patient has any drug allergies. Be aware of potential drugs – drug or drug food interactions. *** To protect your patient and your license, follow these guidelines for avoiding medication error.
I. Setting up: 1. Verify written prescription and make IV label. 2. Observe the ten (10) Rs when preparing and administering IVF. 3. Explain the procedure to reassure patient and /or significant other, secure consent if necessary. 4. Assess patient’s vein, choose appropriate site, location, size / condition. 5. Do hand hygiene before and after the procedure. 6. Prepare necessary materials for procedure ( IV tray with IV solution, administration set, IV cannula, forcep soaked in antiseptic solution, alcohol swabs or cotton balls soaked in alcohol with cover (this should be exclusively used for IV), plaster, tourniquet, gloves, splint, and IV hook, sterile 2x2 gauze or transparent dressing.
7. Check the sterility and integrity of the IV solution, IV set and other devices. 8. Place IV label on IVF bottle duly signed by RN who prepared it (patient’s name, room number, solution, time and date) 9. Open IV administration set aseptically following the infection control measure. 10. Open IV administration set aseptically and close the roller clamp and spike the infusate container aseptically. 11. Fill drip chamber to at least half and prime it with IV fluid aseptically. 12. Expel air bubbles if any and put back the cover to the distal end of the IV set ( get ready for IV insertion)
Prepare complete IV tray with IV infusions; Dummy Arm and over-the-needle catheter or butterfly needle.
1. Verify the written prescription for IV therapy; check prepared IVF and other things needed. 2. Explain procedure to reassure the patient and significant others and observe the 10 Rs. 3. Do hand hygiene before and after the procedure. 4. Choose site for IV. 5. Apply tourniquet 5-12 cm. (2-6 inches) above injection site depending on condition of patient. 6. Check for radial pulse below tourniquet.
Prepare site with effective topical antiseptic according to hospital policy or cotton balls with alcohol in circular motion and allow 30 seconds to dry (no touch technique).
Note: Always wear gloves when doing any venipuncture. 7. Using the appropriate IV cannula, pierce skin with the correct technique. 8. Upon backflow visualization, continue inserting the catheter into the vein. 9. Position the IV catheter parallel to the skin. Hold stylet stationary and slowly advance the catheter until the hub is 1 mm to the puncture site. 10. Slip a sterilize gauze under the hub. Release the tourniquet; remove the styletwhile applying digital pressure over the catheter with one finger about 1-2 inches from the tip of the inserted catheter.
11. Connect the infusion tubing of the prepared IVF aseptically to the IV catheter. 12. Open the clamp and regulate the flow rate. Reassure patient. 13. Anchor needle firmly in place with the use of: a. Transparent tape/dressing directly on the puncture site. b. Tape (using any appropriate anchoring style) c. Band Aid Note: Never place unsterile tape directly on IV insertion site. Instead, place a small piece of sterile OS and then secure it with adhesive tape.
14. Tape a small loop of IV tubing for additional anchoring. Apply splint, if needed. 15. Calibrate the IV fluid bottle and regulate flow of infusion according to prescribed duration. 16. Label on IV tape near the IV site to indicate the date of insertion, type and gauge of IV catheter and countersign. 17. Label with plaster on the IV tubing to indicate the date when to change the IV tubing. 18. Observe patient and report any untoward effect. 19. Discard sharps and waste according to Health Care Waste Management (DOH/DENR). 20. Document in the patient’s chart and endorse to incoming shift.
III. Discontinuing an IV infusion 1. Verify written doctor’s order to discontinue IV including IV medications. 2. Observe 10 Rs. 3. Assess and inform the patient of the discontinuation of IV infusion. 4. Prepare the necessary materials, IV tray or injection tray with sterile cotton balls with alcohol, plaster, pick up forcep in antiseptic solution, kidney basin and band aid. 5. Wash hands before and after procedure. 6. Close the roller clamp of the IV administration set. 7. Moisten adhesive tapes around the IV catheter with cotton balls with alcohol; remove plaster gently.
8. Use pick up forcep to get cotton ball with alcohol and without applying pressure, remove needle or IV catheter then immediately apply pressure over the venipuncture site. 9. Inspect IV catheter for completeness. 10. Place dressing over the venipuncture site. 11. Discard all waste materials including the IV cannula according to Health Care Waste Management (DOH/DENR) 12. Reassure patient. 13. Document time of discontinuance, status of insertion site and integrity of IV catheter and endorse accordingly.
IV. IV MEDICATION INCORPORATION INTO THE VOLUMETRIC CHAMBER IV medication of drug into IV bottle/bag Note: Put the protocol of the hospital in consideration Verify the written medication card against the MD prescription; observe hospital policy on drug administration. Observe 10 Rs when preparing and administering medication. Explain procedure (medication and action) to reassure patient and significant others and check patency and IV site.
4. Verify for skin test of drug for IV incorporation (if skin testing is necessary)5. Do hand hygiene before and after the procedure.6. Prepare the necessary materials needed for the procedure such as: tray, syringes needed, right drug to be incorporated either in vial or ampule.7. Disinfect injection port of the vial and the ampule before breaking then aspirate the right dose asseptically.8. Remove the cover of the administration set, maintain sterility and incorporate prepared drug into the airway aseptically. Recap airway after.
Note: If the administration set has no airway, pull out the set and incorporate the prepared drug and re-spike the IV set to the bottle then place the label (all these should be done aseptically) 9. Swirl the IV bottle to mix the drug with IVF and regulate the flow rate accordingly. 10. Observe for 5-10 min for any drug interaction while reassuring the patient, monitor VS. 11. Discard sharp and other wastes according to Health care Waste management (DOH/DENR) 12. Document the procedure done on the patient’s chart.
Thank You and prepare for a return demonstration tomorrow Good Luck!!!