ACKNOWLEDGEMENT

This is to acknowledge, receipt of one (1) copy of Nursing Audit.

Received by:

_______________________ Print Name & Signature

_______________________ Position/ Title

_______________________ Date

AUDIT SUMMARY FORM TO: Emergency Room Department DATE: February 21 FROM: RLE Group 8 Audit Chairperson: Hazel Yvonne C. Ferrer Members: Michael Angelo P. Bisenio Michelle Kris C. Florin Joaisa F. Fornoles Rose Ann L. Frial Irene B. Gabiola Errol B. Galan Ma. Daryl Jann D. Gallarte Maridean A. Ganera Jona Ivy O. Gascon Elora G. Sarmiento ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ 23, 2011

Topic: Student Nurses Performance on Setting up Intravenous Infusion

Retrospective Audit (Process audit) ____14_____Number of student nurses observed

FINDINGS AND RECOMMENDATIONS: Indicators of Quality Care-There are 4 identified indicators of quality care these are filling up the drip chamber to at least half and priming the tubing aseptically with a weighted mean of 1, preparing the necessary materials for the procedure with a weighted mean of 0.92, closing the roller clamp and spiking the container aseptically with a weighted mean of 0.92. Expelling air

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bubbles if present and put back the cover of the distal end of the IV tubing with a weighted mean of 0.85. This findings can be recognized to an excellent indicator of actual performance of student nurses on setting up IV Infusion. y Outstanding Problems Based from the findings procedures February 21 3:00 7:00: Rose Ann Frial & Michelle Kris Florin 7:00 10:30: Michael Angelo Bisenio & Hazel Yvonne Ferrer

OBSERVER SCHEDULE February 22 7:00 11:00: Maridean Ganera & Elora Sarmiento 11:00 3:00: Daryl Gallarte & Jona Ivy Gascon 3:00 7:00: Errol Galan & Hazel Yvonne Ferrer 7:00 10:30: Joaisa Fornoles & Irene Gabiola February 23 7:00 11:00: Joaisa Fornoles & Irene Gabiola 11:00 3:00: Maridean Ganera & Elora Sarmiento 3:00 7:00: Rose Ann Frial & Michelle Kris Florin 7:00 10:30: Michael Angelo Bisenio & Errol Galan

such as doing hand washing before and after the procedure with a weighted mean of 0.21 and O.14, verifying doctor s order with a weighted mean of 0.14 interpreted as poor and placing of IV label on the IVF bottle by the person who prepares the materials to be used with a weighted mean of 0. These results can be interpreted as poor indicator of quality care and indicates a room for improvement. . y Indicators of Improvement- Checking the sterility and integrity of the IV solution, IV administration set and other devices with a weighted mean of 0.35 and opening the seal of the IV solution and disinfect port with cotton balls with alcohol with a weighted mean of 0.5 are the identified indicators for improvement. These findings are interpreted as fair indicators of quality care that needs improvement. y Recommendationinterpretation we Upon highly collation, recommend tabulation, to analysis a and

LEADER of EACH COMMITTEES RESEARCH COMMITTEE: Errol B. Galan FINANCE: Maridean Ganera TABULATION: Michelle Kris C. Florin LIASON / COMMUNICATION: Ma. Daryl Jann Gallarte COMPUTATION / INTERPRETATION: Joaisa F. Fornoles OBSERVER: Irene B. Gabiola INTRODUCTION: Errol B. Galan IDENTIFYING OUTSTANDING PROB.: Joaisa F. Fornoles INDICATORS FOR IMPROVEMENT: Rose Ann L. Frial RECOMMENDATION/SPECIAL COMMENTS: Jona Ivy O. Gas

conduct

student

development program. Handwashing slogan, making strips of paper enough to be use as an IV label, to include sharp receptacles in the IV tray to avoid needle prick incidents. y Special Comments- Since IV insertion is an invasive procedure, Consent to Care should be verified, to reduce malpractice risk and or to avoid liability.

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APPENDIX G

INDICATORS OF QUALITY CARE The role and responsibilities of nurses are changing along with the evolving healthcare environment. It varies with the needs of the client, the nurse s credentials and the type of employment setting. As a nurse, they are responsible for obtaining and maintaining specific knowledge and skills should emphasize health promotion and illness prevention, as well as concern for the client as a whole. Emergency room nurses provide first assessments and treatments to patients experiencing medical crisis. They need assertive responses to patients with serious illness and trauma, backed with extensive medical knowledge. Though they typically work alongside with medical doctors, they are expected to work independently and take leadership roles when necessary. Another skill that emergency room nurses must possess is attentiveness and effective communication skills because in this kind of hospital setting events are more likely unpredictable which requires abrupt thinking. Often needs to make immediate decisions and pay close attention to details. Also they need to be cautious and observe strict guidelines to guard against potentially disease transmission. Setting up of intravenous fluid infusion is one of the clinical skills required in every day nursing practice. Intravenous fluid infusion is the introduction of fluid into a vein to prevent or to treat electrolyte imbalance or to deliver medications, nutrition or blood products. It is important to remember that setting up and application of intravenous fluids must follow the standard policies and procedures. The Department of Health (DH) has commissioned a prevalence study of Healthcare Associated Infections (HCAIs) in 2005-2006. Experts estimate that 9% of in-patients have an HCAI at any one time, equivalent to at least 300,000 HCAIs per year in the UK. HCAIs may cause 5,000 deaths and contribute to over 15,000 deaths per year in the UK.

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However, these are estimates based on data over 10 years old. The audit committee conducted performance observation to the student nurses of level 4 on intensive practicum with background concepts on Fundamentals of Nursing, Maternal and Child Nursing, Community Health Nursing, Medical-Surgical Nursing, Pharmacology

cotton balls with alcohol, plaster, tourniquet, gloves, splint, I.V. hook and IV label. PROCEDURE: 1. Verifies doctor s order ( Avoid medication errors) 2. Do hand washing before the procedure(Reduce transmission of infection) 3. Prepare the necessary materials for the procedure(Save the time and avoid the patient to feel anxiety) 4. Check the sterility and integrity of the IV solution, IV administration set and other devices(Prevent cross contamination to patient) 5. Place IV label on IVF bottle duly signed by the person who prepares it. (Prevents medication errors.) 6. Open the seal of the IV solution and disinfect port with cotton balls with alcohol (Prevents microorganism from entering the port.) 7. Close the roller clamp and spike the container aseptically (Prevents air bubble formation and microorganism to enter the solution) 8. Fill drip chamber to at least half and prime the tubing aseptically (Prevents air bubble formation.) 9. Expel air bubbles if present and put back the cover of the distal end of the IV tubing(get ready for IV insertion)( Prevent air embolism and maintain the sterility of the tubing) 10. Do hand washing after the procedure (Promotes safety to the health provider.)

Nursing, and Nursing Jurisprudence. Student nurses in the level 4 are classified as on Stage 2: Advance Beginners. These are those who can demonstrate marginally acceptable performance, those who have coped with enough real situations to note or to have pointed out by their mentor, the recurring meaningful situation components. The data were gathered through an observation with the aid of performance checklist. The students were observed on their second week of intensive practicum on moderate supervision with the clinical instructor. The observation lasted for 2 ½ days the audit committee assigned non participant observers. The performance checklist was based on the criteria given on the students manual and ANSAP Nursing Practice Standards on IV practice. To determine the level of performance of the student nurses in ER on setting up IV infusion weighted mean, percentage and ranking was utilized. The goal of the nursing audit committee mainly to determine the performance of BSN 4 students on setting up of intravenous infusion in Emergency Room in Mother Seton Hospital for improvement of skills and to ensure quality nursing care. The objective of this audit is to observe the standards criteria and principles performed by the student nurses in setting up IVF in their actual performance. Conscientiously perform procedure of setting up IVF with ease and confidence. This will be beneficial to the student will develop and enhance their performance in performing of setting up IV infusion, so as to give safe and quality nursing care to the patient. The client will be assured that quality care is rendered through minimizing risk of infections and providing safe nursing care.

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APPENDIX F PROPOSED RECOMMENDATION I. II. III. IV. TITLE: Skills Enhancement on Setting Up IV. THEME: Enhancing Skills towards Safe and Quality Care PROPONENTS: RLE Group 8 Batch 2011 BENEFICIARIES: Students Nurses of Universidad de Sta. Isabel V. VI. VII. TARGET DATE: March 14, 2011 VENUE: USI- Social Hall

solution, IV IV administration set, IV cannula, and forceps soaked in antiseptic solution, Clinical Instructor will give them the performance assessment on the identified procedure to intensify the skills of the students. The Audit committee decided to use a Performance checklist as a tool to gather the necessary data for the study. The performance checklist on setting up IV infusion was based on the Level 3 RLE Manual and ANSAP Nursing Practice Standards on IV practice. There are 10 criteria in the checklist every criterion is graded as 0=not done and 1=done. The checklist was used in the performance observation which was conducted in the MSHER for 2
1/2

GENERAL OBJECTIVE: Develop the skills of student nurses of USI in setting up IV.

days from morning shift (7-3) to afternoon shift (3-11). 

OBJECTIVES: At the end of the skills enhancemnet the participants will: a. increase basic skills in preparing IV infusion b. Familiarize the steps on setting up IV infusion c. minimize common errors committed related to the preparation of IV VIII. Methodology:

The method of teaching to be used is lecture-discussion and return demonstration. IX. CONTENT Intravenous (IV) fluid therapy is essential when clients are unable to take food and fluids orally. It is an efficient and effective method of supplying fluids directly into the intravascular fluid compartment and replacing electrolyte losses. Intravenous solutions can be classified as: isotonic; hypotonic or hypertonic. The needed materials: I.V. tray with IV

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Table 1: Actual Performance of Student Nurses on Setting up IV Infusion Procedure 1. Verifies doctor s order. 2. Do hand washing before the procedure 3. Prepare the necessary materials for the procedure 4. Check the sterility and integrity of the IV solution, IV administration set and other devices 5. Place IV label on IVF bottle duly signed by the person who prepares it 6. Open the seal of the IV solution and disinfect port with cotton balls with alcohol 7. Close the roller clamp and spike the container aseptically 8. Fill drip chamber to at least half and prime the tubing aseptically 9. Expel air bubbles if present and put back the cover of the distal end of the IV tubing(get ready for IV insertion) 10. Do hand washing after the procedure OVERALL WM 0.14 0.21 0.92 Interpretation Poor Poor Excellent Ranking 8.5 7 2 9. Expel air bubbles if present and put back the cover of the distal end of the IV tubing(get ready for IV insertion)

0.35

Fair

6 10. Do hand washing after the procedure

0

Poor

10

0.5

Fair

5

0.92

Excellent

3

1

Excellent

1

0.85

Excellent

4

0.14 0.50

Poor SATISFACTORY

8.5

0.75 1 = EXCELLENT; 0.50 0.74 = SATISFACTORY; 0.25 0.49= FAIR; 0 0.24 = POOR

Table 1 shows the criteria for the procedure of Setting up an IV Infusion with a weighted mean indicated every criterion, its interpretation which is categorize as Excellent, Satisfactory, Fair and Poor.

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5. Place IV label on IVF bottle duly signed by the person who prepares it

It also presents the ranking of the criterion from rank 1 to 10. INDICATORS OF QUALITY CARE Table 2: Actual Performance of Student Nurses on Setting up IV Infusion Procedure WM 1 Interpretation Excellent Ranking 1

6. Open the seal of the IV solution and disinfect port with cotton balls with alcohol.

7. Close the roller clamp and spike the container aseptically

1. Fill drip chamber to at least half and prime the tubing aseptically procedure 2. Prepare the necessary materials for the 3. Close the roller clamp and spike the container aseptically 4. Expel air bubbles if present and put back the cover of the distal end of the IV tubing(get ready for IV insertion)

0.92 0.92

Excellent Excellent

3 2

0.85

Excellent

4

Table 2 indicates the identified indicators of quality care with its weighted mean, interpretation and ranking. The actual performance of student nurses on filling up the drip chamber to at least half and priming the tubing aseptically with a weighted mean of 1 and can be recognized to an excellent indicator of actual 8. Fill drip chamber to at least half and prime the tubing aseptically performance of student nurses on setting up IV Infusion. Based from the findings student nurses assigned in the MSH-ER filled the chamber and primed the tubing properly within the IV tray while preventing the tubing to touch other materials to maintain its sterility. This procedure is strictly performed to avoid introduction of air to the tubing. Air bubbles less that 0.5 ml usually do not cause problems in peripheral site. To avoid such circumstances re-clamp the tubing and replace the tubing cap, maintaining sterile technique. For caps with air vents, do not

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remove the cap when priming this tubing. The flow of the solution through the tubing will cease when the cap is moist with one drop of solution. (Kozier and Erb, 2008) The actual performance of student nurses on Preparing the necessary materials for the procedure with a weighted mean of 0.92 is categorize as excellent indicator. Based form the observation, the materials that are necessary to the procedure are already prepared on an IV tray that is why procedure no. 3 is identified as one of the indicators of quality care. Preparing the necessary materials for the procedure can save time and effort in the part of the person who are performing the procedure. (Kozier and Erb,2008) The actual performance of student nurses on closing the roller clamp and spiking the container aseptically is identified with a weighted mean of 0.92 categorize as excellent. Closing the roller clamp and spiking the container aseptically prevents fluids to escape from the tubing as well as spiking aseptically prevent microorganism to enter the container and avoid the contamination of the fluid. (Kozier and Erb, 2008) The actual performance of student nurses in expelling air bubbles if present and putting back the cover of the distal end of the IV tubing is discovered with a weighted mean of 0.85 and categorize as excellent. Expelling the air bubbles removes air from the tubing that may post further risk to patients moreover the cover of the distal end on the IV tubing was remained in place until the procedure is done. .(Kozier and Erb,2008)

APPENDIX E PROPER SETTING UP OF INTRAVENOUS INFUSION PROCEDURES 1. Verifies doctor s order and make intravenous fluid label

2. Do hand washing before the procedure

3. Prepare the necessary materials for the procedure.

4. Check the sterility and integrity of the IV solution, IV administration set and other devices

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APPENDIX D Universidad de Sta. Isabel Higher Education Department College of Nursing Observation Tool Performance Checklist Setting up IVF Infusion Procedure
1. 2. 3. Verifies doctor s order. Do hand washing before the procedure Prepare the necessary materials for the procedure Check the sterility and integrity of the IV solution, IV administration set and other devices Place IV label on IVF bottle duly signed by the person who prepares it

INDICATORS FOR IMPROVEMENT Table 3: Actual Performance of Student Nurses on Setting up IV Infusion Procedure WM Interpretation Ranking

WM
0.14 0.21 0.92

Interpretation
Poor Poor Excellent

Ranking
8.5 7 2

4.

0.35

Fair

6

1. Open the seal of the IV 0.5 Fair 5 solution and disinfect port with cotton balls with alcohol 2. Check the sterility and 0.35 Fair 6 integrity of the IV solution, IV administration set and other devices Table 3 shows the identified indicators for improvement with its weighted mean, interpretation and ranking indicated. The actual performance of student nurses in opening the seal of the

5.

0

Poor

10

IV solution and disinfecting the port with cotton balls soaked in alcohol with a weighted mean of 0.5 that can be identified as fair indicator of quality

6.

Open the seal of the IV solution and disinfect port with cotton balls with alcohol 7. Close the roller clamp and spike the container aseptically 8. Fill drip chamber to at least half and prime the tubing aseptically 9. Expel air bubbles if present and put back the cover of the distal end of the IV tubing(get ready for IV insertion) 10. Do hand washing after the procedure a. OVERALL

0.5

Fair

5

care. Assessment revealed that some of the student nurses are not disinfecting the port of the IV fluid because they believed that when they

0.92

Excellent

3

open the seal of the IVF and expose it for a awhile will not harbor microorganism. One of the mode of transmission which is through an airborne or microorganism can be transmitted through air. It is still a must to disinfect the port after opening the seal because as the port was exposed even a minute it can still harbor microorganism especially in the ER unit where in

1

Excellent

1

0.85

Excellent

4

0.14 0.50

Poor SATISFACTORY

8.5

patients chief complaints varies to different cases such as tuberculosis that can remain in the air for long periods that can cause contamination to the solution and may post further risk to the patient. The actual performance of student nurses in checking of sterility and integrity of the IV solution, IV administration set and other devices is

0.75 ± 1 = EXCELLENT; 0.50 ± 0.74 = SATISFACTORY; 0.25 ± 0.49= FAIR; 0 ± 0.24 = POOR

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recognized with a weighted mean of 0.35 and categorize as fair indicator of quality care which signify room for improvement. Based from the observation conducted, we saw that most of the students did not perform the checking of sterility and integrity of the IV solution, IV administration set and other devices. Not performing the said procedure would increase the risk of the patient to acquiring infections for the devices and the infusion itself have lost their integrity and sterility. In hospitals across our country and worldwide, however, patients indeed are increasingly at risk for harm as related to health care- associated infection (HAI). Such infections are leading cause of patient morbidity and mortality (Scott, 2009). Understandably, the topic of health care-associated infection is receiving a great deal of attention by the federal government, state and private regulators, policy makers, and institution. In part as a result of increasingly numbers of HAIs, the new 2010 Patient Protection and Affordable Care Act (Public Law 111 148) includes specific language

Universidad de Sta. Isabel Higher Education Department College of Nursing

March 1, 2011 ______________________ ______________________ ______________________

Dear _________________, Greetings of Peace! We, RLE group 8 of USI Level 4 BSN will be having our presentation of performance appraisal entitled Student Nurses Performance on Setting Up Intravenous Infusion on March 2, 2011 at the Seton Hall of Mother Seton Hospital. In connection with this, we would like to invite you to become one of the panelist of the said event. Thank you and God Bless.

regarding HAIs. Penalties are now assessed on Medicare and Medicaid reimbursement to hospitals with high rates of infection, and hospitals now are required to make their HAI statistics available to the public. Likewise, private insurers have begun to follow the lead of this Act in allocating higher payments to facilities with demonstrated decreased rates of HAIs.

Sincerely yours,

OUTSTANDING PROBLEM Table 4: Actual Performance of Student Nurses on Setting up IV Infusion Procedure 1. Do hand washing before the procedure. 2. Verifies doctor s order WM 0.21 0.14 Interpretation Poor Poor Ranking 7 8.5

Hazel Yvonne C. Ferrer RLE group 8 Leader

Noted by:

Cecilia A. Hidalgo, RN Moderating Clinical Instructor

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1. Do hand washing after the procedure 2. Place IV label on IVF bottle duly signed by the person who prepares it

0.14

Poor

8.5

0

Poor

10

Table 4 shows the outstanding problems with its weighted mean, interpretation and ranking indicated. The actual performance of student nurses in performing hand washing before the procedure is identified as an outstanding problem with a weighted mean of 0.21 and can be interpreted as poor. Results of the tally showed that washing of hands before the procedure was occasionally done by the students for the reason that the kind of setting requires immediate intervention to be delivered so hand washing is not commonly done prior to setting up an IV because it may cause delayed instead they just used an cotton balls soaked in an alcohol. Hand-washing is the most significant procedure in preventing cross infection (Voss and Widmer, 1977). Organisms present on the hands are either resident or transient. Transient organisms are those that are not usually part of the skin flora. They are acquired by contact with infected patients or infected equipment. They can be easily removed by effective hand-washing techniques. Our own normal resident skin flora consists of mainly Staphylococcus epidermis and Staphylococcus aureus bacteria. These are normally deeply ingrained into the epidermis and cannot be totally removed by hand-washing (Church, 1986b), although effective handwashing can reduce the number significantly. However, research continues to highlight that many health care workers fail to wash their hands effectively (Pritchard, 1994). The actual performance of student nurses in verifying doctor s order

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with a weighted mean of 0.14 interpreted as poor. Concerning with the verification of doctor s order, the students were unable perform this specific procedure because the staff nurse often delegate IV preparation to the students, in return the students were not verifying the doctor s order to the chart itself. Recently 10 Golden Rules for Administering Drugs Safely (from Nursing 88 Vol. 18, August 1988) was presented and it is identified as one way of providing safe and quality care. The 10R s includes the ff: (1) Administer the right drug, (2)Administer the right drug to the right patient, (3)Administer the right dose, (4)Administer the right drug by the right route, (5)Administer the right drug at the right time, (6)Document each drug you administer, (7)Teach your patient about the drugs he is receiving, (8)Take a complete patient drug history. (There is a risk of adverse drug reactions when a number of drugs are taken or when patient is taking alcohol drinks.), (9) Find out if the patient has any drug allergies, (10)Be aware of potential drug drug or drug food interactions. To protect your patient and your Dear Ma am, Greetings of joy! February 16, 2011

Universidad de Sta. Isabel Higher Education Department College of Nursing

Ms. Ma. Claudette Tria, RN, ER - Supervisor

We, RLE group 8 of BSN Level IV of Universidad de Sta. Isabel will be conducting a nursing audit entitled Students Nurses Performance on Setting up of Intravenous Infusion . This is in partial fulfillment of the requirements in NCM 106: Nursing Leadership and Management-Intensive Practicum. In connection with this, we would like to ask permission for our group to conduct a performance observation of the student nurses on the identified indicators of quality of care in Emergency Room Department of the institution on February 21-23, 2011. On the respective days of observation 2 student nurses from our group will be assigned to observe on two shifts (7-3 and 3-11). The data gathered will serve a great value in the enhancement of student nurses in the performance of the said procedure. Hoping for your favorable response. Thank you very much!

license, follow these guidelines for avoiding medication errors. The actual performance of student nurses in performing hand washing after the procedure is identified as one of the outstanding problem in setting up IV infusion with a weighted mean of 0.21 and can be categorize as poor indicator of quality care. Assessment revealed that most of the students don t performed hand washing after the procedure; instead most of them prefer using alcohol as an alternative to hand washing. Cleaning hands promptly and thoroughly between patient contact and after contact with blood, body fluids, secretions, excretions, equipment and potentially contaminated surfaces is an important strategy for preventing Healthcare - associated infections Maintaining asepsis of key parts is achieved by preventing them coming into contact with a significant amount of potentially harmful organisms.

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APPENDIX C

This is difficult, as the very tools we use to perform Aseptic non-touch technique. (ANTT) are covered in bacteria - our hands. It has been estimated there are as many as three million bacteria present per square centimetre of normal skin (Gould, 1991).Pathogenic bacteria, such as pseudomonas and klebsiella, can be harbored on hands for months (Adams and Marrie, 1982). A worrying trend in hospitals is the emergence of antibiotic-resistant organisms which can survive on the hands of health care workers. Many, if not most, hospital-acquired infections continue to be spread by direct contact by the hands of health care workers (Bauer et al, 1990) The actual performance of student nurses in placing of IV label on the IVF bottle by the person who prepares the materials to be used is identified as one of the outstanding problem in setting up IV infusion with a weighted mean of 0 and can be categorize as poor indicator of quality care because no one perform the above procedure. The Joint Commission s National Patient Safety Goals is to promote specific improvements in patient safety. One of the goals of this organization is to improve the safety of using medication and solution label that is supposed to be instilled to the patient and this is through NSPG 03.04.01, which is to label all medications, medication containers, and other solutions on and off the sterile field in peri-operative and other procedural settings. The Rationale to this is that medications or other solutions in unlabeled containers are unidentifiable. Errors, sometimes tragic, have resulted from medications and other solutions removed from their original containers and placed into unlabeled containers. This unsafe practice neglects basic principles of safe medication management, yet it is routine in any organizations. The labeling of all medications, medication containers, and other solutions is a risk-reduction activity consistent with safe medication management.

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In every procedural settings both on and off the sterile field, medication or solution labels include the following: medication name, strength, quantity, diluents and volume (if not apparent from the container), expiration date when not used within 24 hours expiration time when expiration occurs in less than 24 hours. Label each medication or solution as soon as it is prepared, unless it is immediately administered. Immediately discard any medication or solution found unlabelled. Removed all labeled containers on the sterile field and discard their contents at the conclusion of the procedure. All medications and solutions both on and off the sterile field and their labels are reviewed by entering and exiting staff responsible for the management of medications. Recommendation Upon collation, tabulation, analysis and interpretation we recommend a proposed student development program. See appendix (F). SPECIAL COMMENT Verifying Consent to Care should be added to the given criteria in every procedural setting, most especially in administering IV infusion, so that the risk for malpractice is reduce and / or to avoid liability in battery. The Bristol Royal Infirmary Inquiry recommends that consent is not just applicable to surgical procedures, but also to all activities that involve 'touching', this includes many nursing procedures such as assisting with washing and dressing of wound or incision site, starting intravenous infusion and etc. (Gallagher, 2001) ADDITIONAL RECOMMENDATIONS  We recommend that in every hand washing area in a certain unit there should be a slogan which promotes proper hand washing.  The student nurses should make IV label or medication card of paper enough to be use as an IV label.

APPENDIX B Acknowledgement The audit committee would like to extend our innermost gratitude to those persons who helped us in the conceptualization of this performance appraisal. To our moderating clinical instructors, Niño Jesus B. Ballesteros and Cecilia A. Hidalgo for giving us concrete comments and suggestions toward the formulation entire Nursing Audit. To the Dean of the College of Nursing, Sr. Lourdes S. Sabidong, DC, RN, MAN for her unconditional support to our department. To the Panelists who patiently shared their time and scholarly advice during the presentation of our performance appraisal. To the Director of Nursing Affiliation, Training and Continuing Education, Amer de Castro, RN, MAN and Supervisor of Emergency Room, Maria Claudette C. Tria, RN, for approving and accommodating us to conduct a performance observation in the Emergency Room. To Mr. Rodel L. Orta ez, MA and Ms. Sheryll E. Belmoro for sharing to us their expertise in statistical treatment and giving us intelligent suggestions with regards to the interpretation which help us out in the computation of the data collated. To our Parents for their undying support and encouragement that continually strengthen us to accomplish all the tasks required in the fulfillment of our performance appraisal. To RLE group 8 for their efforts, suggestions and cooperation in the completion of the performance appraisal To Almighty God for giving us this opportunity to conduct and share our findings in our performance appraisal to the beneficiaries.

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APPENDIX A BIBLIOGRAPHY BOOK Potter, P. & Perry, A. FUNDAMENTALS OF NURSING 7th EDITION Singapore: Elsevier PTE. LTD. 2009 p 995 Craven, R. & Hirnle, C. FUNDAMENTALS OF NURSING (Human Health & Function) 5th Ed. Philadepia: Lippincott Williams & Wilkins. 2007 Fundamentals of Nursing: concepts, process and procedure/Barbara Kozier 7th edition p.388 Nursing Standards on Intravenous Practice 7th edition/ Association of Nursing Service Administration of the Philippines, Inc. (ANSAP) p. 29 JOURNAL Younger, G. & Khan, M. NURSING STANDARD Volume 40. United Kingdom. June 11 17, 2008 July 2010 / Vol. 110, no.7 pp 66-67 Vol19 / No. 6 pp. 315- 

That in every procedure Consent to Care should be stressed. This practice may safeguard every healthcare provider from any liabilities.  That in every IV tray should include sharp receptacles in the IV tray to avoid needle prick incidents.

American Journal of Nursing Med-Surg Nursing 316

November / December 2010

Gallagher, A. & McHale, J., Nursing Times Issue 49; page 32 WEBSITE

6 December, 2001 / Volume 97

http://education-portal.com/emergency_room_nursing.html http://www.parliament.uk/documents/post/postpn247.pdf http://www.defenseofmedicine.com/2010/09/recent-study-highlights-theimportance-of-informed-consent/

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