NATIONAL NURSING AUDIT MINISTRY OF HEALTH MALAYSIA ELEMENT

5: CONTINUUM OF CARE

5.2 ADMINISTRATION OF INTRAVENOUS (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.
2.2. 2.2. To ensure nurses administer all intravenous infusions as To ensure that patients do not develop IV infusion misadventures during the therapy. To ensure nurses exhibit the caring component when administering the IV infusion.

prescribed.

3.

STANDARD 3.1. 3.2. Nurses administer the intravenous infusion according to regime 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. 4.

Nurses document accurately and completely the IV fluid infused.

CRITERIA Structure Process
1. 2. 3. 4. I.V. regime. 5. Prepare and check IV solution. 6. Explain and inform patient. 7. Assess infusion site for Thrombophlebitis; Greet patient. Identify right patient Verify prescription Prepare schedule for 2. Patient receives safe administration of intravenous infusion during hospital stay 3. IV infusion misadventures are detected early and appropriate measures taken timely

Outcome
1. Patient receives the IV regime as prescribed.

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.

(swelling, redness, warm, 4. Patient is informed of his pain) and infusion regime. dislodgement 5. Documentation is 8. Listen and responds accurate and complete. 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

National Nursing Audit, Ministry of Health Malaysia : Version 1 / September 2008, Bahagian Kejururawatan , Kementerian Kesihatan Malaysia Page 2

5. •

TECHNICAL identify patient accordingly verify prescription.

DOCUMENTATION • 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
• •

SOFT SKILL •

greet patient explain and inform patient responds promptly and politely to patient’s questions. exhibit caring component when attending to patient


assess patient prior to • administration of Intravenous infusion

administer IV infusion according to schedule •

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)

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6.3.

INSTRUMENT
Audit form (E5 AF 5.2) – every line must have one audit form.

6.4.

Methodology
6.4.1 6.4.2 6.4.3 6.4.4 6.4.5 Direct observation of I.V. line and gathering of information from documents. Setting : All wards Population : Patient with I.V. infusion. Sample Design Convenient Sampling 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. 7.2. Written prescription – any legal orders of I.V. regime must be endorsed in the patient’s case notes. 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. 7.3.2. 7.3.3. 7.3.4. right solution expiry date contains no sediments / particles 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. 7.6. 7.7. 7.8. 7.9.

Condition of cannula – securely anchored, no kinking and no retraction. Right flow rate : ± 2 to 5 drops per minute is acceptable. Right amount infused : ± 50 mls. is acceptable for the bottle checked. [Air vent must be open]. Assessment of patient infusion site for pain, thrombophlebitis and dislodgement 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 / date / presence of sediments and particles / change in colour. 7.8.4 blood clot along line. 7.8.5 7.8.6 cannula must be securely anchored, not kinked and no cannula retraction. 7.8.7 7.8.9 incorrect flow rate. incorrect amount infused dry infusion cannula not properly anchored, in other words failure to maintain patency of line due to tissue infiltration / thrombophlebitis / air bubbles or expiry

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7.8.10

improper / incomplete documentation schedule

- no

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 ELEMENT 5: CONTINUUM OF CARE TOPIC : 5.2 ADMINISTRATION OF DATE : 1.11.2008 PAGE No. 1/3 VERSION 1/08

INTRAVENOUS INFUSION DOCUMENT NO : E5 AF 5.2

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. 2.2. 2.3. To ensure nurses administer all intravenous infusions as prescribed. To ensure that patients do not develop IV infusion misadventures during the therapy. To ensure nurse exhibit the caring component when administering the IV infusion. Date of Audit:………………………………………….

National Nursing Audit, Ministry of Health Malaysia : Version 1 / September 2008, Bahagian Kejururawatan , Kementerian Kesihatan Malaysia Page 6

Locality:…………………………………………………. Auditors : Auditors : 1. ……………………………………………. 2……………………………………………… N.B. Instructions for Auditors 1. 2.
S/NO 1. 2. 3. 4.

Tick [√] at appropriate column Item 4 is not rated if no specific nursing measures require
ITEM Schedule for I/V regime available. The nurse explains to patient/carer prior to procedure. The nurse is responsive to the need for patient’s comfort. Schedule for I .V. regime is concurrent with latest prescription. Infusion in progress : 5.1 5.2 Is concurrent with prescribed regime. Has indicator of time commence and complete on 5.3 IV bottle. Is valid (Not expired) Check I.V bottle to validate correct solution. Check label on IV bottle. The time is to be written on the label only. Check expiry date on IV bottle. Check solution for any change in color. Check solution for any sediments / particles. Check flow rate. Check balance in IV bottle. SOURCE OF INFORMATION Check for I.V. schedule. Ask patient/carer Observe nurse Check prescription / validate with the I.V. regime . YE S N O N/A

5.

5.4

Is clear : a. no change in color b. no sediments / particles

5.5 6

Is infused as scheduled.

Fluid balance in IV bottle correspond to regime.

National Nursing Audit, Ministry of Health Malaysia : Version 1 / September 2008, Bahagian Kejururawatan , Kementerian Kesihatan Malaysia Page 7

7 8. 9. 10.

Fluid level in IV bottle is above spike / more than half in chamber. Line patent. Cannula properly anchored. Accuracy and completeness of documentation.

Check fluid level in IV bottle. Inspect line and site of infusion. Inspect IV line. Check documents.

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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