| Popis: |
Problem: Intermittent intravenous infusion (III), also referred to as a secondary infusion or intravenous piggyback, is a common but complex process with safety risks in medication errors, infection, and residual medication management. Almost all patients receive IV therapy in acute care hospitals. III is a method frequently used to deliver IV medications, usually with the assistance of a smart pump. Little evidence exists to guide nursing practice with III. Available literature reports issues with poor nursing practice, errors, and limited knowledge by the nurse. Aims: This quality improvement study addressed the following questions. 1. What are the frequencies and types of III medication errors?2. What are the frequencies and types of infection risks observed in III administration?3. What are the frequencies of residual volume and what types of administration techniques are used to manage residual volume? Methods: An observational technique, framed in Donabedian’s Structure, Process, and Outcome Model, was used to collect data in a large level one trauma center in the Midwest. Medications, fluids, tubings, smart pumps, and eMAR documentation were assessed with an adapted observation checklist tool initially developed by a multidisciplinary group from Brigham and Women’s Hospital in Boston, MA. Pertinent findings: A total of 102 patients with 117 III medication administrations were assessed. Medication errors of unauthorized fluids, incomplete drug library within the smart pump, wrong concentrations and rates, and incomplete patient name labeling were found. Of the observed infusions 110 (96%) had between one to six medication errors each. Of the 102 patients, 77% had one to four infection risks from inappropriate end cap coverings of the IV tubing and incorrect or absent date labeling of tubing and fluids. In regard to residual volume, 56% of the 104 completed infusions had medication remaining in the IV bag or tubing chamber at completion of the infusion via the smart pump. Conclusions: This study identified medication errors, infection risks, and residual volume in the administration of III. Although relatively few errors were immediately harmful, the potential for poor patient outcomes or more serious harm exists. The results of this study will serve as a baseline for quality improvement and future education. |
