advance infusion technology and excellence nursing

8/14/2019 Advance Infusion technology and Excellence nursing

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Advances InfusionTechnologyVS

Excellent Nursing Practice

Pongpak Pittayapan. R.N, DNSc.Cert.in IV Therapy and Oncology Nursing. UK.


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Equipments

Solution containerMaterialSizes

Types of containers


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Clinical Considerations1. Wash hands before opening or spiking

solution containers2. Inspect bags and bottles before use for

cracks , leaks , damaged

ports or seals , expiration date , clarity ,discoloration , turbidity , andparticulate matter ; discard if problemsfound

3. Label bags and bottles with date andtime the solution container was opened


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Clinical Considerations5. Change solution containers in accordance with the

Infusion Nursing Standards of Practice (Intravenous Nurses Society [INS ], 2000),particularly if a closed system is not maintained ,to prevent the potential growth of

microorganisms that might have entered thesystem6. Discard solution containers removed from the

intravenous system ; do not save for later use


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Administration setTypesDrop factorConstruction

Internal administration set diameterClampsInjection /access ports

Considerations When Using Administration Sets


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Considerations When UsingAdministration Sets1. Assess product and package integrity before use ; do not use

if violated2. Assess patient for latex sensitive ; some administration sets

contain parts with latex3. Determine appropriateness of administration set based on

medication /solution to be administereda . Certain medications , such as Taxol , must be given through

administration sets not made of polyvinyl chloride (PVC )b . Administration sets used to administer other medications

such as propofol should be replaced every 6 to 12 hours oraccording to manufactures recommendations


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4. Change peripheral and central primary and secondary

administration sets in accordance with the Infusion Nursingstandards of practice (INS , 2000) and organizational policiesand procedures

5. Change administration sets at the time of the peripheralcatheter change or when a new solution container is initiated


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6. Discard administration sets used to administer lipid emulsions

after each unit unless additional units are administeredconsecutively and immediately if contamination is suspectedor product integrity is compromised ; change sets used toadminister consecutive units every 24 hours

7. Change administration sets used to administer blood andblood products after each unit or at the end of 4 hours ,whichever comes first , and immediately if contamination issuspected or product integrity is compromised


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Add-On and Junction Securement deviceExtension SetsStopcocksConnectors

Securement DevicesInjection /Access PortsSolid Caps

Vented Spike AdaptersTransducers and Domes


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FiltersFeaturesTypesStructural Configuration

Surface AreaPressure LimitationsIndications for Use


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Flow-control devicesElectronic Infusion DevicesMechanical Infusion DevicesImplanted Pumps

Mechanisms of DeliveryIndication for UseFeatures


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Selection of devicea . safety features : prime consideration

1) Automatic anti -free flow is essential (when door is openor administration set is removed , fluid flow is stoppedby a mechanical clump usually initiated at the time thedoor is opened )

2) Guardrails that set dosage limits for the administrationof medication can prevent serious medication errors atthe bedside

3) Audible alarms4) Appropriate grounding to prevent electrical hazards

and interference from other electrical equipment5) Features to minimize tampering6) Delivery rate within 3% to 5% accuracy


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Risk Factors

Human ErrorRelated with using medicineRelated with using infusion pump

Infusion devices/ Infusion pumpGeneral pumpPatient-controlled analgesia (PCA)

(Medical centers Safe Medication Administration Committee)

Pongpak Pittayapan Pongpak Pittayapan


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Med Errs and FactorassociatedA significant percentage of medical errors are

medication-relatedthese errors account for 1 of 131 outpatientand 1 of 854 inpatient deaths

include prescription and pharmacy-dispensingerrorsunintentional noncompliance with medicationinstructionsinfusion device account for up to 35 % of allmedication error


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Technology to reduce thepotential for error

Computerized prescribe order enter( CPOE)Chemotherapy -specific software

programsComputerized nursing documentationsystems with links to pharmacologyreferences


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personal data assistantsrobots in pharmacies

bar codingFDA Bar Code Label Requirements forHuman Drug Products and biological

Products


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estimate will reduce the risk that apatient will receive the wrongmedication or wrong dose or that wrongpatient will receive a medication (FDA,2004 a )FDA estimate Bar code rule will reduce

50 % reduction in medication error or500,000 med ass-adverse events


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R & Din Technology to reduce errorCPOE reduces medication errors andadverse drug event in general medicine(Bates et al., 1998, 1999; Raschke et al.,

1998)


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Multicenter study of 3,481 COPEPhysicians overload 91.2 % of drug allergy

89.4 % of high severity of drug interactionDespite the use of an automateprescribing system, a patient received acisplatin dose of 760 mg instead of 190mg, cause

severe pancytopeniaRenal failure hemodialysis


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P Patient S Safety S Standards E Eevidence-based recommendations

1.Improve the accuracy

of patientidentification

1.1use at least 2 patientidentifiers whengiving medications .Neither identifiermay be the patient 'sroom number .

1.2Proper identifiersare the patient 'sname, telephonenumber , and date of

birth .


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RecommendHCP should develop a standard patientidentification policy for use in theirinstitution and consistently adhere to it

(Parisi, 2003)


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Measure height and weightin centimeters and kilograms

Strategie 2


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Have good light, employmagnification, and use high-

visibility tools such ascalculators with large-

number buttons and largelighted data display area

Strategie 3


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Ageing VS Nurses Rolein ChemotherapyAging process decreasethe amount of lightentering the eyeDecrease visual acuityand the ability to discernlight or dark contrastand color intensity

The nurses role inchemotherapyadministration is visuallydemanding, and goodlighting is needed to

review ordersRead vial or drug labelsPrepare medications

Enter information intocomputer


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Organize the work andworkspace for safety andefficiency

Strategie 4


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IOM reportKeeping Patients Safe: Transforming thework environment of nurse

Outlined a blueprint of safety promotionactions that include designing the workplacewith both nurses and patient in mindUsing competent and capable nurse to providepatient care, and creating & sustaining anorganizational culture of safety.


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Oncology NursingTransforming LeadershipExamining the workload and work flow tomake patient scheduling or nurse staffingadjustments

Using strategies or resources to maximizetime efficiencyGroup chemotherapy education classes

Instructional videotapes or computerizedprograms)


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Providing comprehensive new staff orientationand trainingFostering an atmosphere where safety is thenumber-one goal

Oncology NursingTransforming Leadership


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Eliminate the use ofabbreviations and acronyms

in all clinical documentation

Strategie 6


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P Patient S Safety S Standards E Eevidence-based recommendations

2. Improve the

effectiveness ofcommunication amongcaregivers.

2.2 Also, organizationsmust use astandardized set ofabbreviations,acronyms, andsymbols throughoutthe organization, andmust also identify

those abbreviationsthat will not be used.


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Provide and use up-to-date,easily accessible information

at the point of care

Strategie 7


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Follow the 80/20 rule

Strategies 8


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The principle of 80/20 rule(Reh,2002)

The 80/20 rule origin in economicsThe principle

20 % of something is responsible for 80 % of

the resultUsing this principle in product or deviceevaluations for instance

A small number of defects (e.g., 20%) willcause the majority (e.g.,80%) of problem


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Reduce the potential forhuman error

Strategies 9


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Include the stakeholder withthe most to lose-thepatient-in chemotherapyerror prevention efforts.

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Partnering with patients to preventchemotherapy errorsVerifying chemotherapyWriting instructions and reiteratechemotherapy teachingCreate a process to ensure that all patientsare given information about their

chemotherapy treatmentsOngoing reinforcement of information may behaphazard

Strategies 10


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Near-miss chemotherapy errors havebeen caught by patients when theyobserve something out of the ordinary

A larger than usual infusion bagChemotherapy drug of a difference color thanthose previously receive

Encouraged pt to speak up

Strategies 10


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Prevention and Reporting ofMedical Errors (ONS)

1) published a peer education newsletter analyzing researchrelated to medication errors,2) developed and circulated a poster on medication errors thatincluded a post-test for staff to complete,3) participated in an institution wide symposium focusing on thefundamentals of dealing with medical errors,4) utilized ONS educational activities and offerings addressingmedication errors, and5) confirmed that all medication-related policies and standardsof practice are current with research findings


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The post-test results will be used as onemechanism for evaluation of theprogram. Ongoing evaluation, critical toinsuring sustained improvement, isdiscussed using a standardizedperformance improvement model

(FOCUS-PDCA)


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advance infusion technology and excellence nursing

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