Simulation Based Teaching Of Fluid Balance Interpretation And Prescription Of Intravenous Fluids

According to the Food and Drug Administration (FDA 2009), the wrong route of administrating medication accounts for 1.3 million injuries each year. An article published in September issue of the Journal of Patient Safety estimates there are between 210,000 and 400,000 deaths per year associated with medical errors. This makes medical errors the third leading cause of deaths in the United States, behind that comes heart disease and cancer. To prevent medical errors always follow the Three Checks and most importantly the Rights of Medication Administration. The “Rights of Medication Administration” helps to ensure accuracy when administering medication to a patient. When administering medication the administer should ensure they have the Right Medication, Right Patient, Right Dosage, Right Route, Right Time, Right Route, Right Reason, and Right Documentation. Also remember the patient has the right to refuse, assess patient for pain, and always assess the patient for signs of effects.

Medication errors are the leading cause of morbidity and preventable death in hospitals (Adams). In fact, approximately 1.5 million Americans are injured each year as a result of medication errors in hospitals (Foote). Not only are medication errors harmful to patients but medication errors are very expensive for hospitals. Medication errors cost America’s health care system 3.5 billion dollars per year (Foote).Errors in medication administration occurs when one of the five rights of medication administration is omitted. The five rights are: a) the right dose, b) the right medication, c) the right patient, d) the right route of administration, and e) the right time of delivery (Adams). Medication administration is an essential part of

As clinical site co-ordinator with many years of clinical experience I feel competent in the drug administration via a variety of routes. Generally the patients I attend have become acutely unwell with most prescriptions not having the third eye of a pharmacist and most drugs being delivered intravenously. It is imperative therefore that the prescription and drugs always be thoroughly checked which relies on good communication throughout. Furthermore, most emergency drugs have a protocol for administration developed by the hospital. However within this situation the nurse is generally the last defence before any medication error actually occurs, therefore it is the nurses responsibility to ensure the prescription is correct and to challenge prescription written

* Monitor fluid and electrolyte status. Disturbances can have an adverse effect on ICP. Closely monitor IV fluids with the use of an accurate intravenous infusion

(Weinberg, Auerbach, & Shah, 2009) This may prove especially important as the assessment and care of critically ill children is particularly stressful for providers. Debriefing after the simulation experience also provides a time for reflection. Concepts taught in lecture become more tangible as a result of their application during the simulation. Simulation has the potential to enhance pediatric nursing education, improve patient safety and provide additional experiences when clinical sites are limited. The student has an opportunity to build and practice a pediatric skill set. (Bultas, 2011)

System failures and poor communication has led to decreased patient safety and satisfaction within the hospital. Three critical areas that need immediate solutions are the drug administration system, hand washing protocols and follow ups and communication between patients and clinicians. Dosage issues whether it is frequency of a drug given or if the patient has even received their medication have occurred because there is no standard system for drug administration . Also, there is little adherence and enforcement to handwashing when interacting with patients. Lastly, there is no protocol when following up with patients leaving them feeling frustrated with the negligence of the clinicians.

One of the most important steps in caring for hospitalized patients is medication administration. Patients come into the hospital to be treated so they will feel better, it does not matter what the physician does if the medications are not given to the patient they will not get better. According to McGonigle and Mastrian, the steps of administering medication have not changed in many years, they are “assessment of need, ordering, dispensing, administration, and evaluation” (McGonigle & Mastrian, 2012, p. 386). The purpose of this paper is explain the medication administration process that is used in my facility, to determine the technology used is effective.

It has the correct fluid amount for the patient and providing an appropriate balance of electrolytes.

Conducted over a 108-day span at the Hospital Clinico ‘San Carlos,’ a university hospital in Madrid, Spain, this randomized controlled trial evaluated both open and closed safety PIVCs, replacing the PIVC only as clinically indicated. Qualifying patients were 18 years of age or older, had a clinically planned PIVC (non-emergent), no other peripheral or central lines, and a temperature less than 38C. The sample included 1200 catheters to eliminate possible effects of IV insertion learning curves. Random computer selection generated the sample group into closed-system (COS) PIVCs and those with open-system (MOS) PIVCs. (Lopez et al., 2014)

This also applies to a new employee; the Enrolled Nurse’s responsibility is to know the work place policy and procedure for an Enrolled Nurse on IV medications. For example as an Enrolled Nurse employee working for Queensland Health the policy is; the Enrolled must have successfully completed HLTEN507: ‘Administer and monitor medications in the work environment’ and HLTEN519: ‘Administer and monitor intravenous medication in the nursing’ (Queensland Government, 2014). Only those Enrolled Nurses who have successfully completed these education requirements are authorised to prepare and administer IV medications to the patient. This includes calculations, administering IV medications through, bolus, via burette, mini infusion pump, piggyback/tandem and a syringe pump (Queensland Government,

The implementation of this component has been delegated to our Quality Indicator Clinical Coordinator. The Quality Indicator goes around every morning to each and every patient that possesses a urinary catheter and asks his or her nurse “What is the reason for the urinary catheter?” and “Can we remove the urinary catheter?” Our organization has put guidelines into action for patients in critical care. These guidelines have been named “No Plastic Left Behind” and are posted throughout the critical care units. The list for when the urinary catheter is not indicated includes, tube feedings, pressors with minimal titration, diuretic IV pushes/PO doses, sedation/ drowsiness/ lethargy, dementia/ confusion, and mechanical ventilation. Indicators for the use and continuous need for a urinary catheter are sepsis (first 24-48 hours), hemodynamically unstable patient, hypothermia protocol in use, ARDS with proning, impella, requires prolonged immobilization with strict bedrest, end of life patients, urinary obstruction and/or retention, diuretic drip, new spinal cord injuries, incontinent patients with a stage 3 or 4 pressure ulcer, organ donation patients. Removing the urinary catheter when a patient does not meet the above indicators, consider using urinary alternatives, utilize the urinary retention algorithm, and if

For many years, hospital personnel have struggled with maintaining the accuracy of fluid intake/output measurements of patients. Your decision to focus a change project aimed at addressing this issue and making changes to correct the problem is important to maintain the safety of patients during hospitalization.

Throughout the clinical week my main concerns were safety, fluid balance, and seizure precautions. The patient refused anything NPO and had no intake of fluid or food on my shift. To aid in fluid balance he is placed on an IV infusion of .9% sodium chloride. Gloves are applied

As healthcare continues to develop, so too has the technology involved. In the article, “A Controlled Trial of Smart Infusion Pumps to Improve Medication Safety in Critically Ill Patients” the authors seek to understand the impact of smart pumps, how they are used in the clinical setting and how this technology effects medication errors and adverse drug events. The thesis of this article recognizes that while the medication administration process is complex and allows many opportunities for error, the impact of advancing technology has great promise in improving the safety of infusion-based medications. The study also provides an opportunity to understand how critical care nurses are (or are not) integrating new technology into their practice. This non-blinded, prospective time series study sheds light on the fact that both the technology and the nurse’s performance were the critical factors in the current rates of intravenous infusion errors (Rothschild et al., 2005, p. 13, 20).

This is especially important on those patients admitted with low mortality risk DRGs. This is accomplished by identifying and preventing, potentially avoidable complications and adverse events. For example, patients admitted for syncope and collapse secondary to dehydration will more than likely be placed on IV Fluids. One goal would be to hydrate the patient and reevaluate them throughout their hospitalization for improvement. However, if the patient’s intake and output is not monitored closely, the patient can become volume overloaded and develop symptoms similar to those seen with Right Sided Heart Failure. Once that happens, the patient will require additional medications and additional hospital days because of provider error of not placing an order for the Nurses to monitor his/her volume status.