IV medications incompatibilities and push times for nursing students
I have developed a reference guide for nursing students that contains information regarding IV medication incompatibilities and push times. I have supplied this reference guide to the students in two 3rd semester nursing clinicals - a total of 18 nursing students. I have developed and approved a survey to gather information regarding the usefulness of this reference guide in the clinical setting. This survey will be passed out to the students and the information will be returned to me. I would then like to present the information I have gathered to other students and faculty completing my honors project for the school of nursing.
IV Medication Incompatibilities and Push Times A Survey of Student Nurse Perceptions Cari Meats Mentor: Lori Edwards School of Nursing Washburn University Introduction Medication errors are a huge concern in the health care profession. Medication errors consist of violating the five rights: right patient, right drug, right dose, right time, and right route. In addition to these five rights, documentation and communication are also essential for safe and efficient patient centered care. By following these rights, medication errors can be diminished in occurrence and patient safety can be maintained. However, these are not the only issues when it comes to medication administration. What if, as a nurse, you have the right patient, it is the right time, you have the right drug, right route, and right dose… but you administer the drug with another drug that it happens to be incompatible with? Is that not also a medication error? Or say you have the right patient, right drug, right dose, right route, and it is the right time but you as a nurse are in a hurry so you push the IV medication faster than it is to be administered? Is that also not a medication error? While following the five rights definitely decreases the chance of making a medication error, they are not the only measures that need to be considered. A guide that lays out exactly what the drug is incompatible with along with how fast to push the drug IV would decrease medication errors, increase patient safety, and increase in nurse’s duty of beneficence towards their patients. Special Thanks: Lori Edwards Crystal Acker Shirley Waugh Jane Carpenter Washburn Nursing Students Supported by: Washburn Transformational Experience (WTE) Results Please indicate how useful the guide was for ensuring IV medication compatibility (n=17) n=0 n=0 n=0 n=0 n=0 n=1 n=2 n=4 n=5 n=5 not useful Likert Scale extremely useful 1 2 3 4 5 6 7 8 9 10 Please indicate how useful the guide was in preparing to administer IV medication in a timely manner (n=17) n=0 n=0 n=0 n=0 n=0 n=0 n=3 n=5 n=2 n=7 not useful Likert Scale extremely useful 1 2 3 4 5 6 7 8 9 10 Please indicate how useful the guide was for ensuring accurate push times (n=17) n=0 n=0 n=0 n=0 n=0 n=0 n=1 n=4 n=4 n=8 not useful Likert Scale extremely useful 1 2 3 4 5 6 7 8 9 10 Survey Purpose The purpose of creating a reference guide that includes IV medication incompatibilities and push times was to: •decrease the risk of incompatibility and push time errors •increase nursing student’s knowledge of IV medication incompatibilities and push times •improve timeliness, efficiency, and safety of IV medication administration Conceptual Framework Imogene King developed her Theory of Goal Attainment in the 1960s while she was an associate professor of nursing at Loyola University in Chicago Illinois. Her theory “describes a dynamic, interpersonal relationship in which a person grows and develops to attain certain life goals” (Nursing Theories, 2010). One of King’s assumptions is that the “nurse and client communicate information, set goals mutually and then act to attain those goals” (Nursing Theories, 2010). The nurse’s role is to ensure safe and equitable care of the patient through building a relationship and setting goals to help the patient return to health. King’s theory is centered on attainment of goals and effectiveness of nursing care. In order to provide safe, accurate, and effective nursing care, a nurse and their patient must include proper medication administration as a set goal. Medication errors can cause harm and delay the return of health for the patient. Process and Method I compiled all the information needed about IV medication incompatibilities and IV push times from drug books, pharmacists, and other reliable sources. This information was gathered from December 17 through December 31, 2010. I then formatted the reference guide and provided it to 18 nursing students for use in their clinical practicum. On March 31, 2011 I surveyed the nursing students to assess their perceptions regarding the usefulness of the reference guide. Conclusion Following the five rights of medication administration decreases the incidence of these errors, however, they do not cover all aspects involved in medication administration. An error can also occur in relation to incompatibilities and IV push times. According to the results, the IV Incompatibilities and Push Time reference guide was used by seventeen of the eighteen students during their clinical experience. Of the seventeen students, the majority used the reference guide three to eight times during their clinical hours in relation to giving IV medications to patients. All of the students rated the reference guide as a six to ten on a Likert scale with ten being “extremely useful/friendly” in relation to ensuring IV medication compatibility. All of the students rated the reference guide as a seven to ten on the Likert scale in relation to ensuring accurate push times and usefulness in preparing to administer IV medications in a timely manner. The majority of the students rated the reference guide as seven to ten on the Likert scale in relation to user friendliness with one student rating the reference guide as a four. The majority of the students included in the study reported the reference guide as a great resource of information regarding IV medication incompatibilities and IV push times. The majority of the nursing students also said they used the reference guide during clinical at least three to eight times as a reference when giving IV medications to patients. From this sample size it was determined that the reference guide was useful in the clinical setting for nursing students. The reference guide supplies students with easy access to pertinent information for patient safety. By supplying nursing students with this user friendly reference guide for medication incompatibilities and IV push times, medications were administered in a more timely, efficient, and safe manner. Themes for Improvement n=2 n=1 n=1 n=7 n=1 What information or changes would improve this reference guide? (n=11) Publish to promote reference guide as a reliable tool. Add pharmacodynamic information for medications. Create pocket size. No additions. Great reference. Improve orientation. Please indicate the user friendliness of the reference guide Easy to navigate, easy to read (n=18) n=0 n=0 n=0 n=1 n=0 n=0 n=2 n=1 n=4 n=10 not friendly Likert Scale extremely friendly 1 2 3 4 5 6 7 8 9 10 References Nursing, Theories. (2010, November 04). Imogene King's theory of goal attainment. Retrieved from http://currentnursing.com/nursing_theory/goal_attainment_theory.html Mitchell, P.H., & Soule, E.S. (2008). Patient safety and quality: an evidence-based handbook for nurses. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2681/ Moyen, E., Camire, E., & Stelfox, H.T. (2008). Clinical review: medication errors in critical care. Crit Care, 12(2), Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2447555/ doi: 10.1186/cc6813 Aspden, P., Wolcott, J. A., Bootman, J. L., & Croenenwett, L. R. (2007). Preventing medication errors. Washington, D.C.: The National Academies Press. Gahart, B.L., & Nazareno, A.R. (2011). 2011 intravenous medications. St. Louis, MO: Elsevier-Mosby, Inc. Six Aims of Quality Care Safe Equitable Efficient Effective Timely Patient Centered Washburn University School of Nursing Please enclose your completed survey in the addressed, stamped envelope and the consent form in the second addressed envelope by Monday, March 28, 2011. Thank you for participating in this Honor’s Project. A Survey of Student Nurse Perception of IV Incompatibilities and Push Times Reference Guide 1. How often did you administer IV medications that required knowledge of the medication’s compatibility with other IV medications this semester? a. 0 – 2 times b. 3 – 5 times c. 6 – 8 times d. 9 or more times 2. How often did you administer IV medications that required knowledge of the length of time to push the medication this semester? a. 0 – 2 times b. 3 – 5 times c. 6 – 8 times d. 9 or more times 3. If you administered IV medications, did you use the provided IV Incompatibilities and Push Times Reference Guide to prepare? ____ Yes ____ No ____ Did not administer IV medications 4. If you answered No, what reference did you use to prepare and is this reference user friendly? If you used the guide, please circle the number that best reflects your perceptions 5. Please indicate how useful the guide was for ensuring IV medication compatibility. not useful extremely useful 6. Please indicate how useful the guide was for ensuring accurate push times. not useful extremely useful 7. Please indicate how useful the guide was in preparing to administer IV medication in a timely manner. not useful extremely useful 8. Please indicate the user friendliness of the reference guide? Easy to navigate, easy to read. not friendly extremely friendly 9. What information or changes would improve this reference guide? (Please use the back if needed)