Chapter 7: Parenteral Medication Administration Show
Critical Thinking Exercises: Questions, Answers, and Sources / References
Answer: using the same secondary IV tubing more than once and for more than one kind of medication depends on the nature of the medication and the frequency. Back flushing is one practice with secondary lines that may be sufficient for cleansing the line of remnants of the previous medications. Replacing the secondary line entirely is another (though more expensive) option. The nurse should always consult an IV medication resource to learn about compatibility / incompatibility. Because a secondary tubing system is generally opened frequently (ie. the minibags are changed frequently thus exposing the spike to room air) it is recommended to be changed every 24 hours. 2. What is the purpose of hanging the secondary (piggyback) IV medication higher than the primary IV solution? Answer: physics principles apply. The solution that is the highest will infuse first as long as the clamp is opened. Source: Perry, A., Potter, P., & Ostendorf, W. (2017). Clinical skills and nursing techniques (9th ed.). St. Louis, MO: Elsevier-Mosby. 3. Your patient has an IV antibiotic infusing via a mini-bag and requests analgesic. The analgesic is IV route and not compatible with the current antibiotic. Explain your next action(s). Answer: if the patient only has 1 IV access, the nurse will have to decide if they will stop the IV antibiotic and administer the analgesic or wait until the antibiotic is completely infused before administering the analgesic. Either way the nurse will have to note incompatibility between the 2 meds and ensure that the line is free of one drug before administering the other. If the analgesic is to be given via minibag then the secondary line will have to either be back flushed with a compatible primary solution or the line flushed with an appropriate solution attached to the secondary spike / drip chamber. If the analgesic is to be given IV direct the nurse can stop the IV antibiotic, flush the line at the port closest to the IV insertion site with an appropriate compatible solution, administer the IV medication followed by an IV flush with an appropriate compatible solution. At this point, the IV antibiotic infusion can be resumed. Note: always follow agency guidelines for IV medication administration practices. Sample Quiz Questions
Answer: 100 ml x 60 minutes = 300 ml 20 minutes 1 hour hour 2. You are administering a new IV antibiotic to a patient. 20 minutes into the infusion, the patient calls you to show you his rash on his arms and torso. What is your next action?
HCA 375 Ashford University CH5 Continuous Quality Monitoring & Accreditation Essay Adverse Event Reporting Read Chapters 5, 6, and 7 in our textbook. After reviewing this week’s required reading, consider the following scenario. You are the lead of the risk management team that has been assigned to evaluate an incident that has occurred. You will prepare a report for the CEO of the hospital that includes all system failures that contributed to the adverse event as well as create a CQI tool (i.e., Pareto, Fishbone, or Flowchart). You are required to download and use the Adverse Event Template Download Adverse Event Template document to complete the assignment. Note: If you have responded substantively to each of the content items within the assignment document and included your graph of the data as well as the CQI tool illustration, the template document should be between eight to 10 pages. Part 1: Description of Adverse Event (Complete Part 1 of the Adverse Event Template Download Adverse Event Template) Medication error Patient falls Post-operative hemorrhage Completing the template: Adverse Event Identify the chosen event. Create a scenario based on your chosen event. Discuss the incident and what happened. Identify the health care professionals involved. Explain the health care professional’s role in the incident. Historical Background Discuss the prevalence of the adverse event including historical information (i.e., how often this type of event occurs, and prevention methods used by the industry). Legal and Accrediting Agency Requirements Address legal ramifications and accreditation agency requirements regarding the adverse event. CQI Team and Communication Identify the CQI team members. Based on the members you chose: Explain how their role within the hospital would benefit your team in identifying and analyzing the cause of the adverse event. Discuss issues that could arise between the team members when attempting to develop an improvement plan. Describe the steps you would take as the CQI team lead to make sure that everyone is able to communicate their opinions and recommendations. Describe barriers or conflicts that could occur within your team regarding effective communication. Operational or Safety Processes Discuss at least two operational and safety processes that you would recommend to the team to avoid future events from occurring. Explain the rationale for your recommendations. Impact of Event Discuss the impact on the hospital if the events continue to occur. Discuss the impact to the patients if the events continue to occur. Note: The number of beds and operating rooms increased from 2017 to 2018. Part 2: Graph the Data (Complete Part 2 of the Adverse Event Template Download Adverse Event Template) Once you choose your adverse event, graph the data from the chart above Download chart above. You will graph Column A and B against the chosen event (i.e., number of medication errors, number of patient falls, or number of post-operative hemorrhages). For example, if you were to choose medication errors, you would enter the details from column A, B, and C. Once your graph is complete, right click over the graph to copy it, then paste it in the space indicated within the template. Include an analysis of the data within the spaces indicated in the template: Discuss the frequency of the adverse event as compared to the increase or decrease of patient discharges. Analyze the data (what is the data telling you?). Identify the possible factors, in your opinion, that could be attributed to the change. Part 3: Create the CQI tool (Complete Part 3 of the Adverse Event Template Download Adverse Event Template) Choose one of the CQI Tools listed below that best aligns with your chosen Adverse Event. Each of the tools listed below are hyperlinked to the Institute for Health Care Improvement website, which discusses and illustrates examples of each type of tool. Fishbone (Cause and Effect) Diagram (Links to an external site.) Flowchart (Links to an external site.) Pareto Chart (Links to an external site.) Next, you will be responsible for creating the CQI Tool, completing the tool, taking a screenshot, and copying/pasting the screenshot into the space indicated within the Adverse Event Template Download Adverse Event Template. If you are unfamiliar with these tools, please refer to the recommended readings, specifically the Siriwardena (2009) article from Week 2, Using Quality Improvement Methods for Evaluating Health Care Download Using Quality Improvement Methods for Evaluating Health Care. Part 4: Future Prevention (Complete Part 4 of the Adverse Event Template Download Adverse Event Template) After describing the event in Part 1, using a Graph in Part 2 and CQI tool in Part 3, you will apply the PDSA model in Part 4 to summarize the process and steps that your team would recommend to the CEO to prevent this adverse event from reoccurring. Respond to the items in Part 4 of the template by including the following: Plan Identify the problem that caused the adverse event/ Identify your objective. Identify the team members that will assist in the development of a plan for improvement. Describe how you would communicate the plan to the stakeholders. Discuss the reasons for collecting the data associated with the chosen scenario. Identify where you will pilot the new plan of action. Identify who, what, or why for your pilot of the improvement plan. (When you implement any new plan of action in a hospital setting, you will do a pilot of the new plan in a small, targeted area or department. For example, if you chose medication errors, a group of patients will be on the same floor [e.g., medical unit, cardiac unit, etc.]. If you chose patient falls, the patients will have the same diagnosis [e.g., hip replacement, etc.]. If you chose post-operative hemorrhage, the patients will have the same type of surgical procedure [e.g., abdominal surgeries, etc.].) Do Develop three possible solutions to the problem. Select one of the possible solutions to implement in the pilot phase. Discuss the result of the pilot (create your own scenario). Explain in detail the methods utilized to communicate the improvement process to the area chosen for the pilot phase. Study Summarize the data collected. Discuss how you would measure whether the pilot solution was effective. List observations. Discuss any problems that may have occurred in your scenario. Discuss any communication issues. Compare your objective in the Plan phase to that of the actual pilot result. Discuss what needs to be revised in your improvement plan to meet your objective. Act Discuss your revised plan. Describe how you are going to implement the plan hospital-wide. Describe how you will continually monitor the improvement plan to ensure sustained success. Determine if one of the steps you are recommending would require a check and balance step. Discuss why it is necessary. (It is important to keep in mind that some processes require a system of checks and balances.) Paper Requirements: The Adverse Event Template document, once completed, Should demonstrate an understanding of the reading assignments, class discussions, your own research, and the application of new knowledge. Must have substantive responses within the template and include complete sentences in paragraph format, including citations for each reference listed. Refer to the Writing Center (Links to an external site.) for information on APA guidelines. Must demonstrate understanding of the reading assignments, class discussions, your own research, and the application of new knowledge. Two of your four sources must be from the University of Arizona Global Campus Library and must have been published within the past five years. The Adverse Event Reporting paper, in the template, Must be eight to 10 double-spaced pages in length (not including title and references pages) and formatted according to APA style as outlined in the Writing Center (Links to an external site.). What is the best way to prevent infection and conserve resources when terminating an IV piggyback?What is the best way to prevent infection and conserve resources when terminating an IV piggyback medication infusion in a patient who also has a primary fluid infusion? Remove the tubing from the primary line Y-site port, and cap the end.
When administering an IV piggyback medication to infused by gravity How can the nurse ensure that the medication will flow properly?When administering an IV piggyback medication to infuse by gravity, how can the nurse ensure that the medication will flow properly? Use an infusion pump to regulate the flow rate of the piggyback medication.
What is the most important action the nurse can take to to protect the patient when administering a medication by IV bolus?CORRECT. Injecting the medication at the prescribed rate is the most important action the nurse can take to protect the patient when administering a narcotic analgesic by IV bolus, since injecting the medication faster than recommended may result in injury or death.
Why must the piggyback medication be at a higher level than the primary solution?"An important step when hanging secondary infusions is to hang secondary solution bags higher than the primary infusion bag, thus "piggybacking" it on top of the primary IV infusion. This higher position places greater gravitational pressure on the secondary IV solution.
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What is the best way to prevent infection and conserve resources when terminating an IV piggyback medication infusion in a patient who also has a primary fluid infusion?
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