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Many medications are delivered intravenously (IV). Like all other medication
administration procedures the "Five Rights" are essential -
Right Patient, Right Medication, Right Dose, Right Time, Right Route.
IV fluids with or without additives are medications. And it is essential
that the correct patient receives the correct medication, in the correct
amount, at the correct times when infusing IV solutions
Many nurses today work in facilities where electronic devices automatically
calculate drip rate factors and deliver the amount of fluid/medication
needed as scheduled. The nurse uses the device's built in computer and
enters an amount of fluid and the time it is to run and the infusion machine
calculates the rate of infusion. The nurses generally rely on the machines
and never calculate a drip rate themselves. They believe the days of "counting
drops" are long gone - they may even have forgotten how to calculate
and measure intravenous drug dosages.
O'Brien (2001) urges nurses to demand adequate support and technology
such as infusion pumps with built in software at the point of interaction
with the nurse. She suggests that use of such equipment can reduce medication
errors. It should also be noted that one of the 2004 Patient Safety Goals
identified by the Joint commission on Accreditation of Healthcare Organizations
(JCAHO, 2004) is to improve the safety of using infusion pumps and ensure
free-flow protection on all general-use and patient controlled analgesia
(PCA) intravenous infusion pumps used in an organization.
It is important to remember that even in facilities where the use of
electronic devices is standard, the nurse is not absolved of the responsibility
of administering medications correctly and must be knowledgeable and competent
in the calculation of doses and IV flow rates.
What if there suddenly are not enough pumps to go around? What if the
pump breaks and there is no replacement available? What if you change
jobs and infusion pumps aren't used in the new place? If this happens
there may not be time to look up a formula. It's never enough to rely
on electronic devices; nurses must be prepared to administer IV solutions
accurately with or without a pump. The ability to calculate accurate administration
rates is essential. Errors that occur in IV medication/solution administration
have the potential to be more deadly even more quickly than other medication
errors. Ignorance is not an acceptable excuse or defense.
In an article in Nursing 97 (1997), the author tells of her experience
as a new nurse who "felt nervous about calculating an IV drip rate."
Rather than calculate the drip rate she consulted the pharmacist who calculated
for her. When she returned to work the next day an incident report had
been filed because the patient had received half the required dose of
dopamine. There is no acceptable defense for this and the author learned
that there is also no substitute for doing one's own drug calculations
and double checking them. Even if IV solutions come from the pharmacy
with labeled directions for flow rates, the nurse administering the solution,
as the individual responsible for the administration, must do the calculation
and verify that it is correct before hanging.
This course covers basic principles of administration of IV fluids and
calculation of IV drip rates. Mathematical calculations will be demonstrated
and opportunities for self assessment included.
© 2004 NYSNA All rights reserved.
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