Transcript
ACKNOWLEDGEMENT
This is to acknowledge, receipt of one (1) copy of Nursing Audit.
Received by:
_______________________
Print Name & Signature
_______________________
Position/ Title
_______________________
Date
i
AUDIT SUMMARY FORM
TO: Emergency Room Department
DATE: February 21 – 23, 2011
FROM: RLE Group 8
Audit Chairperson: Hazel Yvonne C. Ferrer
___________
Members:
Michael Angelo P. Bisenio
___________
Michelle Kris C. Florin ___________
Joaisa F. Fornoles ___________
Rose Ann L. Frial ___________
Irene B. Gabiola ___________
Errol B. Galan
___________
Ma. Daryl Jann D. Gallarte
___________
Maridean A. Ganera
___________
Jona Ivy O. Gascon ___________
Elora G. Sarmiento ___________
Topic: Student Nurses Performance on Setting up
Intravenous Infusion
Retrospective Audit (Process audit)
____14_____Number of student nurses observed
FINDINGS AND RECOMMENDATIONS:
Indicators of Quality Care-There are 4 identified indicators of
quality care these are filling up the drip chamber to at least half
and priming the tubing aseptically with a weighted mean of 1,
preparing the necessary materials for the procedure with a
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weighted mean of 0.92, closing the roller clamp and spiking the
container aseptically with a weighted mean of 0.92. Expelling air
bubbles if present and put back the cover of the distal end of the IV
tubing with a weighted mean of 0.85. This findings can be
recognized to an excellent indicator of actual performance of
student nurses on setting up IV Infusion.
Outstanding Problems – Based from the findings
procedures such as doing hand washing before and after
the procedure with a weighted mean of 0.21 and O.14,
verifying doctor’s order with a weighted mean of 0.14
interpreted as poor and placing of IV label on the IVF bottle by
the person who prepares the materials to be used with a
weighted mean of 0. These results can be interpreted as poor
indicator of quality care and indicates a room for
improvement. .
Indicators of Improvement- Checking the sterility and
integrity of the IV solution, IV administration set and other
devices with a weighted mean of 0.35 and opening the seal of
the IV solution and disinfect port with cotton balls with alcohol
with a weighted mean of 0.5 are the identified indicators for
improvement. These findings are interpreted as fair indicators
of quality care that needs improvement.
Recommendation- Upon collation, tabulation, analysis and
interpretation we highly recommend to conduct a student
development program. Handwashing slogan, making strips of
paper enough to be use as an IV label, to include sharp
receptacles in the IV tray to avoid needle prick incidents.
Special Comments- Since IV insertion is an invasive
procedure, Consent to Care should be verified, to reduce
malpractice risk and or to avoid liability.
OBSERVER SCHEDULE
February 21 February 22 February 233:00 – 7:00: Rose Ann Frial & Michelle Kris Florin7:00 – 10:30: Michael Angelo Bisenio & Hazel Yvonne Ferrer
7:00 – 11:00: Maridean Ganera & Elora Sarmiento11:00 – 3:00: Daryl Gallarte & Jona Ivy Gascon3:00 – 7:00: Errol Galan & Hazel Yvonne Ferrer7:00 – 10:30: Joaisa Fornoles & Irene Gabiola
7:00 – 11:00: Joaisa Fornoles & Irene Gabiola 11:00 – 3:00: Maridean Ganera & Elora Sarmiento 3:00 – 7:00: Rose Ann Frial & Michelle Kris Florin7:00 – 10:30: Michael Angelo Bisenio & Errol Galan
LEADER of EACH COMMITTEES
RESEARCH COMMITTEE: Errol B. Galan
FINANCE: Maridean Ganera
TABULATION: Michelle Kris C. Florin
LIASON / COMMUNICATION: Ma. Daryl Jann Gallarte
COMPUTATION / INTERPRETATION: Joaisa F. Fornoles
OBSERVER: Irene B. Gabiola
INTRODUCTION: Errol B. Galan
IDENTIFYING OUTSTANDING PROB.: Joaisa F. Fornoles
INDICATORS FOR IMPROVEMENT: Rose Ann L. Frial
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RECOMMENDATION/SPECIAL COMMENTS: Jona Ivy O. Gas
APPENDIX G
INDICATORS OF QUALITY CARE
The role and responsibilities of nurses are changing along
with the evolving healthcare environment. It varies with the needs
of the client, the nurse’s credentials and the type of employment
setting. As a nurse, they are responsible for obtaining and
maintaining specific knowledge and skills should emphasize health
promotion and illness prevention, as well as concern for the client
as a whole.
Emergency room nurses provide first assessments and
treatments to patients experiencing medical crisis. They need
assertive responses to patients with serious illness and trauma,
backed with extensive medical knowledge. Though they typically
work alongside with medical doctors, they are expected to work
independently and take leadership roles when necessary. Another
skill that emergency room nurses must possess is attentiveness
and effective communication skills because in this kind of hospital
setting events are more likely unpredictable which requires abrupt
thinking. Often needs to make immediate decisions and pay close
attention to details. Also they need to be cautious and observe
strict guidelines to guard against potentially disease transmission.
Setting up of intravenous fluid infusion is one of the clinical
skills required in every day nursing practice. Intravenous fluid
infusion is the introduction of fluid into a vein to prevent or to treat
electrolyte imbalance or to deliver medications, nutrition or blood
products. It is important to remember that setting up and
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application of intravenous fluids must follow the standard policies
and procedures.
The Department of Health (DH) has commissioned a
prevalence study of Healthcare Associated Infections (HCAIs) in
2005-2006. Experts estimate that 9% of in-patients have an HCAI
at any one time, equivalent to at least 300,000 HCAIs per year in
the UK. HCAIs may cause 5,000 deaths and contribute to over
15,000 deaths per year in the UK.
However, these are estimates based on data over 10 years old.
The audit committee conducted performance
observation to the student nurses of level 4 on intensive practicum
with background concepts on Fundamentals of Nursing, Maternal
and Child Nursing, Community Health Nursing, Medical-Surgical
Nursing, Pharmacology Nursing, and Nursing Jurisprudence.
Student nurses in the level 4 are classified as on Stage 2: Advance
Beginners. These are those who can demonstrate marginally
acceptable performance, those who have coped with enough real
situations to note or to have pointed out by their mentor, the
recurring meaningful situation components. The data were
gathered through an observation with the aid of performance
checklist. The students were observed on their second week of
intensive practicum on moderate supervision with the clinical
instructor. The observation lasted for 2 ½ days the audit
committee assigned non participant observers. The performance
checklist was based on the criteria given on the students manual
and ANSAP Nursing Practice Standards on IV practice. To determine
the level of performance of the student nurses in ER on setting up
IV infusion weighted mean, percentage and ranking was utilized.
The goal of the nursing audit committee mainly to
determine the performance of BSN 4 students on setting up of
intravenous infusion in Emergency Room in Mother Seton Hospital
for improvement of skills and to ensure quality nursing care. The
objective of this audit is to observe the standards criteria and
principles performed by the student nurses in setting up IVF in
their actual performance. Conscientiously perform procedure of
setting up IVF with ease and confidence. This will be beneficial to
the student will develop and enhance their performance in
performing of setting up IV infusion, so as to give safe and quality
nursing care to the patient. The client will be assured that quality
care is rendered through minimizing risk of infections and
providing safe nursing care.
cotton balls with alcohol, plaster, tourniquet, gloves, splint, I.V.
hook and IV label.
PROCEDURE:
1. Verifies doctor’s order ( Avoid medication errors)
2. Do hand washing before the procedure(Reduce
transmission of infection)
3. Prepare the necessary materials for the procedure(Save
the time and avoid the patient to feel anxiety)
4. Check the sterility and integrity of the IV solution, IV
administration set and other devices(Prevent cross
contamination to patient)
5. Place IV label on IVF bottle duly signed by the person who
prepares it. (Prevents medication errors.)
6. Open the seal of the IV solution and disinfect port with
cotton balls with alcohol (Prevents microorganism from
entering the port.)
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7. Close the roller clamp and spike the container aseptically
(Prevents air bubble formation and microorganism to
enter the solution)
8. Fill drip chamber to at least half and prime the tubing
aseptically (Prevents air bubble formation.)
9. Expel air bubbles if present and put back the cover of the
distal end of the IV tubing(get ready for IV insertion)
( Prevent air embolism and maintain the sterility of
the tubing)
10. Do hand washing after the procedure (Promotes safety to the health provider.)
APPENDIX F
PROPOSED RECOMMENDATION
I. TITLE: Skills Enhancement on Setting Up IV.II. THEME: “Enhancing Skills towards Safe and Quality Care”III. PROPONENTS: RLE Group 8 Batch 2011
IV. BENEFICIARIES: Students Nurses of Universidad de
Sta. Isabel
V. TARGET DATE: March 14, 2011
VI. VENUE: USI- Social Hall
VII. GENERAL OBJECTIVE:
Develop the skills of student nurses of USI in setting up IV.
OBJECTIVES:
At the end of the skills enhancemnet the participants
will:
a. increase basic skills in preparing IV infusion
b. Familiarize the steps on setting up IV infusion
c. minimize common errors committed related to the preparation
of IV
VIII. Methodology:
The method of teaching to be used is lecture-discussion and
return demonstration.
IX. CONTENT
Intravenous (IV) fluid therapy is essential when clients are
unable to take food and fluids orally. It is an efficient and effective
method of supplying fluids directly into the intravascular fluid
compartment and replacing electrolyte losses. Intravenous
solutions can be classified as: isotonic; hypotonic or hypertonic.
The needed materials: I.V. tray with IV solution, IV IV administration
set, IV cannula, and forceps soaked in antiseptic solution,
Clinical Instructor will give them the performance assessment on
the identified procedure to intensify the skills of the students.
The Audit committee decided to use a Performance
checklist as a tool to gather the necessary data for the study. The
performance checklist on setting up IV infusion was based on the
Level 3 RLE Manual and ANSAP Nursing Practice Standards on IV
practice. There are 10 criteria in the checklist every criterion is
graded as 0=not done and 1=done. The checklist was used in the
performance observation which was conducted in the MSH-ER for 2 1/2 days from morning shift (7-3) to afternoon shift (3-11).
3Table 1: Actual Performance of Student Nurses on
Setting up IV Infusion
Procedure WM Interpretatio
n
Rankin
g
1. Verifies doctor’s order. 0.14 Poor 8.5
2. Do hand washing before the procedure
0.21 Poor 7
3. Prepare the necessary materials for the procedure
0.92 Excellent 2
4. Check the sterility and integrity of the IV solution, IV administration set and
0.35 Fair 6
other devices5. Place IV label on IVF
bottle duly signed by the person who prepares it
0 Poor 10
6. Open the seal of the IV solution and disinfect port with cotton balls with alcohol
0.5 Fair 5
7. Close the roller clamp and spike the container aseptically
0.92 Excellent 3
8. Fill drip chamber to at least half and prime the tubing aseptically
1 Excellent 1
9. Expel air bubbles if present and put back the cover of the distal end of the IV tubing(get ready for IV insertion)
0.85 Excellent 4
10. Do hand washing after the procedure
0.14 Poor 8.5
OVERALL 0.50 SATISFACTOR
Y
0.75 – 1 = EXCELLENT; 0.50 – 0.74 = SATISFACTORY; 0.25 – 0.49= FAIR; 0 – 0.24 = POOR
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Table 1 shows the criteria for
the procedure of Setting up an IV
Infusion with a weighted mean
indicated every criterion, its interpretation which is categorize as
Excellent, Satisfactory, Fair and Poor.
5. Place IV label on IVF bottle duly signed by the person who prepares it
6. Open the seal of the IV solution and disinfect port with
cotton balls with alcohol.
7. Close the roller clamp and spike the container aseptically
8. Fill drip chamber to at least half and prime the tubing
aseptically
It also presents the ranking of the criterion from rank 1 to 10.
INDICATORS OF QUALITY CARE
Table 2: Actual Performance of Student Nurses on
9. Expel air bubbles if present and put back the cover of the
distal end of the IV tubing(get
ready for IV insertion)
10. Do hand washing after the
procedure
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Setting up IV Infusion
Procedure W
M
Interpretatio
n
Rankin
g
1. Fill drip chamber to at least half and prime the tubing aseptically procedure
1 Excellent 1
2. Prepare the necessary materials for the
0.9
2
Excellent 3
3. Close the roller clamp and spike the container aseptically
0.9
2
Excellent 2
4. Expel air bubbles if present and put back the cover of the distal end of the IV tubing(get ready for IV insertion)
0.8
5
Excellent 4
Table 2 indicates the identified indicators of quality care
with its weighted mean, interpretation and ranking.
The actual performance of student nurses on filling up the
drip chamber to at least half and priming the tubing aseptically
with a weighted mean of 1 and can be recognized to an excellent
indicator of actual performance of student nurses on setting up IV
Infusion.
Based from the findings student nurses assigned in the
MSH-ER filled the chamber and primed the tubing properly within
the IV tray while preventing the tubing to touch other materials to
maintain its sterility.
This procedure is strictly performed to avoid introduction of
air to the tubing. Air bubbles less that 0.5 ml usually do not cause
problems in peripheral site. To avoid such circumstances re-clamp
the tubing and replace
the tubing cap, maintaining sterile technique. For caps with air
vents, do not
remove the cap when priming this tubing. The flow of the solution
through the tubing will cease when the cap is moist with one drop
of solution. (Kozier and Erb, 2008)
The actual performance of student nurses on Preparing the
necessary materials for the procedure with a weighted mean of
0.92 is categorize as excellent indicator. Based form the
observation, the materials that are necessary to the procedure are
already prepared on an IV tray that is why procedure no. 3 is
identified as one of the indicators of quality care.
Preparing the necessary materials for the procedure can save time
and effort in the part of the person who are performing the
procedure. (Kozier and Erb,2008)
The actual performance of student nurses on closing the
roller clamp and spiking the container aseptically is identified with
a weighted mean of 0.92 categorize as excellent.
Closing the roller clamp and spiking the container
aseptically prevents fluids to escape from the tubing as well as
spiking aseptically prevent microorganism to enter the container
and avoid the contamination of the fluid. (Kozier and Erb, 2008)
The actual performance of student nurses in expelling air
bubbles if present and putting back the cover of the distal end of
the IV tubing is discovered with a weighted mean of 0.85 and
categorize as excellent.
Expelling the air bubbles removes air from the tubing that
may post further risk to patients moreover the cover of the distal
end on the IV tubing was remained in place until the procedure is
done. .(Kozier and Erb,2008)
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APPENDIX E
PROPER SETTING UP OF INTRAVENOUS INFUSION
PROCEDURES
1. Verifies doctor’s order and
make intravenous fluid label
2. Do hand washing before the
procedure
3. Prepare the necessary materials for the procedure.
4. Check the sterility and integrity of the IV solution, IV
administration set and other devices
APPENDIX DUniversidad de Sta. Isabel
Higher Education DepartmentCollege of Nursing
Observation Tool Performance ChecklistSetting up IVF Infusion
Procedure WM Interpretatio
n
Ranking
1. Verifies doctor’s order. 0.14 Poor 8.5
2. Do hand washing before the procedure
0.21 Poor 7
3. Prepare the necessary materials for the procedure
0.92 Excellent 2
4. Check the sterility and integrity of the IV solution, IV administration set and other devices
0.35 Fair 6
5. Place IV label on IVF bottle duly signed by the person who prepares it
0 Poor 10
6. Open the seal of the IV solution and disinfect port with cotton balls with alcohol
0.5 Fair 5
7. Close the roller clamp and spike the container
0.92 Excellent 3
7
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aseptically8. Fill drip chamber to at
least half and prime the tubing aseptically
1 Excellent 1
9. Expel air bubbles if present and put back the cover of the distal end of the IV tubing(get ready for IV insertion)
0.85 Excellent 4
10. Do hand washing after the procedure
0.14 Poor 8.5
a. OVERALL 0.50 SATISFACTORY
0.75 – 1 = EXCELLENT; 0.50 – 0.74 = SATISFACTORY; 0.25 – 0.49= FAIR; 0 – 0.24 = POOR
INDICATORS FOR IMPROVEMENT
Table 3: Actual Performance of Student Nurses on
Setting up IV Infusion
Procedure WM Interpretatio
n
R
anking
1. Open the seal of the IV solution and disinfect port with cotton balls with alcohol
0.5 Fair 5
2. Check the sterility and integrity of the IV solution, IV administration set and other devices
0.35 Fair 6
Table 3 shows the identified indicators for improvement
with its weighted mean, interpretation and ranking indicated.
The actual performance of student nurses in opening the
seal of the IV solution and disinfecting the port with cotton balls
soaked in alcohol with a weighted mean of 0.5 that can be
identified as fair indicator of quality care.
Assessment revealed that some of the student nurses are
not disinfecting the port of the IV fluid because they believed that
when they open the seal of the IVF and expose it for a awhile will
not harbor microorganism.
One of the mode of transmission which is through an
airborne or microorganism can be transmitted through air. It is still
a must to disinfect the port after opening the seal because as the
port was exposed even a minute it can still harbor microorganism
especially in the ER unit where in patients’ chief complaints varies
to different cases such as tuberculosis that can remain in the air for
long periods that can cause contamination to the solution and may
post further risk to the patient.
The actual performance of student nurses in checking of
sterility and
integrity of the IV solution, IV administration set and other devices
is
recognized with a weighted mean of 0.35 and categorize as fair
indicator of quality care which signify room for improvement.
Based from the observation conducted, we saw that most of
the students did not perform the checking of sterility and integrity
of the IV solution, IV administration set and other devices. Not
performing the said procedure would increase the risk of the
patient to acquiring infections for the devices and the infusion itself
have lost their integrity and sterility.
In hospitals across our country and worldwide, however,
patients indeed are increasingly at risk for harm as related to
health care- associated infection (HAI). Such infections are leading
cause of patient morbidity and mortality (Scott, 2009).
Understandably, the topic of health care-associated infection is
receiving a great deal of attention by the federal government,
state and private regulators, policy makers, and institution. In part
as a result of increasingly numbers of HAIs, the new 2010 Patient
Protection and Affordable Care Act (Public Law 111 – 148) includes
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specific language regarding HAIs. Penalties are now assessed on
Medicare and Medicaid reimbursement to hospitals with high rates
of infection, and hospitals now are required to make their HAI
statistics available to the public. Likewise, private insurers have
begun to follow the lead of this Act in allocating higher payments
to facilities with demonstrated decreased rates of HAIs.
OUTSTANDING PROBLEM
Table 4: Actual Performance of Student Nurses on
Setting up IV Infusion
Procedure W
M
Interpretatio
n
Rankin
g
1. Do hand washing before the procedure.
0.2
1
Poor 7
2. Verifies doctor’s order
0.1
4
Poor 8.5
Universidad de Sta. IsabelHigher Education Department
College of Nursing
March 1, 2011
__________________________________________________________________
Dear _________________,
Greetings of Peace!
We, RLE group 8 of USI Level 4 BSN will be having our presentation of performance appraisal entitled “Student Nurses Performance on Setting Up Intravenous Infusion” on March 2, 2011 at the Seton Hall of Mother Seton Hospital. In connection with this, we would like to invite you to become one of the panelist of the said event.
Thank you and God Bless.
Sincerely yours,
Hazel Yvonne C. FerrerRLE group 8 Leader
Noted by:
Cecilia A. Hidalgo, RNModerating Clinical Instructor
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181. Do hand washing after the procedure
0.1
4
Poor 8.5
2. Place IV label on IVF bottle duly signed by the person who prepares it
0 Poor 10
Table 4 shows the outstanding problems with its weighted
mean, interpretation and ranking indicated.
The actual performance of student nurses in performing
hand washing before the procedure is identified as an outstanding
problem with a weighted mean of 0.21 and can be interpreted as
poor.
Results of the tally showed that washing of hands before
the procedure was occasionally done by the students for the
reason that the kind of setting requires immediate intervention to
be delivered so hand washing is not commonly done prior to
setting up an IV because it may cause delayed instead they just
used an cotton balls soaked in an alcohol.
Hand-washing is the most significant procedure in
preventing cross infection (Voss and Widmer, 1977). Organisms
present on the hands are either resident or transient. Transient
organisms are those that are not usually part of the skin flora. They
are acquired by contact with infected patients or infected
equipment. They can be easily removed by effective hand-washing
techniques. Our own normal resident skin flora consists of mainly
Staphylococcus epidermis and Staphylococcus aureus bacteria.
These are normally deeply ingrained into the epidermis and cannot
be totally removed by hand-washing (Church, 1986b), although
effective hand-washing can reduce the number significantly.
However, research continues to highlight that many health care
workers fail to wash their hands effectively (Pritchard, 1994).
The actual performance of student nurses in verifying
doctor’s order
with a weighted mean of 0.14 interpreted as poor. Concerning with
the verification of doctor’s order, the students were unable perform
this specific procedure because the staff nurse often delegate IV
preparation to the students, in return the students were not
verifying the doctor’s order to the chart itself.
Recently 10 Golden Rules for Administering Drugs Safely
(from Nursing 88 Vol. 18, August 1988) was presented and it is
identified as one way of providing safe and quality care. The 10R’s
includes the ff: (1) Administer the right drug, (2)Administer the
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right drug to the right patient, (3)Administer the right dose,
(4)Administer the right drug by the right route, (5)Administer the
right drug at the right time, (6)Document each drug you
administer, (7)Teach your patient about the drugs he is receiving,
(8)Take a complete patient drug history. (There is a risk of adverse
drug reactions when a number of drugs are taken or when patient
is taking alcohol drinks.), (9) Find out if the patient has any drug
allergies, (10)Be aware of potential drug – drug or drug – food
interactions. To protect your patient and your license, follow these
guidelines for avoiding medication errors.
The actual performance of student nurses in performing
hand washing after the procedure is identified as one of the
outstanding problem in setting up IV infusion with a weighted
mean of 0.21 and can be categorize as poor indicator of quality
care.
Assessment revealed that most of the students don’t
performed hand washing after the procedure; instead most of them
prefer using alcohol as an alternative to hand washing. Cleaning
hands promptly and thoroughly between patient contact and after
contact with blood, body fluids, secretions, excretions, equipment
and potentially contaminated surfaces is an important strategy for
preventing Healthcare - associated infections
Maintaining asepsis of key parts is achieved by preventing them
coming into contact with a significant amount of potentially
harmful organisms.
Universidad de Sta. IsabelHigher Education Department
College of Nursing
February 16, 2011
Ms. Ma. Claudette Tria, RN, ER - Supervisor
Dear Ma’am,
Greetings of joy!
We, RLE group 8 of BSN Level IV of Universidad de Sta. Isabel will be conducting a nursing audit entitled “Students Nurses Performance on Setting up of Intravenous Infusion”. This is in partial fulfillment of the requirements in NCM 106: Nursing Leadership and Management-Intensive Practicum.
In connection with this, we would like to ask permission for our group to conduct a performance observation of the student nurses on the identified indicators of quality of care in Emergency Room Department of the institution on February 21-23, 2011. On the respective days of observation 2 student nurses from our group will be assigned to observe on two shifts (7-3 and 3-11).
The data gathered will serve a great value in the enhancement of student nurses in the performance of the said procedure.
Hoping for your favorable response. Thank you very much!
APPENDIX C
11
16This is difficult, as the very tools we use to perform Aseptic non-
touch technique. (ANTT) are covered in bacteria - our hands. It has
been estimated there are as many as three million bacteria present
per square centimetre of normal skin (Gould, 1991).Pathogenic
bacteria, such as pseudomonas and klebsiella, can be harbored on
hands for months (Adams and Marrie, 1982). A worrying trend in
hospitals is the emergence of antibiotic-resistant organisms which
can survive on the hands of health care workers. Many, if not most,
hospital-acquired infections continue to be spread by direct contact
by the hands of health care workers (Bauer et al, 1990)
The actual performance of student nurses in placing of IV
label on the IVF bottle by the person who prepares the materials to
be used is identified as one of the outstanding problem in setting
up IV infusion with a weighted mean of 0 and can be categorize as
poor indicator of quality care because no one perform the above
procedure.
The Joint Commission’s National Patient Safety Goals is to
promote specific improvements in patient safety. One of the goals
of this organization is to improve the safety of using medication
and solution label that is supposed to be instilled to the patient and
this is through NSPG 03.04.01, which is to label all medications,
medication containers, and other solutions on and off the sterile
field in peri-operative and other procedural settings. The Rationale
to this is that medications or other solutions in unlabeled
containers are unidentifiable. Errors, sometimes tragic, have
resulted from medications and other solutions removed from their
original containers and placed into unlabeled containers. This
unsafe practice neglects basic principles of safe medication
management, yet it is routine in any organizations. The labeling of
all medications, medication containers, and other solutions is a
risk-reduction activity consistent with safe medication
management.
In every procedural settings both on and off the sterile field,
medication or solution labels include the following: medication
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name, strength, quantity, diluents and volume (if not apparent
from the container), expiration date when not used within 24 hours
expiration time when expiration occurs in less than 24 hours. Label
each medication or solution as soon as it is prepared, unless it is
immediately administered. Immediately discard any medication or
solution found unlabelled. Removed all labeled containers on the
sterile field and discard their contents at the conclusion of the
procedure. All medications and solutions both on and off the sterile
field and their labels are reviewed by entering and exiting staff
responsible for the management of medications.
Recommendation
Upon collation, tabulation, analysis and interpretation we
recommend a proposed student development program. See
appendix (F).
SPECIAL COMMENT
Verifying Consent to Care should be added to the given
criteria in every procedural setting, most especially in
administering IV infusion, so that the risk for malpractice is reduce
and / or to avoid liability in battery.
The Bristol Royal Infirmary Inquiry recommends that
consent is not just applicable to surgical procedures, but also to all
activities that involve 'touching', this includes many nursing
procedures such as assisting with washing and dressing of wound
or incision site, starting intravenous infusion and etc. (Gallagher,
2001)
ADDITIONAL RECOMMENDATIONS
We recommend that in every hand washing area in a
certain unit there should be a slogan which promotes proper
hand washing.
The student nurses should make IV label or medication card
of paper enough to be use as an IV label.
APPENDIX B
Acknowledgement
The audit committee would like to extend our innermost
gratitude to those persons who helped us in the conceptualization
of this performance appraisal.
To our moderating clinical instructors, Niño Jesus B.
Ballesteros and Cecilia A. Hidalgo for giving us concrete comments
and suggestions toward the formulation entire Nursing Audit.
To the Dean of the College of Nursing, Sr. Lourdes S.
Sabidong, DC, RN, MAN for her unconditional support to our
department.
To the Panelists who patiently shared their time and
scholarly advice during the presentation of our performance
appraisal.
To the Director of Nursing Affiliation, Training and
Continuing Education, Amer de Castro, RN, MAN and Supervisor of
Emergency Room, Maria Claudette C. Tria, RN, for approving and
accommodating us to conduct a performance observation in the
Emergency Room.
To Mr. Rodel L. Ortaňez, MA and Ms. Sheryll E. Belmoro for
sharing to us their expertise in statistical treatment and giving us
intelligent suggestions with regards to the interpretation which
help us out in the computation of the data collated.
To our Parents for their undying support and
encouragement that continually strengthen us to accomplish all
the tasks required in the fulfillment of our performance appraisal.
1415
To RLE group 8 for their efforts, suggestions and
cooperation in the completion of the performance appraisal
To Almighty God for giving us this opportunity to conduct
and share our findings in our performance appraisal to the
beneficiaries.
APPENDIX A
BIBLIOGRAPHY
BOOK
Potter, P. & Perry, A. FUNDAMENTALS OF NURSING 7th EDITION
Singapore: Elsevier PTE. LTD. 2009 p 995
Craven, R. & Hirnle, C. FUNDAMENTALS OF NURSING (Human
Health & Function) 5th Ed. Philadepia: Lippincott Williams & Wilkins.
2007
Fundamentals of Nursing: concepts, process and
procedure/Barbara Kozier – 7th edition p.388
Nursing Standards on Intravenous Practice 7th edition/ Association
of Nursing Service Administration of the Philippines, Inc. (ANSAP) p.
29
JOURNAL
Younger, G. & Khan, M. NURSING STANDARD Volume 40. United
Kingdom. June 11 – 17, 2008
American Journal of Nursing – July 2010 / Vol. 110, no.7 pp 66-67
Med-Surg Nursing – November / December 2010 – Vol19 / No. 6 pp.
315-316
Gallagher, A. & McHale, J., Nursing Times – 6 December, 2001 /
Volume 97 – Issue 49; page 32
WEBSITE
http://education-portal.com/emergency_room_nursing.html
http://www.parliament.uk/documents/post/postpn247.pdf
http://www.defenseofmedicine.com/2010/09/recent-study-highlights-the-
importance-of-informed-consent/
That in every procedure Consent to Care should be
stressed. This practice may safeguard every healthcare
provider from any liabilities.
That in every IV tray should include sharp receptacles in the
IV tray to avoid needle prick incidents.
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