Nursing Audit

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

ii

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

2627

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

1

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.)

24

25

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


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

4

22

23

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.


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

5


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


0.9

2

Excellent 2


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)

6

21

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


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


0 Poor 10


0.5 Fair 5

7. Close the roller clamp and spike the container

0.92 Excellent 3

7

20

aseptically8. Fill drip chamber to at

least half and prime the tubing aseptically

1 Excellent 1


0.85 Excellent 4


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




n

R

anking


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

8

19

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



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

9


0.1

4

Poor 8.5


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

10 17

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

12

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.

http://www.defenseofmedicine.com/2010/09/recent-study-highlights-the-importance-of-informed-consent/

http://www.defenseofmedicine.com/2010/09/recent-study-highlights-the-importance-of-informed-consent/

http://www.parliament.uk/documents/post/postpn247.pdf

http://education-portal.com/emergency_room_nursing.html

13

Nursing Audit

Documents

weighted mean

fornoles indicators

iv solution

iv tubing

iv label

iv tray

florin joaisa

gabiola errol