Post on 30-May-2018
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Advances InfusionTechnologyVS
Excellent Nursing Practice
Pongpak Pittayapan. R.N, DNSc.Cert.in IV Therapy and Oncology Nursing. UK.
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Equipments
Solution containerMaterialSizes
Types of containers
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Clinical Considerations1. Wash hands before opening or spiking
solution containers2. Inspect bags and bottles before use for
cracks , leaks , damaged
ports or seals , expiration date , clarity ,discoloration , turbidity , andparticulate matter ; discard if problemsfound
3. Label bags and bottles with date andtime the solution container was opened
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Clinical Considerations5. Change solution containers in accordance with the
Infusion Nursing Standards of Practice (Intravenous Nurses Society [INS ], 2000),particularly if a closed system is not maintained ,to prevent the potential growth of
microorganisms that might have entered thesystem6. Discard solution containers removed from the
intravenous system ; do not save for later use
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Administration setTypesDrop factorConstruction
Internal administration set diameterClampsInjection /access ports
Considerations When Using Administration Sets
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Considerations When UsingAdministration Sets1. Assess product and package integrity before use ; do not use
if violated2. Assess patient for latex sensitive ; some administration sets
contain parts with latex3. Determine appropriateness of administration set based on
medication /solution to be administereda . Certain medications , such as Taxol , must be given through
administration sets not made of polyvinyl chloride (PVC )b . Administration sets used to administer other medications
such as propofol should be replaced every 6 to 12 hours oraccording to manufactures recommendations
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4. Change peripheral and central primary and secondary
administration sets in accordance with the Infusion Nursingstandards of practice (INS , 2000) and organizational policiesand procedures
5. Change administration sets at the time of the peripheralcatheter change or when a new solution container is initiated
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6. Discard administration sets used to administer lipid emulsions
after each unit unless additional units are administeredconsecutively and immediately if contamination is suspectedor product integrity is compromised ; change sets used toadminister consecutive units every 24 hours
7. Change administration sets used to administer blood andblood products after each unit or at the end of 4 hours ,whichever comes first , and immediately if contamination issuspected or product integrity is compromised
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Add-On and Junction Securement deviceExtension SetsStopcocksConnectors
Securement DevicesInjection /Access PortsSolid Caps
Vented Spike AdaptersTransducers and Domes
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FiltersFeaturesTypesStructural Configuration
Surface AreaPressure LimitationsIndications for Use
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Flow-control devicesElectronic Infusion DevicesMechanical Infusion DevicesImplanted Pumps
Mechanisms of DeliveryIndication for UseFeatures
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Selection of devicea . safety features : prime consideration
1) Automatic anti -free flow is essential (when door is openor administration set is removed , fluid flow is stoppedby a mechanical clump usually initiated at the time thedoor is opened )
2) Guardrails that set dosage limits for the administrationof medication can prevent serious medication errors atthe bedside
3) Audible alarms4) Appropriate grounding to prevent electrical hazards
and interference from other electrical equipment5) Features to minimize tampering6) Delivery rate within 3% to 5% accuracy
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Risk Factors
Human ErrorRelated with using medicineRelated with using infusion pump
Infusion devices/ Infusion pumpGeneral pumpPatient-controlled analgesia (PCA)
(Medical centers Safe Medication Administration Committee)
Pongpak Pittayapan Pongpak Pittayapan
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Med Errs and FactorassociatedA significant percentage of medical errors are
medication-relatedthese errors account for 1 of 131 outpatientand 1 of 854 inpatient deaths
include prescription and pharmacy-dispensingerrorsunintentional noncompliance with medicationinstructionsinfusion device account for up to 35 % of allmedication error
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Technology to reduce thepotential for error
Computerized prescribe order enter( CPOE)Chemotherapy -specific software
programsComputerized nursing documentationsystems with links to pharmacologyreferences
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personal data assistantsrobots in pharmacies
bar codingFDA Bar Code Label Requirements forHuman Drug Products and biological
Products
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estimate will reduce the risk that apatient will receive the wrongmedication or wrong dose or that wrongpatient will receive a medication (FDA,2004 a )FDA estimate Bar code rule will reduce
50 % reduction in medication error or500,000 med ass-adverse events
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R & Din Technology to reduce errorCPOE reduces medication errors andadverse drug event in general medicine(Bates et al., 1998, 1999; Raschke et al.,
1998)
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Multicenter study of 3,481 COPEPhysicians overload 91.2 % of drug allergy
89.4 % of high severity of drug interactionDespite the use of an automateprescribing system, a patient received acisplatin dose of 760 mg instead of 190mg, cause
severe pancytopeniaRenal failure hemodialysis
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P Patient S Safety S Standards E Eevidence-based recommendations
1.Improve the accuracy
of patientidentification
1.1use at least 2 patientidentifiers whengiving medications .Neither identifiermay be the patient 'sroom number .
1.2Proper identifiersare the patient 'sname, telephonenumber , and date of
birth .
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RecommendHCP should develop a standard patientidentification policy for use in theirinstitution and consistently adhere to it
(Parisi, 2003)
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Measure height and weightin centimeters and kilograms
Strategie 2
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Have good light, employmagnification, and use high-
visibility tools such ascalculators with large-
number buttons and largelighted data display area
Strategie 3
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Ageing VS Nurses Rolein ChemotherapyAging process decreasethe amount of lightentering the eyeDecrease visual acuityand the ability to discernlight or dark contrastand color intensity
The nurses role inchemotherapyadministration is visuallydemanding, and goodlighting is needed to
review ordersRead vial or drug labelsPrepare medications
Enter information intocomputer
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Organize the work andworkspace for safety andefficiency
Strategie 4
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IOM reportKeeping Patients Safe: Transforming thework environment of nurse
Outlined a blueprint of safety promotionactions that include designing the workplacewith both nurses and patient in mindUsing competent and capable nurse to providepatient care, and creating & sustaining anorganizational culture of safety.
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Oncology NursingTransforming LeadershipExamining the workload and work flow tomake patient scheduling or nurse staffingadjustments
Using strategies or resources to maximizetime efficiencyGroup chemotherapy education classes
Instructional videotapes or computerizedprograms)
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Providing comprehensive new staff orientationand trainingFostering an atmosphere where safety is thenumber-one goal
Oncology NursingTransforming Leadership
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Eliminate the use ofabbreviations and acronyms
in all clinical documentation
Strategie 6
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P Patient S Safety S Standards E Eevidence-based recommendations
2. Improve the
effectiveness ofcommunication amongcaregivers.
2.2 Also, organizationsmust use astandardized set ofabbreviations,acronyms, andsymbols throughoutthe organization, andmust also identify
those abbreviationsthat will not be used.
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Provide and use up-to-date,easily accessible information
at the point of care
Strategie 7
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Follow the 80/20 rule
Strategies 8
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The principle of 80/20 rule(Reh,2002)
The 80/20 rule origin in economicsThe principle
20 % of something is responsible for 80 % of
the resultUsing this principle in product or deviceevaluations for instance
A small number of defects (e.g., 20%) willcause the majority (e.g.,80%) of problem
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Reduce the potential forhuman error
Strategies 9
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Include the stakeholder withthe most to lose-thepatient-in chemotherapyerror prevention efforts.
Strategies 10
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Partnering with patients to preventchemotherapy errorsVerifying chemotherapyWriting instructions and reiteratechemotherapy teachingCreate a process to ensure that all patientsare given information about their
chemotherapy treatmentsOngoing reinforcement of information may behaphazard
Strategies 10
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Near-miss chemotherapy errors havebeen caught by patients when theyobserve something out of the ordinary
A larger than usual infusion bagChemotherapy drug of a difference color thanthose previously receive
Encouraged pt to speak up
Strategies 10
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Prevention and Reporting ofMedical Errors (ONS)
1) published a peer education newsletter analyzing researchrelated to medication errors,2) developed and circulated a poster on medication errors thatincluded a post-test for staff to complete,3) participated in an institution wide symposium focusing on thefundamentals of dealing with medical errors,4) utilized ONS educational activities and offerings addressingmedication errors, and5) confirmed that all medication-related policies and standardsof practice are current with research findings
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The post-test results will be used as onemechanism for evaluation of theprogram. Ongoing evaluation, critical toinsuring sustained improvement, isdiscussed using a standardizedperformance improvement model
(FOCUS-PDCA)
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