By Loretta K Dorn RN MSN CRNI , Director Clinical Liaisons Fresenius Kabi USA
Intravenous (IV) therapy is one of the most common practices performed by nurses with 90% of patients receiving some form of Intravenous (IV) medication. Adverse events can occur in any phase of the IV push administration process. IV Push medications can be particularly dangerous given the immediate bioavailability and the narrow therapeutic dose range and the difficulty in reversing systemic effects after IV administration (ISMP, 2015).The use of evidence-based practice is especially important in IVP administration because of the potential for harm. The practice of IV Push administration should be based on evidence-based practice and not in ritual or tradition or how the individual nurse has always practiced. (White-Wiliams, et al., 2013).The implementation or translation of Evidenced-Based practice to bedside nursing remains a gap even in Magnet® designated hospitals (Lavenberg, et al., 2019).
Many studies have demonstrated that nurses tend to get practice and standards information from colleagues. Nursing students in transition to practice obtain information from preceptors.
The information passed on to collaborating nurses are often based on previous practices, clinical assumption, personal experiences and opinions, and the nurse’s individual skills. (Rahmayanti, Kadar, & Saleh, 2020).
The lack of standardization for IV Push medication administration has led the Institute for Safe Medication Practicesto create a list of Adult IVP Practice Guidelines. In addition, the Infusion Nurses Society (INS) has just published the updated 2021Infusion Therapy Standards of Practice which incorporated many of the ISMP Guidelines for Adult IV Push Medications.
The standards address IV push presentation, preparation, and administration. The guidelines provide information to mitigate the potential for harm associated with Adult IV push administration. The ISMP guidelines inform nurses and other healthcare professionals on the use of ready-to-administer forms and state that to the greatest extent possible, provide adult IV push medications in a ready-to-administer form (ISMP, 2015). The INS Infusion Therapy Standards of Practice state, to administer solutions and medications prepared and dispensed from the pharmacy or in a commercially prepared solution, and medications whenever possible (Gorski, et al., 2021 S 180). INS practice also recommends using commercially available prefilled syringes to reduce the risk of Catheter Associated Blood Stream Infections (CABSI) save time for syringe preparation and aid optimal flushing technique and objectives (Gorski, et al., 2021 S113).
In this study the researchers showed that the overall observed error rate for ready-to-administer products was 2.5%, and the overall observed error rate for IV push traditional practice was 10.4% (Hertig, et al., 2017)
The ISMP standards also note that IV push medications should not be withdrawn from a commercially available, cartridge -type syringe into another syringe for administration. IV push medications should not be diluted unless recommended by the manufacturer, supported by evidence in peer-reviewed journals or per institutional policies. All IV Push medications must be labeled unless it is prepared at the patient’s bedside and immediately administered (ISMP, 2015). Make sure to flush before IV medication administration with a 10 mL flush syringe to assess the line for patency and to eliminate drug incompatibility, then use a syringe appropriately sized for the medication being injected (Gorski, et al., 2021) After administration, flush the catheter using a 10 mL flush syringe at the same rate of administration of the (ISMP, 2015).
It is especially important that nurses use best practices during IV push medication administration.
Some institutions have added IV push medication administration to the annual skills day as a constant reminder of best practices in a process that can have a high potential for harm. It is up to each nurse to understand and practice with the most updated standards and take part in the practice committees to influence the use of evidence-based best practices.
Gorski, L., Hadaway, L., Hagle, M., Broadhurst, D., Clare, S., Kleidon, T., . . . Alexander, M. (2021). Infusion Therapy Standards of Practice. Journal of Infusion Nursing, 8th edition .
Hertig, J. B., D. D., Scott, C. R., Lenz, J. R., Li, X., & Anderson, C. M. (2017, March). A Comparison of Error Rates Between Intravenous Push Methods: A Prospective, Multisite, Observational Study. Patient Safety, 60-65. doi:10.1097/PTS.0000000000000419
ISMP. (2015). ISMP safe Practice Guidelines for Adult IV Push Medications. Retrieved from Institute for Safe Mediction Practices: https://www.ismp.org/sites/default/files/attachments/2017-11/ISMP97-Guidelines-071415-3.%20FINAL.pdf
Lavenberg, J., Cacchione, P., Jayakumar, K., Leas, B., Mitchell, M., Mull, N., & Umscheid, C. (2019, Feb). Impact of hospital evidence-based practice center( EPC) on nursing policy and practice. Worldviews on Evidence-Based Nursing, 4-11. doi:10.1111/wvn.12346
Rahmayanti, E. I., Kadar, K., & Saleh, A. (2020, May). Readiness, barriers, and potential strength of nursing in implmenting evidence-based practice. International Jounral of Caring Sciences, 13, 1203-1211. doi:10.1111/wvn.12149
White-Wiliams, C., Patrician, P., Fazeli, P., Degges, m. A., Graham, S., Andison, M., . . . McCaleb, K. A. (2013, April). Use, knowledge, and attitudes toward eveidence-based practice among nursing staff. The Journal of Contiunning Education in Nursing, 246-254. doi:10.3928/00220124-20130402-38