30/01/2013 Objectives 1. Identify the process for Nursing and Midwifery Staff to attain Canterbury and West Coast Level 1 IV Certification 2. Show awareness of the key responsibilities of administration of IV therapy 3. Identify the eight key complications of IV therapy administration 4. Identify the timeframe that IV equipment can be safely utilised 5. Describe how risk is minimised in the administration of IV therapy 6. Identify the actions to take following an anaphylaxic reaction 7. Describe how risk is minimised in the administration of blood and blood products 8. Describe the process of blood product administration 9. Identify actions to take when an adverse blood reaction occurs Level 1 IV Therapy Canterbury and the West Coast Your Logo Policies To gain your Canterbury/West Coast http://www.cdhb.govt.nz/cdhbpolicies Level 1 IV Certificate Volume 12 Handouts Assessment The Volume 12 tHandouts for the IV Standards are 1 1 2 3 1. Attend Mandatory IV Lecture Fluid and level 1 IV based on and set medication competency can by the Infusing 2. Complete all theory and practical sections of the manual can be be located on the Nursing New located on the CDHB Zealand Canterbury and West Coast IV Assessment CDHB internet Professional Incorporated page Development Society. 3. Understand the action and reaction of the Website in the IV medication that you are administering Section 4. You agree to accept the responsibility for the http://www.ivnnz.co.nz administration of the prescribed intravenous therapy. http://www.cdhb.govt.nz/pdu Your Level 1 IV Competency is a pre-requisite for attaining the following competencies To gain your Canterbury/West Coast Level 1 IV Competency Level 2 IV allows a staff member to care for and access the following IV devices – PICC , Level 2 Hickman and Central Venous lines. Also an Assessments IV Competency additional portacath Competency can be attained if required for your area – Clinical calculations Assessment (100%) – Theory Assessment/s based on Volume 12 (85%) Venepuncture, allows a staff member to obtain Venepuncture – IV Practical Checklist (100%) blood from a peripheral blood vessel. It is expected that all Registered Nurses, Midwives and new EN Scope attain their level 1 IV The Peripheral IV Cannulation competency Competency (unless exempted by workplace eg. Mental Health) IV Peripheral allows the staff member to place a peripheral Cannulation cannula in a blood vessel No recertification is required, instead regular clinical audits occur. Recertification is only required if away from the organisation for over 12 Months Further information on these competencies is available on the PDU Website www.cdhb.govt.nz/pdu 1
30/01/2013 Key Policies Transportability IV Competencies are recognised by the following All CDHB and WCDHB St Georges Hospital Hospitals Pegasus Group and the Southern Cross Hospital Rural Canterbury PHO Oxford Clinic Nurse Maude Double Independent Checking Role of the Double Independent Checker • The Double Independent Checker is just as legally Double Independent Checking is the key step in the accountable as the person administering the drug medication safety process • They must be present for ALL stages: • Both staff interpret the prescription independently � Preparation and drawing up • Both staff perform calculations independently � Administration • Both Staff perform the patient identification checks at the � Bedside checks patients bedside � Documentation • Both staff are present through all stages of preparation, drawing up and administration of the medication. Includes TWO staff to the bedside CDHB (2012) Fluid and Medication Checking Procedure Medications that require Double Independent Transitioned Enrolled Nurses Checking � Any Controlled Drug/Infusion Need to Gain the following competencies � Any Blood or Blood Products � Warfarin and Oral Cytotoxic’s 1. Independent Medication Administration AND Competency. This will enable an enrolled Nurse Any fluid/medication administered by the below routes to independently administer oral medications, and � Intra muscular undertake independent double checking � Intra dermal � Subcutaneous responsibilities. This is attained by completing the � Intravenous clinical calculations and theory components of the � Intrapleural level 1 IV therapy competency. � Intrathecal � Epidural route Please Note: Exceptions only where local policy stipulates - e.g. rural , specialist mental health. For Child Health and Neonatal Policy please refer to Volume Q 2
30/01/2013 Transitioned Enrolled Nurses Enrolled Nurses who have not transitioned – and/or do not hold their competencies 2. Level 1 IV Competency (EN Scope) � Must check all Medications and Fluids with their designated Registered Nurse Once a transitioned Enrolled Nurse has completed their Level 1 IV Competency they can; � May clamp tubing or turn off a pump if an infusion – Enrolled Nurses can double independent check with another has completed Enrolled Nurse who has also completed their independent medication administration competency when their designated � Monitor whether an IV infusion is running to time registered health professional is not available � Perform hourly patient checks when an IV infusion – May Administer IV Saline Flushes as per local policy – May Administer IV fluids (without additives or Potassium) is in progress – May Administer IV or SC Premixed bags i.e. N/Saline 0.9% or � Maintain the patient fluid balance record Dextrose 4% in N/saline 0.18% premixed bags which are running 8- 12 hourly (Adults only) Verbal Telephone Orders Verbal Orders in an Emergency Situation � The verbal order is given by the Medical Officer • Can be initiated by Registered Nurses and Midwives � The verbal order is repeated to the medical officer by the nurse • For ‘Urgent’ clinical situations when the prescriber is receiving the order and also provides a running total of the unavailable to come to the clinical area amount of drug the patient has already received • Recorded in Red on the prescription chart � The Medication is then drawn up by the nurse who received the • Repeated by prescriber to second checker (RN/RM/EN but order not student nurse) � The Verbal order is repeated by the nurse as the medication is • One verbal order for a class A or B drug is acceptable if a handed to the Medical Officer, and the ampoule is second pre-existing order for that drug is present checked by the Medical Officer. • Exceptions e.g epidural boluses, blood, paediatrics, � The order is documented, and then signed by the Medical significant renal disease or abortion inducing medications Officer at the conclusion of the Emergency Situation. Complications of IV Therapy Complications of IV Therapy • Hypersensitivity/Allergy 1. Hypersensivity 1. Hypersensivity 2. Infiltration 2. Infiltration 3. Extravasation 3. Extravasation 4. Phlebitis 4. Phlebitis • Infiltration - Infiltration occurs when I.V. fluid leaks into 5. Infection 5. Infection 6. Fluid Overload 6. Fluid Overload surrounding tissue 7. Air Embolism 7. Air Embolism 8. Anaphylaxis 8. Anaphylaxis Nursing Made Incredibly Easy! (2008) I.V. Essentials: Complications of peripheral I.V. therapy, 6(1). pp 14-17 Intravenous Infusions and Related Tasks [retrieved 23/11/11 from http://nursing411.org/Courses/MD0553_Intravenous_Infusions/1-08_Intravenous_Infusions.html 3
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