QUALITY ASSURANCE IN IV THERAPY

Malena Joy F. Villanueva, RN Nursing Educator Aqiq General Hospital

WHAT IS QUALITY?
The quality of technical care consists in the application of medical science and technology in a way that maximizes its benefits to health without correspondingly increasing its risks. The degree of quality is, therefore, the extent to which the care provided is expected to achieve the most favorable balance of risks and benefits. Avedis Donabedian, M.D., 1980

The most comprehensive and perhaps the simplest definition of quality is that used by advocates of total quality management:

Doing the right thing right, right away.

What is Quality Assurance ?

Set of activities that are carried out to set standards and to monitor and improve performance so that the care provided is effective and safe as possible.

QUALITY ASSURANCE
formal methodology designed to assess the quality of products or services provided. includes formal review of care, problem identification, corrective actions to remedy any deficiencies and evaluation of actions taken. implies that necessary precautions have been taken so that the entire production of a product or service is within specifications under a wide conditions of operation.

Purpose of Setting Standards in IV Therapy

Improvement of patient care, to lessen mortality & morbidity. Provide guidelines for quality assurance. Inform & educate staff about current best evidence and practice. Risks needs to be identified & managed to reduce risks associated with IV therapy

Recommended Standards
Education of IV therapy personnel Policies to guide individuals who administer IV therapy. Problem areas in practices & procedures for IV therapy. Equipment & supplies

Why Set Policies?

Ensures the maintenance of skills, decrease of infections. Addresses any limitations related to professional accountability. Assure product utilization thru the use of an IV team.

IV Therapy Today
It is integral part of nurses professional practice Adheres concept to patient centred care

Encourage patient partnership Emphasis on education & training, standardisation and adherence to local and national guidelines and policies In - cooperate robust monitoring and reporting system to improve current practice
9

Education & Training

Legal, professional and ethical issues Local and national IV therapy guidelines and policies Anatomy and physiology of the vascular system Mathematical calculation related to medication administration Infection Control Measures Pharmacology related to reconstitution & administration

(Continued ) 10

Education & Training

Patient assessment, planning and implementation of care Drug & blood administration Fluid Balance & Documentation Use, care and management of IV therapy site and devices Local and systemic complications of IV therapy & its management Patient and staff risk assessment and management

IV Therapy Training for paediatric nurses

Aim - to enable nurses to gain an understanding of the theoretical and practical principles of IV therapy for children. 1 study day Distance learning package IV competency document

Annual Update
Not mandatory in all NHS trust at the moment. However the nurses must ensure: - they maintain their own IV
administration competency - they understand their responsibilities as defined in the Standards for Medicine Management - only use medical devices that they have been trained to use (NMC 2008)

Patients & Caregivers Education

Vascular access device Prescribed IV Therapy Plan of Care Infection control measures Signs & symptoms, and management of potential complications

Vital principles of IV Therapy

Infection Control
Sterile products Aseptic technique Closed IV administration system Effective decontamination of injections hubs and connections Universal Precautions

Cleaning & sterilising

Use disposable equipment Disinfect reusable equipments Single use devices must not be reused

IV administration devices
Syringes Giving sets Add-on extensions Connectors and bungs Syringe & Volumetric Pumps

Reconstitution
Avoid where possible Determine safety Determine own knowledge Use dedicated drug dilution area Use aseptic technique Label clearly and accurately NEVER RELY ON COLOUR / PACKAGING

19

Accessing IV site
Avoid where possible Decontaminate assess point Check patency of the cannula Flush line with 0.9% Saline before, between drugs and on completion Maintain patency of cannula

20

Device Stabilisation
Material used should not:
- hinder assessment of insertion site or extremity - impede circulation or infusion

Dressings protocol

changed

per

local

A catheter that has migrated externally should not be readvanced

Device Stabilisation

22

Sharps Management

23

Documentation
IV site Type of IV cannula Date Drug / diluent / IV site and port details Method and Rate of administration Effects / side effects / complications / actions taken or not taken
24

25

26

27

28

29

Incident Reporting System

All incidents and near misses must be: - reported - graded - investigated - analysed - actioned to prevent similar reoccurrence - monitored & evaluated
30

Audit
Ongoing process to monitor, maintain and improve clinical practice Identified deficiencies documented & evaluated. Action plan to improve deficiencies formulated, implemented, monitored and evaluated.

Evaluation will include a: Mechanism for recording, reviewing and acting on adverse peripheral intravenous cannulation incidents. System for maintaining practitioner competence. Method for identifying

further

training needs.

On going challenges
Maintaining the basic Surveillance & eradication complications at early stage of

Maintenance of good infection control practice Enhancing the safety features of the current IV administration systems Conducting regular audit & training.

33

Summary
In summary IV therapy has come a long way since 1492, patients today receive better care. Ongoing challenges exist these are being looked into by health care providers, higher education institutes and department of health.
34

35

THANK YOU

Reference
Daugherty L (2008) Back to basics in IV therapy: an unfortunate necessity. BJN. 17(19):S Department of Health (2007) Saving Lives:Reducing Infection, Delivering Clean and Safe Care. High Impact Intervention No2: Peripheral Intravenous Care Bundle. DoH: London Millam D (1996) The history of intravenous therapy. Journal of Intravenous Nursing. 9(1):5-14. National Patient Safety Agency (2007) Promoting Safer Use of Injectable Medicines. NPSA. London. Royal College of Nursing (2008) Standards for Infusion Therapy.RCN:London
37