Purpose: The purpose of this project was to standardize administration times and dilution amounts for all medications given intravenous push (IVP) across our health care system (HCS). This project was spearheaded by our hospital, which is one hospital in the HSC. The objectives were to: 1. Identify IVP drugs frequently given in our HCS. 2. Compare IVP dilution amounts and administration times across nursing drug references, published guidelines, and research studies. 3. Recommend dilution amounts and administration times for IVP drugs to standardize practice.
Description: Studies show some drugs that were once administered by intermittent intravenous infusion can be safely administered by IVP. Because there is no standardization of administration time and dilution amounts among nurses giving IVP medications in our HCS, patients receiving IVP medications complained about practice variations between nurses. There are no standardized national recommendations about dilution amounts or administration times for several drugs given IVP across our system. Our hospital clinical practice council requested that the research, evidence-based practice, and innovation council (RINK) review published data and recommend dilution amounts and administration times for all drugs given IVP in the HSC.
We began the process by asking nurses at all HSC hospitals for a list of medications they were giving IVP. Once we had compiled an exhaustive list, we identified references for review. Nursing drug books, published guideline, and research articles were reviewed, including: Lexicomp; PDR Online; Lippincott, Jones & Bartlett and Davis drug references, Gahart's 2020 Intravenous Medications Handbook, Facts and Comparisons, the Institute for Safe Medication Practices, and research article recommendations. Two RINK nurses separately reviewed and documented information from each reference. We then entered that data into an Excel spreadsheet. Then the entire research team reviewed results and reached consensus about our recommendation for the dilution amount and administration time for each drug. At this point, we sent the spreadsheet to the clinical pharmacy director at our hospital. She forwarded the spreadsheet to clinical pharmacists in other HSC hospitals, who edited it using information from pharmacy drug references. Once the review by pharmacists was completed, the list of standardized dilution amounts and administration times was then taken through all necessary HSC committees for approval. The list was approved in April 2022.
Evaluation/outcomes: Front-line nurses rely on personal and hospital-supplied drug references if they need information about dilution amounts or administration times for IVP drugs. Both the clinical nurse researchers and clinical pharmacists were surprised and concerned by the variations seen in drug references frequently used by all frontline staff. We were also concerned by differences in drugs given IVP between system hospitals. Standardized IVP drug dilution amounts and administration times are currently being incorporated into the medication administration record in the electronic medical record. An electronic format for use on an IPAD/smart phone and a hardcopy in the form of a booklet are also in development. Standardization of IVP medication dilution amounts and administration times will improve nursing medication practices and should decrease patients’ concerns about variation in IVP medication administration.
Evidence-based references 1. 2020 Nursing Drug Handbook, 19th ed., Jones and Bartlett. 2. Gahart, B.L., Nazareno, A.R., & Ortega, M.Q. (2020). Gahart’s 2020 Intravenous Medications A Handbook for Nurses and Health Professionals. 36th ed. Elsevier. 3. Hertig, J.B., Degnan, D.D., Scott, C.R., Jenz, J.R., Ki, X., & Anderson, C.M. (2018). A comparison of error rates between intravenous push methods: A prospective, multisite, observational study. Journal of Patient Safety, 14(1), 6065. 4. Lippincott (2020). Nursing 2020 Drug Handbook, 40th ed. Wolters Kluwer. 5. PDR (2020). PDR Prescribers’ Digital Reference. http://www.pdr.net 6. Skidemore-Roth, L. (2020). Mosby’s 2020 Nursing Drug Reference, Mosby. 7. Vallerand, A.H. & Sanoski, C.A. (2020). Davis Drug Guide for Nurses. 17th ed. F. A. Davis. 8. Wicker, E., & Sheridan, D.J. (2021). Diluting I.V. push medications: Risky business. Nursing 2021, August 9. doi:10.1097/01.NURSE.0000754032.48938.77. 9. Wolters Kluwer (2020). Facts and Comparisons. https://wolterskluwer.com 10. Wolters Kluwer (2020). Lexicomp: Evidence-Based Drug Solutions. https://wolterskluwer.com