Quality Assurance in IV Therapy

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 to patient centred care concept

• 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

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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

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(Continued)

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

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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

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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

Device Stabilisation

• Material used should not:

- hinder assessment of insertion site or extremity

- impede circulation or infusion

• Dressings changed per local protocol

• A catheter that has migrated externally should not be re-advanced

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Device Stabilisation

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Sharps Management

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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

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Incident Reporting System

• All incidents and near misses must be:

- reported

- graded

- investigated

- analysed

- actioned to prevent similar reoccurrence

- monitored & evaluated

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.

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On going challenges • Maintaining the basic

• Surveillance & eradication of complications at early stage

• Maintenance of good infection control practice

• Enhancing the safety features of the current IV administration systems

• Conducting regular audit & training.

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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.

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THANK YOU

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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