Download PRACTICE ON INTRAVENOUS DRUG PREPARATION AND

PRACTICE ON INTRAVENOUS DRUG PREPARATION AND
ADMINISTRATION AMONG STAFF NURSES
M.Sc. Nursing Dissertation protocol submitted to
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
BY:
Ms. JANET JOY
M. Sc. NURSING 1ST YEAR
YEAR: 2012-2014
UNDER THE GUIDANCE OF:
MR. YOGEENDRA PRABHU
LECTURER, DEPARTMENT of MEDICAL SURGICAL NURSING
M S RAMAIAH INSTITUTE OF NURSING EDUCATION AND
RESEARCH,
M. S. RAMAIAH NAGAR, BANGALORE-56005
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
1
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
SYNOPSIS PERFORMA FOR REGISTRATION OF SUBJECT
FOR DISSERTATION
1
NAME OF THE
Ms. JANET JOY
CANDIDATE AND
D/O MR. V.A JOY
ADDRESS
VATTAKERIL (H),
THALAYOLAPARUMBU (P.O)
KOTTAYAM (DIST)
KERALA PIN: 686605
2
NAME OF THE
M.S.RAMAIAH
INSTITUTE
INSTITUTION
EDUCATION AND RESEARCH
OF
NURSING
M.S.R.I.T POST, BANGALORE-54
3
COURSE OF STUDY AND
M.Sc. NURSING
SUBJECT
MEDICAL AND SURGICAL NURSING
DISSERTATION PROTOCOL
4
DATE OF ADMISSION TO
27/06/2012
THE COURSE
5
TITLE OF THE STUDY:
PRACTICE
ON
INTRAVENOUS
DRUG
ADMINISTRATION AMONG STAFF NURSES
2
PREPARATION
AND
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
Patient safety is one of the main objectives for all health care systems and it is a key step
in ensuring a good quality of care. There are many health care processes to be analyzed in
order to improve patient safety, but medication management should be highlighted
because of its complexity and many steps involved from prescription to administration.
Administration of medicine is one of the greatest responsibilities of a nurse1.
A medication is a substance used in the diagnosis, treatment, cure, relief or prevention of
health alterations. Too much of a medicine may cause severe unwanted effects 2.
Dosage forms are the means by which drug molecules are delivered to sites of action
within the body. The different forms in which drugs may be supplied to a patient
are Implants, Insufflations, Irrigation Solutions, Linctus, Liniments, Lotions, Lozenges,
Mixtures, Mouthwashes, Oral Emulsions, Oral Liquids, Paints, Parenteral Preparations
(Injectable Preparations), Pastes, Pills, Tablets, Poultices, and Powders 3.
There are five distinct methods for taking a medicine or drug. These methods are: topical
administration, inhalation, oral administration, parenteral, and rectal administration.
There are three ways of parenteral administration: intravenous (drug injected into a blood
vessel), intramuscular (drug injected into a muscle), and subcutaneous (drug injected
beneath the skin). There are a variety of reasons for using each of these methods, such as
how quickly a drug’s effect is required or where a physician may want the drug to act
(localized) 4.
3
Intravenous drug therapy is the term used to describe the administration of drugs directly
into the blood stream in order to achieve rapid and predictable serum levels (Campbell
1996)5.
Before intravenous drug preparation and administration, the patient is placed in a
comfortable position, the procedure is explained, and the patient is told the name of the
drug to be administered. The patient also should be instructed to alert the health care
professional immediately if he/she has unusual feelings or discomfort after medication
administration. The patency of the I.V. line is checked to ensure that the line is intact and
not leaking. The physician's order is reviewed and the five rights of medication
administration are checked. The label on the medication is checked to be sure that it is not
out-dated6.
The I.V. administration guidelines for the specific drug are reviewed, and the health care
professional verifies that the drug is approved for I.V. administration according to the
policies of the medical setting. After washing his/her hands, the health care professional
calculates and prepares the drug according to drug administration guidelines. Drugs
should be prepared immediately before use and not prepared and stored for future use.
(Dougherty 2002, NMC 2006)6.
Some I.V. push medications must be diluted (reconstitution) before injection. The health
care professional must check the directions for giving the specific drug intravenously
before performing the injection. Calculation of dosage is done for preparing the drug.
Any necessary equipment is assembled and ready access to emergency response
equipment (such as contained in a crash cart) is verified6.
4
The steps included for withdrawing of drugs from vial and ampoules include
Rubber-capped vials:

Wash the hands and put on a clean apron.

Check that both drug and diluent packaging are intact and are to be used prior to their
expiry date.

Check the drug and diluent against the prescription.

Break the seal on the container of the diluent.

Using a syringe and needle (or a withdrawing needle) aspirate the required volume.

Remove the plastic covering cap from the drug vial.

If required, clean the rubber cap with an alcohol wipe. The effectiveness of this procedure
is debatable but if it is carried out it is essential that the alcohol has evaporated before any
needles are inserted.

Insert a venting needle into the rubber cap.

Insert the diluent syringe into the vial, via the rubber cap at a 45 degree angle, with
needle bevel uppermost.

Changing the angle to 90 degree as the needle pushes through is considered to minimise
coring, in which rubber is forced into the lumen of the needle with the resultant risk that
it may then be injected into the patient (Dougherty and Lister, 2004).

Inject the diluent, ensuring that it does not rise above the tip of the venting needle.

Remove the diluent syringe and needle. The venting needle can be covered with an
alcohol wipe.
5

Agitate the vial to reconstitute the drug, taking care to avoid any spillage from the
venting needle.

Inspect the drug to ensure it has taken on the characteristics outlined in the manufacturer's
instructions. Also ensure that there is no particulate contamination.

Insert the syringe and withdraw the required amount of the drug, tilting the vial to one
side if necessary.

Expel any air from the syringe either into the vial (by inverting the vial) or into a
sheathed needle 6.
The procedure for glass ampoules is similar to that for rubber-capped vials with the
following considerations:

Tap the top of the ampoule to allow any trapped drug to drain into the bottom.

Cover the top of the ampoule with gauze.

Snap the top using a dot marker as a guide if appropriate. Some ampoules may require the
application of a file to snap the neck, although the dot marker has minimised this.

Carefully inspect the drug in order to check for glass and particulate contamination6.
Intravenous push medication techniques deliver a bolus (a dose of medication injected all
at once intravenously) of medication directly into a vein or access port to produce an
immediate peak drug level in the patient's bloodstream. Large quantities of fluid
intravenous push can cause severe complications; follow the recommendations of the
drug administration guidelines. To deliver an intravenous bolus medication, draw the
appropriate amount of medication that has been prepared, diluted, and/or reconstituted
according to intravenous drug administration guidelines into a syringe.
6
A bolus injection is most often given through a peripheral intravenous line, a saline lock,
directly into a vein, or through a vascular access port6.
When giving an I.V. bolus medication through a peripheral line with compatible fluid, the
health care professional must shut off the I.V. line using the control clamp. The Y-port
closest to the insertion site is cleaned with an alcohol or povidone-iodine pad to prevent
bacterial contamination. The health care professional must then connect the medication
needle or needle-less system connector to the port. The medication is injected over the
period of time ordered, after which the syringe is disconnected and removed6.
The intravenous line is reopened using the control clamp and the intravenous flow is reset
to the appropriate setting. If the peripheral linefluid is not compatible with the
intravenous bolus medication, two syringes with 3cc of normal saline are prepared before
giving the medication. The line is flushed before and after the intravenous medication
administration with the prepared saline syringes. The Y-port is quite vulnerable to
contamination when switching syringes. After the intravenous line is flushed the second
time, the line can be reopened and the intravenous flow rate reset to the appropriate
setting6.
The health care professional determines the amount of time over which the drug should
be delivered according to the physician's order and/or the intravenous drug administration
guidelines. For I.V push medications this is calculated in cc to be delivered per minute.
This number is calculated by dividing the amount to be delivered (in cc) by the time over
which the drug should be delivered (in minutes). If the drug must be reconstituted, the
rate is calculated using the total amount of drug in cc after reconstitution.
7
The formula for calculating the amount of drug required is as follows:
What you want (mgs) X Volume (mls) / What you have got (mgs)
Medication errors is defined as “any preventable event that may cause or lead to
inappropriate medication use or patient harm, while the medication is in the control of the
health care professional, patient, or consumer. Such events may be related to professional
practice, health care products, procedures, and systems including: prescribing; order
communication; product labelling, packaging and nomenclature; compounding;
dispensing; distribution; administration; education; monitoring; and use” (National
Coordinating Council for Medication Error and Prevention, 2006).
An intravenous drug error is a deviation in the preparation or administration of a
medicine from a doctor’s prescription, hospital intravenous procedures, or the
manufacturer’s instructions 7.
Most common intravenous medication administration errors are improper concentration,
mistakes in calculations, wrong diluents’ calculation, wrong calculation, rapid bolus
administration, wrong infusion rate, inappropriate diluents, inappropriate storage of drug
before, inappropriate storage of diluted drug, incompatibility, and expired drugs usage,
patient identification, mixing multiple medications in a syringe or solution or to deliver
drugs from one intravenous line 8.
Reduced medication errors leads to improvements in the quality of the health care
processes and thus enhances patient safety. Every step in patient care for a nursing
professional involves a potential for error and some degree of risk to patient safety.
However, this is especially true in regards to medication errors. A proper understanding
8
of the contributing factors that increase medication errors is the first step towards
preventing them.
6.1 NEED FOR THE STUDY
Expectations of society and increasing nursing expertise have expanded the registered
nurse’s role from simple administration to collaboration, in which the registered nurse
contributes to the design, implementation and evaluation of the client’s drug regimen.
To ensure the safe and competent administration of I.V. drug therapies the professional
must be able to identify a number of factors: the method of administration, the correct
prescription details and knowledge of the drug to be delivered.
Complications of I.V. medication administration may include: infiltration of the I.V. line
when a drug is injected I.V. bolus, tissue necrosis when drugs are injected into infiltrated
I.V. sites, thrombophlebitis of the vein, injection of air embolism, serious adverse drug
reactions such as hypotension, cardiac arrhythmias, and cardiac arrest, allergic reaction to
the medication, venous thrombosis, pain at the I.V. site.
A study published by Journal of Nursing Administration (2004) U.S on intravenous
medication errors revealsthat 54% of potential adverse drug events and 61% of serious
and life-threatening errors are associated with I.V. medications9.
According to The Joint Commission Sentinel Event Statistics(US), medication error
events reached an all-time high in 2007. Statistics for 2008 revealed 8.7% were the drug
errors of all medical errors reported10.
9
The Federal Drug Administration in USA determines that the most common fatal
medication errors were: Administration of an improper dosage (41%), administering the
wrong drug (16%), and improper route of administering the drug (16%)10.
In the United Kingdom, a study using observation methodology cited an error rate of 49%
in the preparation or administration of I.V. doses. An error rate of 73% was identified
with bolus doses, which were given faster than the recommended time of three to five
minutes. Lack of knowledge on preparation and administration and complex design of
equipment were cited as the causes of the errors11.
In Australia, a study of I.V. administration identified an 18% error rate based on 687
observations. The most common error was wrong rate, and the study recommended the
use of I.V. administration devices and regular checking of administration rates using
checklists12.
According to Express health care management, India’s first newspaper for the healthcare
business, June 2005 states that, in Indian scenario, a proper reporting of medication errors
in the hospital is not available, but out of all visits to the medical emergency departments
6% are drug related ADR accounted for 45%13.
According to AHERF( Apollo hospitals Educational and research Foundation) 2011,
deaths in India due to Adverse Drug Reactions estimated to be 400,000 annually and
720,000 adverse drug reactions occur every year14.
A study was conducted on evaluation of medication errors in a tertiary care teaching
hospital in the medicine wards of Basaveshwar teaching and general hospital, at Gulbarga
from September 2010 to March 2011 among 500 patients. The results show that 167
medication errors were detected in 127 patients. The overall incidence of medication
10
error was found to be 33.4%. A total of 167 medication errors were observed, and 46.1%
were nursing errors in medication administration15.
Medication errors can threaten patient outcomes and are a dimension of patient safety
directly linked to nursing care. It is an integral part of the nurse’s role, therefore the
nurses must adapt the principles and techniques of medication administration to render
quality nursing care.The above mentioned factors, statistical evidence, literature review
and student researcher’s clinical experience motivated to conduct a study on practice on
intravenous drug preparation and administration among staff nurses.
11
6.2 REVIEW OF LITERATURE
The purpose of literature review is to discover what has previously been done about the
problem to be studied, what remains to done, what methods have been employed in other
research and how the result of other research in the area can be combined to develop
knowledge.
This literature which is reviewed and relevant to the present study and organized under
the following headings,
6.2.1 Reviews related to nurses knowledge on intravenous drug preparation and
administration.
6.2.2 Reviews related to factors causing intravenous drug errors.
6.2.3 Reviews related to intravenous drug preparation and administration.
6.2.1 Reviews related to nurses knowledge on intravenous drug preparation and
administration.
A descriptive study was conducted in Malaysia, to assess the knowledge of nurses in the
preparation and administration of intravenous medications among 246 samples by using
questionnaire. Survey respondents (n=246) comprised head nurses (n=4) and staff nurses
(n=242). The results show that mean correct scores for knowledge (maximum score; 16)
of head nurses and staff nurses were 12.5 ± SD 2.1 and 10.3 ± SD 2.6 respectively
indicating average knowledge. Less than 50% of respondents obtained correct answers
for calculation and dosing of IV medications. Training programmes for nurses should
give greater emphasis on these skills16.
12
A study was conducted in Bombay, to assess the knowledge and practices of nurses in
administration of selected emergency intravenous drugs in critical care units among 45
samples by using questionnaire. The result shows that 45 (100%) samples knew the
action of injection Lasix and Aminophylline, 88.88% of samples on (Atropine), 71.11%
of samples knew on (Adrenaline), 46.66% of samples on (Nitroglycerine), 44.44% of
samples on (Digoxin), 33.33% of samples on (Lidocaine), 24.44% of samples on(sodium
bicarbonate), Nitropruside ( none) respectively. The study recommends regular drug
training programme to improve the knowledge of nurses17.
6.2.2 Reviews related to factors causing intravenous drug errors
A study was conducted in Japan to assess on factors which cause medication error among
2800 cases. Results show that there are eight important factors which cause intravenous
medication error were clarified i.e. failed communication of information: illegible
handwritten orders, inaccurate verbal orders and copying cause medication error. 2.
Error-prone design of the hardware: Look-alike packaging and labeling of drugs and the
poor design of infusion pumps cause errors 3. Patient names similar to simultaneously
operating
surgical
procedures
and
interventions:
This
factor
causes
patient
misidentification 4. Interruption in the middle of tasks: The efficient assignment of
medical work and business work should be made. 5. Inaccurate mixing procedure and
insufficient mixing space 6. Time pressure 7. Lack of information about high alert
medications 8. Poor knowledge and skill of recent graduates. The study concluded that
training methods and tools to prevent medication errors must be developed18.
An ethnographic study was conducted in 2003 among 10 wards in 2 hospitals of UK. A
trained observer accompanied nurses during IV drug therapy rounds. The human error
13
theory was used to analyze the cause of IV errors. During 483 drug preparation and 447
drug administration, 265 IV drug errors were identified. The most common type of error
committed was deliberate violation of guidelines when injecting bolus doses where the
drug was administered faster than the recommended speed rate of 3.5 minutes. The errors
were mainly due to lack of knowledge on preparation and administration of IV therapy19.
6.2.3 Reviews related to intravenous drug preparation and administration.
A prospective study was conducted to find medication errors in intravenous drug
preparation and administration in six hospital departments in UK, Germany and France.
Results show that824 doses were prepared and 798 doses administered. The product was
either not labelled or incorrectly labelled in 43%, 99%, and 20% of doses administered in
the UK, German and French hospitals, respectively. The wrong diluent was used in 1%,
49% and 18% of cases, respectively, and the wrong rate of administration was selected
for 49%, 21% and 5% of doses observed, respectively. One deviation from aseptic
technique was observed among 100%, 58%, and 19% of cases in the three countries. The
study concluded that uncontrolled risks in the intravenous systems studied were observed
in all three countries. Intravenous therapy must be regarded as a high risk activity where
the use of risk management procedures to minimise risk to patients is seen as a high
priority by all those involved with these duties. There is a requirement to develop better
national (possibly international) procedures for safe intravenous practice20.
A prospective ethnographic study was conducted to determine the incidence of errors in
preparing and administering intravenous (IV) drugs among 22 nurses using disguised
observation on two wards in a German non-university hospital,. Results show that one or
more errors occurred in the preparation and administration of 58 of 122 IV drug doses
14
(error rate 48%, 95% confidence interval 39–57%). In total, 65 errors were identified. Of
doses, 4 had potentially severe errors (3%), 38 (31%) potentially moderate errors and 16
(13%) potentially minor errors. Common errors included multiple step preparations and
the co-administration of potentially incompatible drugs as intermittent infusions. The
study concluded that a high incidence of IV drug errors was found in the study hospital.
Effective strategies to reduce potentially harmful errors are urgently needed. Measures
could include a reduction in the number of ward-based IV drug preparations,
improvement of staff training and the introduction of ward-based clinical pharmacy
services 21.
A prospective observational study was conducted in Sydney, on errors in administration
of intravenous medications in hospital and the role of correct procedures and nurse
experience among 107 nurses preparing and administering 568 intravenous medications
on six wards across two teaching hospitals. Results reveal that of 568 intravenous
administrations, 69.7% (n=396; 95% CI 65.9 to 73.5) had at least one clinical error and
25.5% (95% CI 21.2 to 29.8) of these were serious. Four error types (wrong intravenous
rate, mixture, volume, and drug incompatibility) accounted for 91.7% of errors. Wrong
rate was the most frequent and accounted for 95 of 101 serious errors. Error rates and
severity decreased with clinical experience. Each year of experience, up to 6 years,
reduced the risk of error by 10.9% and serious error by 18.5%. Administration by bolus
was associated with a 31.2% increased risk of error. Patient identification was only
checked in 47.9% of administrations but was associated with a 56% reduction in
intravenous error risk. The study concluded that intravenous administrations have a
higher risk and severity of error than other medication administrations. A significant
15
proportion of errors suggest skill and knowledge deficiencies, with errors and severity
reducing as clinical experience increases22.
STATEMENT OF PROBLEM
“A study to assess practice on intravenous drug preparation and administration among
staff nurses in selected hospitals at Bangalore in a view to prepare a protocol”.
6.3 OBJECTIEVES
1. To assess practice on intravenous drug preparation and administration among staff nurses
in selected hospitals in Bangalore.
2. To find the association between level of practice on intravenous drug preparation and
administration with selected socio demographic variables.
3. To prepare a protocol regarding intravenous drug preparation and administration.
6.4 HYPOTHESIS
H01. There is no significant association between level of practice on intravenous drug
preparation and administration with selected socio demographic variables.
OPERATIONAL DEFINITIONS
Practice of intravenous drug preparation and administration: refers to sequential
steps performed by nurses during intravenous drug preparation and administration which
includes preparation of the patient, calculation of the drug (if required), preparation of the
drug (from ampoule and vial), administration of the drug, observation of the patient after
administration, replacement and disposal of articles and documentation of the procedure
as assessed by structured observational checklist.
16
Nurses: refers to registered nurses working in medical and surgical wards in selected
hospitals at Bangalore.
Protocol: refers to scientific written description of steps to be followed while intravenous
drug preparation and administration prepared by the investigator in order to improve the
nursing care.
ASSUMPTIONS

The staff nurses may have varying level of practice on intravenous drug preparation and
administration.

The protocol on intravenous drug preparation and administration will promote the nurses
to avoid errors and complications.
6.5 DELIMITATIONS
Study is delimited to:
One month period of data collection
Selected hospitals at Bangalore
7. MATERIALS AND METHODS:7.1 SOURCE OF DATA:
Data will be collected from staff nurses in selected hospitals, Bangalore.
7.2.1 TYPE OF STUDY/APPROACH:
Explorative study
17
7.2.2 RESEARCH DESIGN:
Non experimental descriptive research design.
7.2.3 VARIABLES:
Study variables: - practice on intravenous drug preparation and administration.
Attribute variables: - Age, Gender, Professional qualification, Designation, Professional
experience, Area of work, average number of intravenous drugs prepared and
administered per day, any CNE programmme attended on intravenous drug preparation
and administration.
7.2.4 SAMPLING TECHNIQUE:Simple random sampling.
7.2.5 SAMPLE AND SAMPLE SIZE:Total 50 staff nurses from selected hospitals at Bangalore.
7.2.6 SELECTION CRIETERIA:Inclusion criteria: Staff nurses who are:
 Working in selected hospital at Bangalore.
 Willing to participate in the study.
Exclusion Criteria: The study excludes, staff nurses who are:
 Not available at the time of data collection
 Working in pediatric units
18
7.2.7 FOLLOW UP:
No follow up will be done.
7.2.8 COMPARISION PARAMETER:
No comparison is done
7.2.9 DURATION OF THE STUDY:
One month period of data collection.
7.2.10 TOOL/ INSTRUMENTS
Section A: Socio demographic data of staff nurses:- Age, Gender, Professional
qualification, Designation, Professional experience, area of work, average number of
intravenous drugs prepared and administered per day, any CNE programme attended on
drug preparation and administration.
Section B: Structured observational checklist regarding practice on intravenous drug
preparation and administration.
7.2.11 DATA COLLECTION PROCEDURE:Formal permission will be obtained from the concerned authorities. The researcher will
introduce herself and purpose of the study, due consent will be taken from the staff
nurses. Samples will be selected by simple random sampling technique. Data will be
collected by using structured observational checklist.
19
7.2.12 PLAN FOR STATISTICAL ANALYSIS:
Descriptive statistics:
1. Descriptive statistics:
Frequency and percentage distribution will be used to describe the socio-demographic
data.
Mean, mean percentage and standard deviation will be used to analyze the practice on
intravenous drug preparation and administration among staff nurses
2. Inferential statistics: Chi-square will be used to find the association between level of
practice on intravenous drug preparation and administration with selected socio
demographic variables.
7.3 Does the study require any investigation or interventions to be conducted on
patients or others humans? If so, please describe briefly.
Yes, structured observation checklist will be used to assess practice on
intravenous drug preparation and administration among staff nurses.
7.4 Has ethical clearance been obtained from your institution?
Yes, Ethical clearance will be obtained from the concerned authority
20
8. LIST OF REFERENCES
1. Nancy Sr. Principles and Practice of Nursing. 5th ed. Indore (India):
N.R.Publishing
House; 2001. p.342-379. (Nursing arts procedures; vol1)
2.
Perry P. Fundamentals of Nursing. 1St ed. St. Louis (U.SA):Mosby Elsevier
publications; 2005. p. 821-82.
3. Types of Dosage Forms [Online]. [Cited on 2012 Dec 12]
Available from:
URL:www.efarmasi.com.my/DosageForms.htm
4. Five Routes of Administration [Online]. 2011 [Cited 2012 Nov 24]; Available from:
URL:http://www.pharmacology.org/news/routes-administration/
5. Campbell J. Intravenous drug therapy Professional Nurse 1996;11(7): 437 – 442
6. MartelliElizabeth Mary Medication Administration: Nurse's Clinical Guide. Springhouse,
PA: Springhouse Corporation; 2000. (Intravenous Administration)
7. CousinsD H, Sabatier B, Begue D, Schmitt C, Hoppe-Tichy. Medication errors in
intravenous drug preparation and administration: a multicentre audit in the UK, Germany
and France. QualSaf Health Care 2005 Feb 26;14:190–195.
8. PNAE Research Proposal on Medication Errors. [Cited 2012 Dec 15]Also available
from:URL:http://www.rcn.org.uk/__data/assets/pdf_file/0016/250801/KostasMedication_
Errors.pdf
9. Hatcher I, Sullivan M, Hutchinson J et al. An intravenous medication safety system:
preventing high-risk medication errors at the point of care. J NursAdm 2004; 34:437–439.
21
10. Hastings, Cohan & Walsh. Global Legal resources 2011 Apr 14 [Cited on 2012 Dec
13]
Also available at URL:http://www.hg.org/article.asp?id=21586
11. Taxis K, Barber N. Causes of intravenous medication errors: an ethnographic
study. QualSaf Health Care. 2003; 12:343–347.
12. Han PY, Coombes ID, Green B. Factors predictive of intravenous fluid administration
errors in Australian surgical care wards. QualSaf Health Care2005; 14:179–184.
13. Dr. Joshi. Medication error reporting through prescription audity.Express Health care
Management 2005June 16th-30th;Sect. A:1(col.2). Also available at URL:
www.expresshealthcaremgmt.com/20050630/insight01.shtml
14. Dr.Ranjit Roy Chaudhury Medication ErrorsApollo hospitals Educational and
research Foundation2011 Apr 22
15. Khavane Karna1, Sanjay Sharma, ShivkumarInamdar, Anil Bhandari Study and
Evaluation of Medication Errors In a Tertiary Care Teaching Hospital – A Baseline Study
Int J Pharm PharmSci 2012;4(5):587-593
16. Shamsuddin Fuad Ahmad, Shafie Diyana Sarah. Knowledge of Nurses in the
Preparation and Administration of Intravenous Medications.Procedia - Social and
BehavioralSciences [Serial Online] 2012 October 17 [Cited on 2012 Dec 15];2(60):602–
609. Available from:
URL:http://www.sciencedirect.com/science/article/pii/S1877042812038840
17. Rozario J.M. a study to assessthe knowledge and practices of nurses in the
administration of selected intravenous drug in Intensive Care units. Master of Science in
Nursing Dissertation; SNDT Women’s University.SNDT College of Nursing; Bombay,
1994.
22
18.Kawamura H. The approaches to factors which cause medication error--from the
analyses of many near-miss cases related to intravenous medication which nurses
experienced.Gan To Kagaku Ryoho [Serial Online] 2001 Mar [Cited on 2012 Dec
20];28(3):304-309. Also available from:
URL:http://www.ncbi.nlm.nih.gov/pubmed/11265396
19. Cook, Lynda. IV fluid resuscitation. J Inf Nurses 2003Sept-Oct; 26 (5); 296-303.
20. Cousins D, Sabatier B, Begue D, Schmitt C, and Hoppe-Tichy T.Medication errors in
intravenous drug preparation and administration: a multicentre audit in the UK, Germany
and France. Qual Saf Health Care [serial Online] 2005 June [Cited on 2012 Dec
2]; 14(3): 190–195. Also available from: URL:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1744040
21. Taxis K., Barber N. Incidence and severity of intravenous drug errors in a German
hospital.European Journal of Clinical Pharmacology2004 Jan;59(11):815-817
22. Westbrook IJohanna,RobI Marilyn, Woods Amanda, Parry Dave.Errors in the
administration of intravenous medications in hospital and the role of correct procedures
and nurse experience.BMJ QualSaf[Serial Online] 2011 December [Cited on 2012 Jan 2];
20(12):1027–1034.
Also
available
URL:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3228265/
23
from:
SIGNATURE
OF
THE CANDIDATE :
10.
REMARKS OF THE The preparation and administration of intravenous
GUIDE :
drugs is a relatively common procedure in many
areas of clinical practice. This study will help in
identifying errors in intravenous drug preparation
and administration. Protocol will help in improving
the practice of intravenous drug preparation and
administration.
11.
11.1
NAME AND
Mr. YOGEENDRA PRABHU
DESIGNATION
LECTURER,
GUIDE :
MEDICAL SURGICAL NURSING.
11.2
SIGNATURE :
11.3
Co-GUIDE (if any) :
11.4
SIGNATURE :
11.5
HEAD OF
Mrs. SALOME P
DEPARTMENT :
Asst. PROFESSOR
MEDICAL SURGICAL NURSING.
11.6
SIGNATURE :
12.1
REMARKS OF
Existing literature suggests that medication errors
THE PRINCIPAL :
are the most common errors made by the nurses.
Present study would help to identify specific errors
made by nurses in preparation and administration of
intravenous drugs. This study would give baseline
information to prepare protocol for preparation and
administration of intravenous drugs.
12.2
SIGNATURE :
24