Question

Ordering: In what order should the following be done? Place a number next to each. __ Administer the medication over a 1-minute period. __ Clean the hub of the IV port using an alcohol pad. __ Flush the IV with 3 mL of normal saline to assess its patency. __ Identify the patient per hospital policy. __ Flush the IV with 3 mL of normal saline to clear site of medication.

Short answer

The order of tasks should be: 1 - Identify the patient per hospital policy, 2 - Flush the IV with 3 mL of normal saline to assess its patency, 3 - Clean the hub of the IV port using an alcohol pad, 4 - Administer the medication over a 1-minute period, 5 - Flush the IV with 3 mL of normal saline to clear site of medication.

Step-by-step solution

Identifying the Patient

This should be the first step (1). Before any medical procedure can be done, it is very important to ensure the right patient is being attended to. This is to prevent any possible mix up.

Assessing Patency of IV

This should come second (2). The next step after identifying the patient correctly is to assess the patency of the IV. This is done by flushing it with 3 mL of normal saline. This step ensures the IV is not blocked and is properly functioning.

Cleaning the Hub of the IV Port

The hub of the IV port should be cleaned third (3). After confirming that the IV is not blocked, the hub of the IV port is cleaned using an alcohol pad to ensure no bacteria or other contaminants are present before administering the medication.

Administering the medication

Administering the medication should happen fourth (4). After making sure the patient is right, the IV is functioning correctly and the IV port is cleanly prepared, the medication can safely be administered over a 1-minute period.

Clearing the Site of Medication

This is the final step (5). Following the administration of the medication, the IV should be flushed with another 3 mL of normal saline to clear the site of medication. This ensures that no residual medication remains that could cause complications.

Key concepts

Patient Identification Procedures

The foundation of safe medication administration begins with proper patient identification. Failure to confirm the patient's identity can lead to serious medical errors. To mitigate this risk, nurses must follow a standardized identification process.

Often, hospitals adopt a 'two-identifier' policy requiring, for instance, the patient's name and date of birth to be confirmed. This can be done by checking the patient's wristband and verifying the information with the patient directly if they are conscious and able. Additionally, reviewing the patient’s chart or electronic medical record (EMR) against the medication order ensures that the right patient is about to receive the correct medication and dosage.

This step is critical to patient safety and is considered the first and most crucial step in the medication administration process, as seen in our exercise solution.

IV Patency Assessment

An Intravenous (IV) patency assessment is essential prior to medication administration to ensure that the IV line is open and free of obstructions. This step aids in preventing complications such as infiltration or extravasation, which can occur if the IV catheter becomes dislodged from the vein.

To assess IV patency, nurses will typically flush the IV line with a small volume of normal saline. During the flush, the nurse observes for signs that suggest the IV is not patent, such as swelling at the IV site or patient reports of pain. If the saline flushes without resistance and the patient does not report discomfort, the IV line is considered patent. Subsequently, the medication can be administered safely through this line.

IV Port Cleaning Protocol

Infection prevention is a priority in any healthcare setting, and this extends to nursing procedures like IV port cleaning. Cleaning the IV port before and after medication administration prevents the introduction of pathogens into the bloodstream. The cleaning protocol typically involves the use of an alcohol pad or other approved disinfectant swab.

The nurse is to scrub the hub - the point where medication is injected into the IV line - for a recommended duration, often at least 15 seconds, allowing it to air dry completely to maximize the disinfectant's effectiveness. This step, coupled with hand hygiene and the use of gloves, is a critical component in maintaining patient safety and reducing the risk of healthcare-associated infections.

Nursing Procedures and Protocols

Adhering to nursing procedures and protocols ensures that medication administration is performed consistently and safely. These procedures are based on best practices and regulatory guidelines, such as those set by the Joint Commission or a hospital’s own policies.

For nurses, this includes a series of checks and steps – the 'five rights' of medication administration (right patient, right medication, right dose, right time, right route), proper IV line assessment, aseptic technique during medication preparation and administration, as well as documentation following the procedure.

Following these protocols not only helps to prevent medication errors but also supports overall patient care by establishing routine checks at each point of the medication administration process. These checks are reflected in the logical sequence of steps provided in the textbook exercise, highlighting the importance of a structured approach in nursing practice.