2005 Edition Report on Drug Administration Procedure & Practices ...

(g)Caution should be exercised in the calculation of dose. For high risk drug items, allwork especially the calculation of dose should be checked independently by anothernursing staff member.4.101 Should nurses have any doubt during the course of the procedure, they should withhold drugadministration until verification by the prescribing doctor or, exceptionally, by anotherRegistered Nurse.Administration of Intravenous Medications4.102 As injectable drugs can be associated with very serious medication errors, special cautionmust be exercised in the administration of intravenous drugs.4.103 Administration guidelines for parenteral drugs which provides information on the dilutionand administration of injectable drugs that are commonly used in the HA is available in thepharmacy and on cpo.home of HA intranet. Nurses should always make reference to theguidelines and in the case of any uncertainty about the information provided, nurses shouldrefer to the product inserts or contact the pharmacy department of their hospitals.4.104 When a high risk intravenous medication is prescribed, the prescription order must beindependently checked by 2 nurses to ensure that the order has been correctly interpretedand that the drug, dose calculations, preparations, route & mode of administration areaccurate.4.105 Extreme care should be exercised with those intravenous drugs which can never be given bybolus but only by infusion. In such cases, the dose calculation should preferably be done bya pharmacist. However, pre-defined charts for dilutions and protocols for standardizedinfusion rates should be used when intravenous infusions are to be prepared by nurses in thewards.4.106 The bolus of IV dangerous drugs should preferably be administered by a doctor.4.107 The administration of IV fluids and drug additives should always be documented. The IVchart together with the date, time and the amount of drug to be given should be signed.4.108 Syringes containing drugs should be properly identified in order to prevent any mix-up ofmedications. In no circumstances should any unidentified drugs be given to patients andthey MUST BE discarded immediately when found.4.109 Patients who simultaneously have an IV line and other types of non-IV tubing in place, areat risk of a potential mix-up in the lines. It is important that the tubing lines are traced backcarefully to the site of insertion before drugs or feeds are administered. It should have accessline label if it is more than one line. (refer to Samples of the Line Labels in Appendix 9)4.110 Nursing staff using medication administration devices such as infusion pumps, shouldunderstand their operation and the risks of error that might occur with the use of suchdevices. Double checking should be practised when setting up infusion pumps for infusinghigh risk drugs. Limiting the types of infusion pump available to a minimum would alsohelp to reduce the chances of error.36