Safe Practice In Administering Parenteral Medication PREPARED BY
Safe Practice In Administering Parenteral Medication PREPARED BY: WAN NURFAEEZAH BINTI WAN ABDULLAH SHANI(193280)
PREVENT INFECTION ALWAYS FOLLOW THE PRINCIPLES OF STERILE TECHNIQUE WHEN PREPARING INJECTIONS.
GLOVES STERILITY HAND HYGIENES COMPONENT OF PREVENT INFECTIONS
HAND HYGIENE IS A SIMPLE BUT EFFECTIVE WAY TO PREVENT INFECTIONS. IT CAN PREVENT THE TRANSMISSION OF THE GERMS. HAND HYGIENE REFER TO BOTH WASHING WITH ANTIBACTERIAL SOAP AND WATER AND USE HAND SANITIZER CONTAIN ALCOHOL TO DECONTAMINATE HANDS. Wisconsin Department Of Health Services, Infection Control and Prevention - Standard Precautions. Centers For Disease Control And Prevention, Hand Hygiene in Healthcare Settings.
• Hand hygiene and skin integrity of provider. Perform hand hygiene (i. e. wash or disinfect hands) before preparing injection material and giving injections. • The need for hand hygiene between each injection will vary depending on the setting and whethere was contact with soil, blood, orbody fluids. • Avoid giving injections if skin integrity is compromised by local infection or other skin condition (e. g. weeping dermatitis). Cover any small cuts.
STERILITY
Use Sterile Injection Equipment • Use a sterile syringe and needle for each injection and to reconstitute each unit of medication • Ideally, use a new, single-use syringe and needle. a Inspect packaging for breaches in barrier integrity. Discard a needle or syringe if the package has been punctured, torn, or damaged • If single-use syringes and needles are not available, use equipment designed for steam sterilization. Sterilize equipment according to WHO • recommendations and document the quality of the sterilization process using time, steam, temperature (TST) spot indicators
Prevent Contamination Of Injection Equipment And Medication • Prepare each injection in a clean designated area, where contamination from blood or body fluid is unlikely • Use single-dose vials rather than multi-dose vials. If multi-dose vials must be used, always pierce the septum with a sterile needle • Avoid leaving a needle in place in the stopper of the vial • Select pop-open ampules rather than ampules that need to be opened by using a metal file. If an ampoule that requires a metal file is used, protect fingers with a clean barrier (e. g. small gauze pad) when opening the ampoule. c • Inspect for and discard medications with visible contamination or breaches of integrity (e. g. cracks, leaks) • Follow product-specific recommendations for use, storage, and handling. b Discard a needle that has touched any non-sterile surface. b
Prevent Access To Used Needles • Seal sharps containers for transport to a secure area in preparation for disposal. • After closing and sealing sharps containers, do not open, empty, reuse, or sell them • Manage sharps waste in an efficient, safe, and environment-friendly way to protect people from voluntary and accidental exposure to used injection equipment
GLOVES
• Gloves are not needed for injections. Single-use gloves may be indicated if excessive bleeding is anticipated. . Swabbing vial tops or ampoules. Swabbing of clean vial tops or ampoules with an antiseptic or disinfectant is unnecessary. • If swabbing with an antiseptic is selected for use, use a clean, singleuse swab and maintain product-specific recommended contact time. • Do not use cotton balls stored wet in a multi-use container.
PREVENTING MEDICATION ERROR Definition : Ø Medication error is defined as any preventable event that may cause to inappropriate medication use or patient harm while the medication is in control of the health care professional, patient or consumer.
FACTORS ASSOCIATED WITH MEDICATION ERRORS ØMedications with same name or packaging ØMedication that are not commonly used or prescribed ØIncomplete patient information such as not knowing about patient’s allergies, other medicines they are taking and previous diagnoses. ØMiscommunication of drugs order (eg. Poor hand writing, inappropriate abbreviation)
HOW TO PREVENT THE MEDICATION ERROR ? Follow 12 rights of medication administration 1. Right patient 2. Right drug 3. Right dose 4. Right route 5. Right time 6. Right reason 7. Right documentation 8. Right assessment 9. Right evaluation 10. Right client education 11. Right to refuse the medication 12. Right expiration date
reference • National Coordinating Council for Medication Error Reporting and Prevention. Retrieved from http: //www. nccmerp. org/aboutmedication-errors • Germeline Nabua. Retrieved from http: //www. nursegermz. com/nursing-tips/12 -rights-of-medicationadministration/
PREVENTING MEDICATION ERROR
There are 10 strategies for preventing medication error: 1) 2) 3) 4) 5) 6) 7) 8) Ensure of 5 right medication administration Follow proper medication reconciliation procedures Double check or even triple check procedures Have the physician (or another nurse) read it back Consider using a name alert Document everything Ensure proper storage of medications for proper efficiency Learn your institution’s medication administration policies, regulations and guidelines 9) Place a zero in front of the decimal point 10) Consider having a drug guide available at all times
Nurses role in preventing medication error • Independent double check • Medication review • Knowledge • Patient education • Practice environment
References • NMK, Elden. (2016). The Importance of Medication Error Reporting in Improving the Quality of Clinical Care Service. Retrieved from https: //www. ncbi. nlm. nih. gov/pmc/articles/PMC 5016354/ • V, Dexter. (2017, October 23). 10 strategies for preventing medication error. Retrieved from https: //minoritynurse. com/10 -strategies-forpreventing-medication-errors/
PROMOTING SAFETY AND COMFORT TO THE PATIENT • Comforting is frequently identified as something that a nurse’s responsibility towards the patient. • Nurses is not only provides physical “comfort measures, ” but psychosocial and spiritual support as well. • There is substantial diversity in the literature addressing these comfort measures. • To comfort may be described as an effort to minimize psychobiological distress (Moseley, 1985). • Nurses need to know the exact way of comforting patient depending on their current condition at that time when administering the drug to the patient. • Nurses are required to have a thorough knowledge of pain management and medication titration to alleviate and prevent pain in their patients(Frazier & Kohl, 1984).
• A nurse should create a planning care which involve on managing the pain control, involving both pharmaceutical and non-pharmaceutical interventions, the prevention of fatigue, depression, and anxiety, the prevention of alterations in body functions related to defecation and urination, easement of labored breathing patterns, promotion of proper body alignment, and provision for personal needs especially when administering a procedure especially when administering the drugs to the patient. • Injections can be given safely and effectively • Harm can be prevented if proper injection technique is used. • Most complications related to injections are associated with intramuscular injections, but may occur with any route. • Complications can occur when an incorrect site is used, or with an inappropriate depth or rate of injection (Malkin, 2008). To promote patient safety and comfort during an injection, review the guidelines in Table 7. 3.
To promote patient safety and comfort during an injection, review the guidelines :
Principle Correct needle Additional Information For injections, use a sharp, beveled needle and place bevel side up. Change the needle if liquid coats the shaft of the needle. Correct needle length allows for correct delivery of medication into the correct site and can reduce complications such as abscesses, pain, and bruising. Needle selection should be based on size of patient, gender, injection site, and amount of medication injected. Women tend to have more adipose tissue around the buttocks and deltoid fat pad, which means more than half the injections given do not reach the proper IM depths in women. Large bore needles have been found to reduce pain, swelling, and redness after an injection, as less pressure is required to depress the plunger.
Proper angle of insertion and removal Inserting the needle at the proper angle (depending on the type of injection) and entering the skin smoothly and quickly can reduce pain during injection. Hold the syringe steady once the needle is in the tissue to prevent tissue damage. Withdraw the needle at the same angle used for insertion. The angle for an IM injection is 90 degrees. With all injections, the needle should be inserted all the way up to the hub. Holding the syringe like a dart prevents the medication from being injected during insertion of needle. Removing residue (medication on the tip of the needle) has been shown to reduce pain and discomfort. To remove residue from the needle, change needles after preparation and before administration.
Patient position The patient’s position may affect their perception of pain. Proper position will also facilitate proper landmarking of the site. For IM injections, for example, the ventrogluteal site has the greatest muscle thickness and is free of nerves and blood vessels, with a small layer of fat. Relaxation technique and distraction methods Position the patient’s limbs in a relaxed, comfortable position to reduce muscle tension. For example, lying prone may help a patient relax prior to an IM injection. If giving a deltoid IM injection, have the patient relax the arm by placing the hand in the lap. If a patient is receiving an IM injection in the vastus lateralis or ventrogluteal site, encourage the patient to gently point toes outwards to relax the muscle. Relaxation skills of the health care provider will help decrease the patient’s anxiety-heightened pain. If possible, divert the patient’s attention away from the injection procedure. Pre-medication, if required To decrease pain upon insertion, a vapocoolant spray, topical anesthetic, or wrapped ice may be placed on the insertion site for a minute prior to injection. For IM injections, two studies found that applying pressure to the injection site for 10 seconds before the injection reduced pain. This data supports the gate theory of pain control.
Z-track method for IM injections Some research shows that the Z-track technique results in reduced pain and complications, and fewer injection lesions. However, other research shows that Z-track injections result in more pain and bleeding at the injection site. (See 7. 4 Intramuscular Injections for more on the Z-track method. ) Administration rate Research has found that administrating medications at 10 seconds per ml is an effective rate for IM injections. Increasing the rate to 20 seconds per ml did not show any reduction in pain. Always review drug administration rate as per pharmacy or manufacturer’s recommendations. Gentle touch with insertion sites Gently apply a dry sterile gauze to the site after the injection. Rotate injection sites to prevent the development of indurations and abscesses. Aspiration with IM injections Review the latest research regarding the utility of aspirating IM injections. There is lack of strong evidence to support the technique of aspiration with IM injections.
REFERENCE: • Retrieved from https: //opentextbc. ca/clinicalskills/chapter/safe-injection-administration-and-preparingmedication-from-ampules-and-vials/- (Ağac & Günes, 2011; Canadian Agency for Drugs and Technologies in Health, 2014; Cocoman & Murray, 2008; Greenway, 2014; Hunter, 2008; Malkin, 2008; Mitchell & Whitney, 2001; Nisbit, 2006; Ogston-Tuck, 2014 a; Perry et al. , 2014; Rodgers & King, 2000; Sisson, 2015; Workman, 1999) • https: //www. nursingtimes. net/administration-of-drugs-3 -parenteral/5034777. article
PREVENTING NEEDLE-STICK INJURY
WHAT IS NEEDLE-STICK? � Needle-stick and sharp injuries(NSIs) are accidental skin penetrating wounds caused by sharp instruments in a medical setting. � A break of skin can be from a needle or other” sharp” such as a scalpel or glass
HOW TO PREVENT? • Needle-stick injury can occur at any time during the use or disposal of a device. For example : 1). 40 percent of injuries occur during 2). Another 40 percent of injuries after use and before disposal use. occur 3). 15 percent are disposal-related 4). Recapping needles , a practice that is prohibited, still accounts for nearly 5 percent of needle-stick injuries.
Minimize Handling of Needles and Syringes • Place a needle-disposal box at the immunization work area of every immunizer to permit immediate disposal of used syringes and needles. • Do not manually remove the contaminated needle from the syringe. • Do not walk around the immunization area or work site carrying used syringes. • Do not recap syringes. • Put the needle and syringe in the vial, in the patient, and in the disposal box without setting it down in between steps. • Do not manually sort medical waste
Positioning children for injections. Unexpected motion at the time of injection can lead to accidental needle sticks. To prevent : � position the child securely before giving the injection. � Have the adult sit and place the child on the lap with one arm behind the adult’s back. � Adults may tuck the child’s legs between theirs to secure them, or hold the child’s legs as shown in Figures 10 and 11. � The adult should also hold the child’s free arm (see Figure 12). � Health workers cannot hold the child because they need both hands for the injection. � Even though the child is securely positioned, always tell him/her when you are about to give them an injection.
How To Handle Needle-stick § To prevent needle-sticks during transport or storage, needle-disposal boxes should be: -puncture proof and leak proof, - labeled with a warning that can be understood by local - sealed so they remain closed when stacked people. � Do not fill needle-disposal boxes completely full. -When only three-quarters full, needle-disposal boxes should be sealed and discarded to prevent needle-sticks that occur when the lid is pushed down against an overlyfull box -Needle disposal boxes should be filled only once -Discarded immediately to minimize risk of needle-sticks by workers who empty them.
¾ 3/4(safe) Too full (unsafe) Figure 1: Filling needle-disposal boxes more than three-quarters full may cause needle-sticks
� Be aware: -Remind our employer to evaluate and purchase safety devices -Be sure you receive training on any new safety devices -Always use safety devices -Place a sharps disposal container close to the procedure area -Limit interruptions during procedures -Explain the procedure to patients to gain their cooperation and movement during the procedure -Ask for assistance with patients that might be uncooperative � Dispose with care: - Never recap needles - Dispose of used needles in sharps disposal containers - Ensure that the location of the container are at the height that the top of the container. avoid potential such as children allows users to see
- Use lockable container - Avoid overfilling sharps disposal containers § Steps to do if we are injured : ü Immediately report to supervisor ü Do not apply any pressure to the wound ü Wash the wound with soap and water ü Identify whether patient has any infection or not ü Get medication assessment ü Do blood tests, vaccination or medication to prevent infection if necessary ü Document the incident in the forms provided by our employer
Use safety devices �Hypodermic syringes and needles Syringe with sliding sleeve
�Blood collection devices Phlebotomy device with retractable needle �Scalpels Scalpel with shield covering the blade after use
�Lancets
References 1. Amber Hogan Mitchell, Dr. PH, MPH, CPH, and Ginger B. Parker, MBA. September 2015 Vol. 10 No. 9. Preventing needlestick and sharps injuries. Retrieved from https: //www. americannursetoday. com/preventing-needlesticksharps-injuries/
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