The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [573]
Drugs should never be added to the following: blood; blood products, that is plasma or platelet concentrate (see Chapter 8); mannitol solutions; sodium bicarbonate solution; and so on. Only specially prepared additives should be used with fat emulsions or amino acid preparations (Downie et al. 2003).
Accurate labelling of additives and records of administration are essential (NPSA 2007d, RCN 2010).
Any protective clothing which is advised should be worn, and vinyl gloves should be used to reduce the risk of latex allergy (Hart 2008). Healthcare professionals who use gloves frequently or for long periods face a high risk of allergy from latex products. All healthcare facilities should develop policies and procedures that determine measures to protect staff and patients from latex exposure and outline a treatment plan for latex reactions (Dougherty 2002).
Preventing needlestick injuries should be key in any health and safety programme and organizations should introduce safety devices and needle-free systems wherever possible (NHS Employers 2007). Basic rules of safety include not resheathing needles, disposal of needles immediately after use into a recognized sharps bin and convenient location of sharps bins in all areas where needles and sharps are used (Hart 2008, MHRA 2004, RCN 2010).
Comfort
Both the physical and psychological comfort of the patient must be considered. Comprehensive explanation of the practical aspects of the procedure together with information about the effects of treatment will contribute to reducing anxiety and will need to be tailored to each patient’s individual needs.
Legal and professional issues
At least one patient will experience a potentially serious intravenous (IV) drug error every day in an ‘average’ hospital. IV drug errors have been estimated to be a third of all drug errors. ‘Fifteen million infusions are performed in the NHS every year and 700 unsafe incidents are reported each year with 19% attributed to user error’ (NPSA 2004, p.1). Between 1990 and 2000, there were 1485 incidents reported to the Medical Devices Agency which involved infusion pumps (MHRA 2010b). In 50% of incidents no cause was established. However, of the remaining incidents, 27% were attributed to user error (e.g. misloading of the administration set or syringe, setting the wrong rate, confusing pump type) and 20% to device-related issues (e.g. poor maintenance, cleaning) (MHRA 2010b, Williams and Lefever 2000). Syringe pumps have given rise to the most significant problems in terms of patient mortality and morbidity (Fox 2000, MHRA 2010b, NPSA 2003).
The high frequency of human error has highlighted the need for more formalized, validated, competency-based training and assessment (MHRA 2010b, NPSA 2003, 2004, Pickstone 2000, Quinn 2000). Nurses must be familiar with the device they are using and not attempt to operate any device that they have not been fully trained to use (Murray and Glenister 2001, NPSA 2003). As a minimum, the training should cover the device, drugs and solutions, and the practical procedures related to setting up the device and problem solving (Medical Devices Agency 2000, MHRA 2010b). Staff should also be made aware of the mechanisms for reporting faults with devices and procedures for adverse incident reporting within their trust and to the MHRA and the NPSA (MHRA 2006b).
A useful checklist (Box 13.13) has been produced by the Medical Devices Agency for staff to follow prior to using a medical device to ensure safe practice (Medical Devices Agency 2000, MHRA 2010b).
Box 13.13 Checklist: how safe is your practice?
Have I been trained in the use of the infusion device?
Was the training formalized and recorded or did I just pick it up as I went along?
How was my competency