The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [574]
Have I read the user instructions on how to use the infusion device and am I familiar with any warning labels?
When was the infusion device last serviced?
Are there any signs of wear, damage or faults?
Do I know how to set up and use the infusion device?
Is the infusion device and any additional equipment in good working order?
Do I know how the infusion device should perform and the monitoring that needs to be done to check its performance?
Am I using the correct additional equipment, for example the appropriate disposable administration set for the infusion pump?
Do I know how to recognize whether the infusion device has failed?
Do I know what to do if the infusion device fails?
Do I know how and to whom to report an infusion device-related adverse incident?
Does checking the infusion device indicate it is functioning correctly and to the manufacturer’s specification?
What action should be taken if the infusion device is not functioning properly?
Is there up-to-date documentation to record regular checking of the infusion device?
What are the details (name and serial number) of the infusion device being used?
What is the cleaning and/or decontamination procedure for the infusion device and what are my responsibilities in this process?
Do I know how to report an adverse incident?
Do I have access to MHRA device bulletins of relevance to my area of practice and do I read and take note of hazard and safety notices?
(Adapted from Medical Devices Agency 2000, p.10; 2001, pp.8, 9)
The nurse must have knowledge of the solutions, their effects, rate of administration, factors that affect flow of infusion, as well as the complications which could occur when flow is not controlled (Weinstein and Plumer 2007). The nurse should have an understanding of which groups require accurate flow control in order to prevent complications (Box 13.14) and how to select the most appropriate device for accuracy of delivery to best meet the patient’s flow control needs (according to age, condition, setting and prescribed therapy) (Weinstein and Plumer 2007).
Box 13.14 Groups at risk of complications associated with flow control
Infants and young children.
The elderly.
Patients with compromised cardiovascular status.
Patients with impairment or failure of organs, for example kidneys.
Patients with major sepsis.
Patients suffering from shock, whatever the cause.
Postoperative or post-trauma patients.
Stressed patients, whose endocrine homoeostatic controls may be affected.
Patients receiving multiple medications, whose clinical status may change rapidly.
(Adapted from Quinn 2008)
The identification of risks is crucial, for example complex calculations, prescription errors (Dougherty 2002, Weinstein and Plumer 2007) and the risks associated with infusions, such as neonatal risk infusions, high-risk infusions, low-risk infusions and ambulatory infusions (MHRA 2010b, Quinn 2000). The early detection of errors and infusion-related complications, for example over- and underinfusion (Box 13.15), is imperative in order to instigate the appropriate interventions in response to an error or to manage any complications, as serious errors or complications can result in patient death (Dougherty 2002, NPSA 2003, Quinn 2008). Overinfusion accounts for about half of the reported errors involving infusion pumps, with 80% due to user error rather than a fault with the device (Medical Devices Agency 2000). The use of infusion devices, both mechanical and electronic, has increased the level of safety in intravenous therapy. However, it is recommended that a clearly defined structure for management of infusion systems must exist within a hospital (Department of Health, Social Services and Public Safety 2006, MHRA 2010b, NHS Litigation Authority 2007, NPSA 2004) (Box 13.16).
Box 13.15 Complications of inadequate flow control
Complications associated with overinfusion
Fluid overload with accompanying electrolyte imbalance.
Metabolic disturbances during parenteral nutrition, mainly related to