Running head: IV MEDICATION ADMINISTRATION

Quality Improvement Process for Intravenous Medication Administration

Danielle Dowd, Cassie Mulder, Jason Couturier, Brittany Lynn
Ferris State University

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Quality Improvement Process for Intravenous Medication Administration

Policy change takes copious time and effort, especially when it is a hospital policy.
Medication administration procedures are different depending on the hospital. Intravenous push
(IVP) medications are some of the most common sources of medication administration error, It
has been estimated that the probability of making at least one medication administration error
(MAE) in intravenous doses is 73% and that intravenous doses are ve times more likely to be
associated with a MAE than non-intravenous doses (Keers, Williams, Cooke, & Ashcroft, 2015,
p. 2). Medication administration policy for most hospitals includes IVP rates for each
medication available in IV form. The Spectrum Health intranet holds medication administration
policies that currently include all of this information, but there are no alert systems in place. An
IVP medication information hover window will be implemented to reduce administration error
and increase patient safety. The policy change suggestion is implementing a barcode database
that informs the nurse about the drug manufactured push rate and possible incompatible hanging
fluids.
Identify Clinical Needs
During medication administration there are many factors that influence how an IV drug
should be appropriately administered. It is the nurses responsibility during medication
administration to be aware of the relevant rules and regulations that are needed to ensure safe
patient care. IV therapy is common, It has been estimated that more than 90% of hospitalized
patients receive some form of intravenous (IV) therapy (Paparella & Mandrack, 2016, p. 64).
Because of this reason, there are a multitude of IV medications that nurses must know, as well as
how long each medication needs to be pushed into the IV line to be therapeutic, yet effective.

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Also, every year new medications are introduced which only increases the necessary knowledge
nurses need to have readily available.
Not only are there many medications to know, but also the policy is difficult to access
quickly. For instance, at Spectrum Health the nurse needs to open a web browser, find the
policies and procedures, and browse a document to find the proper information. When interacting
with a patient and administering medications it can take a very long time for the nurse to find the
push rate for a specific medication, especially in emergency situations. There needs to be a faster
method, Drug references that describe the safe rate for IV push drug administration should be
readily available and referenced as necessary when administering IV push medications
(Paparella & Mandrack, 2016, p. 66). The goal of a nurse is to provide effective patient care, but
to be efficient at the same time. Nurses often work in stressful situations where their patients may
be in pain or need medications very quickly; it is times like these that there needs to be strict and
achievable protocol in place to decrease the risk of IVP error. Staff who seek to limit risk and
increase reliability in the care of patients need to develop standard expected practice for the
administration of IV push medications, recognizing that not all efficient practice is necessarily
safe (Paparella & Mandrack, 2016, p. 66).
Another issue nurses often run into is incompatibility between IV medications and IV
fluids. Not all push medications can be administered while certain fluids are running, and nurses
run into similar problems in this situation about not being able to find the information quickly.
Often nurses will clamp the line, flush with normal saline, administer the medication, flush the
line once more, and re-open the clamp. If the hover information window was readily available it
could show if the medication being pushed is compatible with a fluid that may be running. This

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information could ensure nurses are mixing medications appropriately, which could prevent
adverse reactions, and even death.
Interdisciplinary Team
In order to bring about change in a hospital setting, team effort is required. The design of
this information hover window on the MAR would need to first be designed by Cerner. It will be
readily available for nurses when they are scanning their patients medications. The pharmacist
would need to be involved because they would have answers regarding correct push times and
compatibility with running IV fluids. A clinical nurse specialist (CNS) would work closely with
the pharmacist because the CNS works in the office looking up EBP regarding push rates and
compatibility, but at the bedside to ensure the correct practice is incorporated. The CNS will
spend time with nurses and ensure that they are able to use the new information hover window.
Finally, the physicians need to be knowledgeable about the change on the MAR in order
effectively communicate and prescribe medications for their patients.
Data Collection Method
The first step in data collection is to retrospectively identify error rates for each of the
IVP medications in the hospital system. This will identify the floors and medications with the
highest error rates. Next would be to create a survey with the most commonly misgiven
medications to distribute to nurse managers on all floors. This survey will have the medication
name listed and an area to identify the length of time the nurse takes to push that medication. The
survey will be given anonymously to avoid misinformation.
A line graph will be used to identify the floors with the highest rate of error, as well as the
most common medications given in error. A statistician would be consulted, as suggested in
(Yoder-Wise, 2011) to help identify the best way to present data to the nurse managers and

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subsequently the nurses on the floor. Presenting the data to the nurse managers and nurses will
help create a shared vision and ownership in the implementation process when the time comes.
Dean Gesme and Marian Wiseman explain that creating a readiness to change and
communication are two of the most important parts of implementing policy change (Gesme &
Wiseman, 2010). After implementation of the program, this survey will be given again every
three months to track improvements.
Establish Outcomes
Setting specific and achievable outcomes will ensure this new quality improvement
process can be utilized realistically. One desired outcome is that nurses will understand the need
for standardized push rates as well as how to access them in Cerner. Another main goal is to
decrease medication errors in order to increase patient safety. If nurses have constant access to
this information they will never need to question how long to push an IV medication or if it is
compatible with the running IV fluid, therefore ensuring the patient is receiving their medication
safely.
This new system will provide nurses with information to assist them in feeling more
competent, and in turn more confident on the floor. Because of the high rates of IV medication
errors this process should equip practicing nurses with the knowledge they need to practice
safely.
Implementation Strategies
As stated previously, an information hover window will appear when the nurse hovers
over the medications after the nurse scans them in. The same window that appears when a nurse
is hovering over an insulin medication for dosage purposes will appear, but it will now be
utilized in an IVP medication scenario. This quality improvement process will first begin with a

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focus group. They will discuss what is and is not effective about the new information hover
window. After the focus group, the quality improvement project will move to one floor of a
hospital and go under the same review. The CNS will work closely with the nursing staff to
ensure that the staff knows where and how to access the new information hover window. After a
trial run on one floor, the beta program will be completed before it is implemented hospital wide.
During any period of change communication is vital, Communicate the vision of whats going
to happen, how individuals will be involved, what is expected from them and their team, and
why it is important to the practice and the patients (Gesme & Wiseman, 2010, p. 258).
Evaluation
Medication error data will be reviewed every three months, along with the surveys. Line
graphs will be analyzed and presented at quarterly meetings with the quality improvement team
and hospital staff. If improvements are made in error rates for IVP medications, the program will
be implemented on all floors and across the Spectrum Health system.
If improvements are not made due to the implemented process, the quality improvement
team will reconvene and brainstorm possible issues and barriers to success. Focus groups will be
used to identify hindrances and process improvements. The goal of the evaluation is to identify
the effectiveness of the policy change. Each of the nurses using the information hover window
should be using the six steps of the quality improvement process, as identified by Yoder-Wise, to
self-evaluate (Yoder-Wise, 2011).
Conclusion
Through the use of a quality improvement process to create the new information hover
window will decrease IVP medication errors and reduce incompatibilities with IV fluids. A team
approach is necessary in order to impact a hospital-wide protocol. It is important to constantly

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evaluate the new quality improvement process to ensure that it effective for its intended use.
With the incorporation of this new window nurses will feel more confident when administering
IVP medications. Overall the incorporation of the new information hover window is to increase
patient safety and satisfaction in all care settings.

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References
Gesme, D., & Wiseman, M. (2010, September). How to Implement Change in Practice
[Electronic version]. Journal of Oncology Practice, 6(5), 257-259.
doi:10.1200/JOP.000089
Keers, R. N., Williams, S. D., Cooke, J., & Ashcroft, D. M. (2015, March 13). Understanding the
causes of intravenous medication administration errors in hospitals: a qualitative critical
incident study. BMJ Open, 5(3), 1-8. doi:10.1136/bmjopen-2014-005948
Paparella, S. F., & Mandrack, M. M. (2016, January). IV Push Medication Administration:
Making Safe Choices; Choosing Best Practice [Electronic version]. Journal of
Emergency Nursing, 42(1), 64-67. doi:10.1016/j.jen.2015.09.016
Yoder-Wise, P. S. (2011). Leading and Managing in Nursing (5th ed.). St. Louis, MO: Mosby
Elsevier.