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Two Person IV Medication Administration

nurses working with patient
Background:

This project aimed to evaluate the safety, efficiency and cost of a two person independent IV medication administration procedure to the bedside compared to current single person IV medication administration. A secondary objective was to capture the frequency of interruptions during the IV medication process.

Methods:
A randomised controlled design using direct observations at pre and posttest was undertaken to capture IV medication administration data on four clinical areas at a major public tertiary teaching hospital. Medication safety culture was also assessed along with the time taken to administer an IV medication and the frequency of interruptions during this process.

Results:
A total of 310 IV medications were observed being prepared and administered with a total of eight errors (3%) identified across both the intervention and controlled wards. Across both the intervention and controlled wards there were low numbers of IV medication errors observed which were further corroborated by low numbers of IV medication clinical incidents reported. Findings revealed that there was no conclusive evidence that using a two person IV administrative check to the bedside was any safer than using a single nurse administration.

Fifty four percent (n=167) of IV medication administrations were interrupted between 1 and five times, with a total of 305 interruptions observed. The top reasons for interruptions included; to discuss a patient (n=76; 26%) followed by a request from a patient or relative (n=46; 15.8%). Mean medication safety culture scores were positive indicating that staff regard medication safety as important. Timing of IV medication preparation and administration were collected with a mean time of 11 minutes required to prepare, check and administer IV medications in this sample of patients. To contextualised this finding, for every 100 IV medications administered the extra five minutes required to have a second nurse check the IV medication to the bedside equates to an additional 8 hours and 20 minutes of nursing time required.

Conclusion:
The safety net of double checking IV medications remains questionable with definitive findings as to the benefits of this procedure not able to be verified by this project. The reinforcement of independent rather than collaborative medication checking is warranted to ensure that medication checks are completely impartial to outside influences. Finally, any interruption during medication preparation and administration should be viewed as detrimental to patient safety. As such staff and patients need to be made aware of the fact that interruptions can lead to medication errors.