Accepted at Steering Group meeting 1 st July, Implementation date: September 2011 Review Date: May 2012

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1 Intravenous BSc Student Nurse Competency Policy for BSc General and Integrated Nursing Students of Catherine McAuley School of Nursing and Midwifery and associated Health Service Providers. Accepted at Steering Group meeting 1 st July, Implementation date: September 2011 Review Date: May 2012 Developed by Working Group from Clinical Practice Committee Working Group members: Ms. Liz O Connell UCC, Ms. Patricia Barry/Ms Michele Stout, CUH, Ms. Majella Murphy, Bons Secours, Ms. Ruth Lernihan, South Infirmary/Victoria Hospital, Ms. Nuala Walsh, UCC, Ms. Angela Flynn, UCC. Factors Underpinning Proposed Change of Policy The purpose of the registration education programme is to ensure that on successful completion of the programme the student is equipped with the knowledge and skills necessary to practice as a competent and professional nurse (ABA, 2005). IV competency is viewed as a key competency for today s nurses; it is no longer viewed as an extended role but rather a core function. A large percentage of patients in acute hospitals will have intravenous therapy at some point during their hospitalization. In addition community based activity is increasing due to early discharge programs etc. A significant number of students will not be employed by their parent hospital on registration, many will travel abroad although it is acknowledged that most hospitals require newly employed nurses to undertake an IV Competency program regardless of previous experience. Students have consistently raised concerns that the hands off" approach to IV management and view it as a significant disadvantage when they qualify. Patient safety Current Practice In general, students can observe but not actively participate in the management or administration of intravenous fluids however there are some differences between the various Health Service Providers. 1

2 The majority of hospitals require that new employees undergo an IV training program and calculation test prior to administering IV fluids. All newly qualified nurses are required to complete this programme and in some environments complete a number of supervised IV administrations prior to been deemed competent. General Principles This policy is applicable to intravenous peripheral inserted lines only. An intravenous infusion is the instillation into the vein of a fluids, electrolytes, medications, blood or nutrients. It is prescribed in accordance with hospital policy and administered in accordance with the individual hospitals medication administration policy and ABA guidelines. Participation in the preparation, administration and management of intravenous fluids by BSc Nursing Students caring for adult patients will at all times be under the direct supervision of a registered nurse who has successfully completed the required hospital intravenous study day and has achieved competence in that practice ( successfully completed assessment and supervised practice ). Participation in the preparation, administration and management of intravenous fluids by Integrated Children s and General BSc Nursing Students only caring for child/adolescent patients will at all times be under the direct supervision of a registered nurse who has successfully completed the required hospital intravenous study day and has achieved competence in that practice ( successfully completed assessment and supervised practice ). Participation in the preparation, administration and management of intravenous fluids by BSc Nursing Students caring will be limited to the following fluids administered through a peripheral intravenous cannula: Normal Saline 0.9%, Hartmanns Solution, Dextrose 5% and Dextrose Saline. BSc Nursing Students will not be involved in the preparation or administration of blood, blood products, total parenteral nutrition or intravenous fluids with added electrolytes whether these are added at ward level or in preprepared solutions. 2

3 Flushing of peripheral intravenous cannula before during or after fluid administration will not be undertaken by BSc Nursing Students. It is recognized that that students must develop an overall understanding of IV Fluid management, the inherent risks involved and an appreciation of intravenous therapy in addition to pharmacological knowledge and numeracy skills. This will be addressed as part of the educational requirements. However clear guidelines are required with respect to specific elements of intravenous preparation and management and the clinical skills required therein. To this end and for the purpose of discussion a list of proposed areas of involvement is detailed below. All involvement will be in accordance with hospital policy and An Bord Altranais guidance documents. 3

4 BSc General and BSc Integrated Children s & General Nursing Students Broad Skill Skill broken into Specific Components Second Year Third Year Fourth & Fifth Year - Internship Management of peripheral intravenous canulla. Observation and documentation. Exposure and Participation Identification Internalisation Dressing and removal. Exposure and Participation Identification Internalisation Removal of Intravenous Cannula Exposure and Participation Identification Internalisation Preparation, administration and management of prescribed Intravenous fluid (From specified list above) under the direct supervision of a registered nurse in accordance with policy and best practice. Selection of prescribed fluid Prime intravenous line with prescribed fluid. Prime intravenous line with prescribed fluid.

5 Broad Skill Skill broken into Specific Components Second Year Third Year Fourth & Fifth Year - Internship Preparation, administration and management of prescribed Intravenous fluid (From specified list above) under the direct supervision of a registered nurse in accordance with policy and best practice. Calculate rate and adjust flow of infusion with roller clamp if no infusion pump/devise used. Preparation of infusion device (pump), threading tubing through device and commencement of infusion. Troubleshooting of infusion device alarms. Connection of primed line to peripheral venous cannula. Adjust rate of infusion if required, for example infusing too quickly or slowly. Replace empty bag of fluid with next fluid order. 5

6 Broad Skill Skill broken into Specific Components Second Year Third Year Fourth & Fifth Year - Internship Preparation, administration and management of prescribed Intravenous fluid (From specified list above) under the direct supervision of a registered nurse in accordance with policy and best practice. Without Direct Supervision but with proviso to report immediately. Only applies to infusions of Normal Saline 0.9%, Hartmanns Solution Dextrose 5%and Dextrose Saline Without direct supervision and only with infusions of Normal Saline 0.9%, Hartmanns Solution, Dextrose5% and Dextrose Saline. Discontinue fluids when ordered. Pause infusion with rollerclamp in the event of phlebitis or extravasacation and immediately inform Registered Nurse. Use pause function of infusion device /roller clamp when attending to hygiene or clothes change Infusion to be restarted under direct supervision of Registered Nurse Exposure Exposure Exposure and participation BSc Nursing Students must achieve exposure levels in all proposed areas prior to participation. Students should attempt to avail of opportunities when wards are less busy maximizing the amount of time a registered nurse can spend with them. 6

7 A number of supervised attempts should be sought during placements, each one signed by the registered nurse. These could be recorded in miscellaneous skills section of student booklet. Education Currently NU2031 addresses Nursing practice in drug therapy (5 credits) and is delivered in period one and two of Year 2. NU207 (Haematology) delivered in period two of Year 2 addresses blood transfusions, care of peripheral cannuala and priming of IV line in a 2 hour practical session. The curriculum should include relevant theoretical and practical aspects of intravenous therapy and the management of intravenous access devices. This will include but is not limited to - The principals of intravenous therapy and medication, including the components and indications for particular solutions. Potential complications to include signs of extravasation and phlebitis. Management of peripheral intravenous cannula including the care, assessment and documentation. Principles of infusion pumps and gravity infusions. Calculations and numeracy Formal clinical skills sessions are required in third year of programme. Plan Consensus on this policy has now been reached by Clinical Practice Committee on June 29 th 2011 and policy has been passed at Steering Group on the 1 st July, Changes to clinical booklet have been formulated and will be included in third year booklet for 2008 group. They will be added as an addendum to the current th year booklet 2007 group. Policy is to be implemented in September 2011 and reviewed in May 2012.See below for policy summary. 7

8 Intravenous BSc Student Nurse Competency Policy BSc General and Integrated Children s & General Nursing Students of Catherine McAuley School of Nursing and Midwifery and associated Health Service Providers. Developed by: working group from Clinical Practice Committee Effective from date: September 2011 Review date: May/June 2012 Policy restrictions: Student nurses participation in the preparation and administration of prescribed* intravenous fluids must be under the direct supervision of a registered nurse who has successfully completed the required hospital intravenous study day. Student nurses will not be involved in the preparation and administration of blood, blood products, total parenteral nutrition or intravenous fluids with additives whether these are added at ward level or in pre-prepared solutions. Flushing of intravenous cannulae before, during or after fluid administration will not be undertaken by student nurses Policy not applicable for intravenous central line management by nursing students/interns. *List of specified IV Fluids Sodium Chloride 0.9% Hartmanns Solution Dextrose 5% Dextrose Saline Section A: 1 st year General & Integrated student Section B: 2 nd year General student Section C: 3rd year General student Section D: th Year General Student Applicable following May, 2012 pilot review 2 nd & 3 rd Year Integrated student th Year Integrated Student th & 5 th Year Integrated Student Applicable following May, 2012 pilot review Exposure to: Exposure to : Exposure to: Exposure and participation in: Observation and documentation in relation to peripheral intravenous cannulae. Change of dressing of peripheral intravenous cannulae. Removal of peripheral intravenous cannulae. Selection of prescribed intravenous fluid. Prime an intravenous line with prescribed fluid. Calculate flow rate of intravenous infusion and adjust using roller clamp or pump as appropriate. Preparation of infusion pump including threading tubing through device, connecting to peripheral intravenous cannula and commencing infusion. Troubleshooting of infusion device alarms. Replace completed IV infusions with prescribed follow-on infusion. Discontinue fluids and place hub on peripheral intravenous cannula. Use of pause function when attending to hygiene, clothes change or elimination needs. Note infusion must not be Selection of prescribed intravenous fluid. Prime an intravenous line with prescribed fluid. Calculate flow rate of intravenous infusion and adjust using roller clamp or pump as appropriate. Preparation of infusion pump including threading tubing through device, connecting to peripheral intravenous cannula and commencing infusion. Troubleshooting of infusion device alarms. Replace completed IV infusions with prescribed follow-on infusion. Discontinue fluids and place hub on peripheral intravenous cannula. Use of pause function when attending to hygiene, clothes change or elimination needs. Note infusion must not be restarted without direct supervision of registered general nurse. Use of pause function in the event of suspected phlebitis or extravasation. Note that a registered nurse must be contacted immediately. Selection of prescribed intravenous fluid. Prime an intravenous line with prescribed fluid. Calculate flow rate of intravenous infusion and adjust using roller clamp or pump as appropriate. Preparation of infusion pump including threading tubing through device, connecting to peripheral intravenous cannula and commencing infusion. Troubleshooting of infusion device alarms. Replace completed IV infusions with prescribed follow-on infusion. Discontinue fluids and place hub on peripheral intravenous cannula. Use of pause function when attending to hygiene, clothes change or elimination needs. Note infusion must not be restarted without direct supervision of registered general nurse. Use of pause function in the event of suspected phlebitis or extravasation. Note that a registered nurse must be contacted immediately. Selection of prescribed intravenous fluid. Double checker for IV fluids as listed in policy Prime an intravenous line with prescribed fluid. Calculate flow rate of intravenous infusion and adjust using roller clamp or pump as appropriate. Preparation of infusion pump including threading tubing through device, connecting to peripheral intravenous cannula and commencing infusion. Troubleshooting of infusion device alarms. Replace completed IV infusions with prescribed follow-on infusion. Discontinue fluids and place hub on peripheral intravenous cannula. Use of pause function when attending to hygiene, clothes change or elimination needs. Note infusion must not be restarted without direct supervision of registered general nurse. Use of pause function in the event of suspected phlebitis or extravasation. Note that a registered nurse must be contacted immediately. 8

9 restarted without direct supervision of registered nurse. Use of pause function in the event of suspected phlebitis or extravasation. Note that a registered nurse must be contacted immediately. Participation in: Observation and documentation in relation to peripheral intravenous cannulae. Change of dressing of peripheral intravenous cannulae. Removal of peripheral intravenous cannula Identification of: Observation and documentation in relation to peripheral intravenous cannulae. Change of dressing of peripheral intravenous cannulae. Removal of peripheral intravenous cannula Internalisation of: Observation and documentation in relation to peripheral intravenous cannulae. Change of dressing of peripheral intravenous cannula. Removal of intravenous cannula. Double checker for IV fluids as per local policy in Children s \Ward Final Draft

10 IV Management skills BSC General Nursing Programme under direct supervision of a Registered Nurse SKILL: PRIMING AN INTRAVENOUS LINE WITH NORMAL SALINE 0.9%, HARTMANNS SOLUTION, DEXTROSE 5% OR DEXTROSE SALINE SKILL: PREPARATION OF INFUSION PUMP: (A),INSERTIONOF PRIMED INTRAVENOUS LINE CONTAINING NORMAL SALINE 0.9%, HARTMANN S SOLUTION, DEXTROSE 5% OR DEXTROSE SALINE CORRECTLY INTO PUMP. SKILL: CALCULATION AND SETTING OF FLOW RATE USING ROLLER CLAMP OF AN INFUSION OF NORMAL SALINE 0.9%, HARTMANNS SOLUTION, DEXTROSE 5% OR DEXTROSE SALINE 10

11 SKILL: CALCULATION /ADJUSTMENT OF FLOW RATE OF AN INFUSION PUMP WITH NORMAL SALINE 0.9%, HARTMANNS SOLUTION, DEXTROSE 5% OR DEXTROSE SALINE. SKILL:CONNECTION OF PRIMED LINE CONTAINING NORMAL SALINE 0.9%, HARTMANN S SOLUTION, DEXTROSE 5% OR DEXTROSE SALINE TO PERIPHERAL VENOUS CANNULA SKILL: TROUBLESHOOTING OF INFUSION DEVICE ALARMS OF AN INFUSION PUMP DELIVERING NORMAL SALINE 0.9%, HARTMANNS SOLOTION, DEXTROSE 5% OR DEXTROSE SALINE. A REGISTERED STAFF NURSE MUST BE CONTACTED IMMEDIATELY. 11

12 SKILL:REPLACEMENT OF COMPLETED IV INFUSION WITH PRESCRIBED FOLLOW- ON INFUSION OF NORMAL SALINE 0.9%, HARTMANN S SOLUTION, DEXTROSE 5% OR DEXTROSE SALINE. SKILL:INSERTION OF HUB (BUNG) TO IV CANNULA FOLLOWING DISCONTINUATION OF INTRAVENOUS INFUSION OF NORMAL SALINE 0.9%, HARTMANN S SOLUTION, DEXTROSE 5% OR DEXTROSE SALINE. SKILL: CORRECT USE OF PAUSE FUNCTION OF AN INFUSION PUMP /ROLLERCLAMP DELIVERING NORMAL SALINE 0.9%, HARTMANN S SOLUTION, DEXTROSE 5% OR DEXTROSE SALINE. NOTE PAUSE FUNCTION CAN BE USED WHEN ATTENDING TO PATIENT HYGIENE, CLOTHES CHANGE OR ELIMINATION NEEDS BUT INFUSION MUST NOT BE RESTARTED WITHOUT DIRECT SUPERVISION OF A REGISTERED NURSE. PAUSE FUNCTION CAN ALSO BE USED IN THE EVENT OF SUSPECTED PHLEBITIS OR EXTRAVASATION BUT A REGISTERED NURSE MUST BE CONSULTED IMMEDIATELY. 12

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