The Institute for Safe Medication Practices (ISMP) made several recommendations related to the safe administration of I.V. medications based on the results of its survey and has published a compilation of best practices. The Infusion Nurses Society (INS) standards also address I.V. push administration.
Here is checklist of recommendations from ISMP and INS to help ensure safe practice.
- Dispense I.V. push medications in ready-to-administer prefilled syringes.
- If a prefilled syringe isn’t commercially available, prepare a syringe in the dose specific to the patient. Label the syringe with the patient’s name, drug name, strength, dose, directions for administration (e.g., slow I.V. push over 3 to 5 minutes), and the beyond-use date/time.
- If stability is a problem, dispense a single-use vial with instructions.
- Be sure manufacturers’ prefilled syringe cartridge holders are readily available to clinicians administering I.V. push medications.
- Avoid dilution of I.V. push medications, but if required, do so in the pharmacy (instead of having clinicians dilute them).
- Provide the rate of administering I.V. push medications on the medication administration record.
- Do not dilute I.V. push medications unless required to (for example, because stability issues prevent the pharmacist from doing so).
- If you have to dilute, follow the specific directions provided by the pharmacy and prepare the medication in an uncluttered location with the needed supplies.
- Do not use saline flush syringes for diluting medications.
- Do not draw medication from a commercially prepared syringe into another syringe for administration.
- Ask the pharmacy to prepare I.V. push medications whenever possible if a manufacturer-prepared prefilled syringe in not available
- If more than one syringe of medication for a single patient needs to be prepared at the bedside, prepare each one separately and immediately administer it before preparing the next one.
- Label all medication syringes that you prepare when not at the patient’s bedside, even if you think you’ll be administering them right away.
- Use an appropriately sized syringe (for example, 3 mL) for administering I.V. push medications via a central vascular access device. (A 10 mL syringe is required only for confirming patency of the line, not for administering the medication.)
- Use the needleless connector that’s closest to the patient whenever possible for administering medication.
- Disinfect I.V. access ports before administration by scrubbing with the disinfectant used in your organization; allow to dry for 10 seconds.
- Follow the recommended rate for administration and use a watch or clock with a second hand for timing to ensure accuracy.
- Remember to contact a pharmacist if you have a drug information question and a nurse educator or advanced practice nurse if you have a drug administration question.
- Conduct a gap analysis of I.V. push medication practices using the ISMP Gap Analysis Tool (GAT) for Safe IV Push Medication Practices, available at ismp.org/resources/gap-analysis-tool-safe-iv-push-medication-practices. Another resource is the Ready-to-administer (RTA) MedSafety Form from The Joint Commission, available at rtamedsafety.com.
- Provide I.V. push education for clinicians during orientation and annually.
- Ensure policies and procedures follow national standards and guidelines.
- Encourage clinicians to report errors and near-misses, which can help identify areas for improvement.
Sources: Infusion Nurses Society. Infusion therapy standards of practice. 2016;39(1S):1-169.
Institute for Safe Medication Practices (ISMP). Part II: Survey results suggest action is needed to improve safety with adult IV push medications. 2018. ismp.org/resources/part-ii-survey-results-suggest-action-needed-improve-safety-adult-iv-push-medications
ISMP safe practice guidelines for adult IV push medications. 2015. ismp.org/sites/default/files/attachments/2017-11/ISMP97-Guidelines-071415- 3.%20FINAL.pdf