Working in the surgical/trauma intensive care unit (STICU) at a Level I trauma hospital can be highly stressful for bedside nurses. Timely, accurate medication administration is crucial; any delay could place the patient at unnecessary risk.
In this fast-paced, demanding environment, staff nurses at University Hospital in San Antonio, Texas, sought to reduce stress and save time while safely verifying I.V. infusion medications for dosing, concentration, compatibility, and corresponding infusion rates. In the past, nurses in our unit memorized I.V. drug concentrations and dosing, used drug reference books to look up less familiar medications, or called the pharmacy for the information they needed. But these actions took valuable time.
So STICU educators developed a bedside I.V. infusion reference sheet with the assistance of pharmacy staff. The sheet, which includes most of the I.V. infusions given in the STICU, covers each drug’s classification, dilution, initial dosing, maintenance and titration dosing, indications, precautions, and contraindications. For easy access, the sheets initially were placed in the unit’s bedside reference books. But they became so popular among nurses and physicians they often were misplaced or lost, making them inaccessible to other team members. We realized we needed an alternative that would be as accessible as it was effective.
To solve this problem, STICU staff nurses created an I.V. infusion quick-reference card—an abbreviated version of the reference sheet—which employees now hang on their ID badge. The card covers I.V. drug classifications, concentrations, solutes, minimum and maximum doses, and maintenance doses. Having it available gives nurses the confidence to stay at the patient’s bedside to titrate medications. (See Streamlined I.V. drug card by clicking the PDF icon above.)
Identifying compatibilities of I.V. medications remained challenging for nurses whose patients were receiving multiple I.V. infusion drugs, especially with limited administration sites. We found ourselves spending precious time on the phone verifying I.V. compatibility with pharmacy staff, which delayed patient care and impeded pharmacy productivity. So nursing and pharmacy staff worked together to develop a medication compatibility chart for the most frequently used drugs. It was created and placed in the bedside reference book, reducing drug administration delays.
These tools are used not just by nurses but nursing students, medical students, and residents in training.
Of course, they’re meant to augment, not replace, drug reference books. Nurses on our unit appreciate how much time the tools save them. They no longer have to memorize or second-guess drug concentrations and dosing; they’re more comfortable administering I.V.infusions and feel more confident knowing these resources are right at hand.
Although we can’t eliminate all the stresses of the ICU setting, our easy-access I.V. resources have decreased anxiety and stress. The reference cards have been so well received they’re now available to nursing staff in all adult ICUs, recovery rooms, and the emergency center.
When this article was written, James Stovall, Denise Rios, and Marina Martinez were staff nurses at University Hospital in San Antonio, Texas.