{"id":908,"date":"2015-06-07T23:02:58","date_gmt":"2015-06-08T03:02:58","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/6-11-complications-of-intravenous-medications-and-management-of-complications\/"},"modified":"2019-09-30T14:02:31","modified_gmt":"2019-09-30T18:02:31","slug":"7-8-iv-medications-adverse-events-and-management-of-adverse-reactions","status":"publish","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/7-8-iv-medications-adverse-events-and-management-of-adverse-reactions\/","title":{"raw":"7.8  IV Medications Adverse Events and Management of Adverse Reactions","rendered":"7.8  IV Medications Adverse Events and Management of Adverse Reactions"},"content":{"raw":"Safe medication administration requires special attention to transition points where medication errors are more likely to occur. For example, many errors occur in the ordering and preparing phase. Many parenteral medications are considered high-alert medications because of the potential significant harm when used in error. Therefore, these medications require special safeguards to reduce the risk of error.\u00a0ISMP (2014) lists IV medications classified as high alert. All parenteral routes of insulin (SC\/IV) are considered high alert (ISMP, 2014). Specific safeguards may include:\r\n<ul>\r\n \t<li>Know the safe dosage range for each medication you administer.<\/li>\r\n \t<li>Label all medications that are prepared away from the bedside and not in the original container.<\/li>\r\n \t<li>Refer to the ISMP lists for high-alert medications:\u00a0do not crush, do not use any error-prone abbreviations or look-\/sound-alike drugs and symbols.<\/li>\r\n \t<li>Never assume an ordered medication dose is the correct medication or correct dose. Know your medications.<\/li>\r\n<\/ul>\r\nIn addition, complications may occur if medication is injected incorrectly, if incorrect equipment (needle or syringe) is used to prepare the medication, or if an error occurs in preparing (calculation, selection of the med), administration, or post-assessment of the patient receiving the medication.\u00a0Additional complications may include nerve or tissue damage, medication being absorbed too fast or too slow, wrong location for the medication (i.e., heparin given IM instead of SC), pain, bleeding, or a sterile abscess (Perry et al., 20148.\r\n\r\nDespite safe medication administration practices, an adverse reaction may happen to a patient for a variety of complex reasons and contributing factors (College of Nurses of Ontario, 2015). An <strong>adverse reaction, <\/strong>also known as an<strong> adverse event<\/strong>, is an undesirable effect of any health product such as prescription and non-prescription pharmaceuticals, vaccines, serums, and blood-derived products; cells, tissues, and organs; disinfectants; and radiopharmaceuticals. An adverse reaction may occur under normal use and conditions of the product. Reactions may be evident within minutes or years after exposure to the product and may range from minor reactions, like a skin rash, to serious and life-threatening events such as a heart attack or liver damage (Health Canada, 2012). For example, some IV bolus medications may cause a sudden drop in blood pressure or\u00a0heart rate, or hives may result.\r\n<h2>Complications of Intravenous Medications<\/h2>\r\nComplications may result from direct, continuous, or secondary IV medications. The complications are not specific to one medication. It is important for the health care provider to know which adverse event may occur with each individual medication. For example, the administration of an IV opioid (narcotic) medication could result in respiratory depression. Table 7.9 provides a list of possible complications and related interventions.\r\n<table style=\"height: 666px\">\r\n<tbody>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000;text-align: left\" colspan=\"4\">\r\n<h3 style=\"text-align: center\">Table 7.9 Possible Complications related to IV medications and Related Interventions<\/h3>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\r\n<h4 style=\"text-align: center\">Complications<\/h4>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\r\n<h4 style=\"text-align: center\">Related Interventions<\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\"><strong>Speed shock<\/strong>: A systemic reaction caused by the rapid injection of a medication into the circulation, resulting in toxic levels of medication in the plasma. Symptoms can include cardiac arrest, flushed face, headache, irregular pulse, shock, syncope, and tightness in the chest.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Use a peripheral IV site, if possible, to allow for maximum hemodilution before the medication reaches the heart\/brain. Stay with the patient and observe for symptoms or changes in vital signs and level of consciousness during and after administration. Stop the injection immediately if the patient develops signs or symptoms of circulatory (drop in BP), respiratory (dyspnea), or neurological (decrease in LOC) deterioration during administration.<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\"><strong>IV medication is incompatible with IV fluids or residual meds in the same IV line<\/strong>: Results in chemical or physical changes in their composition. Precipitates may form, colour may change (e.g., IV fluid becomes cloudy in the IV tubing), or the change may not be visible. Therapeutic effect of the medication may be reduced, obliterated, or potentiated. Toxic substances may be formed.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Always follow the guidelines in the PDTM.\u00a0Do not mix medications in one syringe and only give one medication at a time. Never add medications to blood, blood products, or\u00a0 parenteral nutrition. To avoid mixing of medications, ensure IV tubing and injection ports are flushed adequately between medication administrations.\r\n\r\nIf precipitates are noted in the tubing, stop the infusion. Prime a new IV line and change at the cannula site. Flush IV catheter with normal saline.\r\n\r\nDocument\u00a0 and notify prescriber. Report incident as per agency policy.<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">IV site shows signs of <strong>phlebitis or irritation<\/strong>: Injection of medication into a vein may cause inflammation or roughening of the endothelial lining (phlebitis), which can result in thrombus formation.\r\n<div id=\"pagecontroller\">\r\n<div><section class=\"ContentButtons\">\r\n<div><article>Septic thrombophlebitis can result from poor aseptic technique.<\/article><\/div>\r\n<\/section><\/div>\r\n<\/div><\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Dilute and administer IV meds according to PDTM. WArm compress may encourage vasodilation and provide patient comfort.Monitor for signs and symptoms of phlebitis: redness, swelling, pain, blanching, and streaking. If these signs are present, stop infusion immediately. Discontinue access device and restart in another site.\u00a0 If required, provide extravasation care as per agency policy.\r\n\r\nSepsis may present as fever, chills, general malaise. Report symptoms to prescriber and investigate cause of symptoms.<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\"><span style=\"font-size: 16.8px\">Medication may also be inadvertently injected into surrounding tissue (<\/span><strong style=\"font-size: 16.8px\">infiltration<\/strong><span style=\"font-size: 16.8px\">) and cause tenderness, swelling and pain. Some agents when infused into tissue cause these symptoms plus tissue necrosis and \/or nerve damage. The later is referred to as\u00a0<\/span><strong style=\"font-size: 16.8px\">extravasation.\u00a0<\/strong><span style=\"font-size: 16.8px\">Agents that can cause extravasation include chemotherapeutic agents<\/span><\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\r\n<p style=\"font-size: 16.8px\">Ensure IVs are patent prior to administering IV medication. Monitor for signs and symptoms of infiltration.<\/p>\r\n<p style=\"font-size: 16.8px\">Sites that are infiltrating must be stopped. Check to determine if the medication is a vesicant and follow agency protocols if infiltration has occurred..<\/p>\r\n<p style=\"font-size: 16.8px\">Document and notify prescriber. Report incident as per agency policy.<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"4\">Data source: Alberta Health Services, 2009;\u00a0Children\u2019s Hospitals and Clinics of Minnesota, 2018; Lynn, 2011<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\nTable 7.10 lists five\u00a0steps to manage an adverse reaction.\r\n<table>\r\n<tbody>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000;text-align: left\" colspan=\"4\">\r\n<h3 style=\"text-align: center\">Table 7.10 Managing Adverse Reactions to IV Medications<\/h3>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\r\n<h4 style=\"text-align: center\">Step<\/h4>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\r\n<h4 style=\"text-align: center\">Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\u00a01.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Immediately stop the injection (or infusion) of the medication. Keep syringe of medication for further investigation of the reaction.<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\u00a02.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Assess and monitor vital signs. Alert other members of the health care team and ask for assistance as required. Provide reassurance to the patient about the event.<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\u00a03.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Notify responsible health care provider.<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\u00a04.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Perform interventions (CPR, O<sub>2<\/sub> support) as required. Ensure patient has a patent IV site for any required medications to manage the adverse reaction.<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\u00a05.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Document and report the event through PSLS or agency-specified reporting system.<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"4\">Data source: Alberta Health Services, 2009; Clayton et al., 2010; College of Nurses of Ontario, 2015; Health Canada, 2012<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<h2>Reporting Medication Errors<\/h2>\r\nMedication errors are the leading cause of preventable errors in Canada (ISMP Canada, 2014a). A <strong>medication incident<\/strong>\u00a0is \"any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer. Medication incidents may be related to professional practice, drug products, procedures, and systems, and include prescribing, order communication, product labelling \/ packaging \/ nomenclature, compounding, dispensing, distribution, administration, education, monitoring, and use\" (ISMP Canada, 2014a, p. 8).\r\n\r\nMost of the critical incidents reported to the ISMP occurred during administration of a medication with the wrong quantity of medication. The top five medications were hydromorphone, desmopressin, epinephrine, heparin, and morphine. Opioids continue to be the top medication classes associated with harmful incidents reported. Most of the opioid-related deaths involved overdoses, overlapping drug toxicities, administration of opioids to people who should not have received them, and use of hydromorphone (ISMP Canada, 2014b).\r\n\r\nOverall, the top three contributing factors were communication, independent check processes, and insufficient knowledge (ISMP Canada, 2014a).\u00a0Table 7.11 lists areas for improvement to prevent IV medication errors.\r\n<table style=\"height: 664px\">\r\n<tbody>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000;text-align: left\" colspan=\"2\">\r\n<h3 style=\"text-align: center\">Table 7.11 Areas for Improvement to Prevent IV Medication Errors<\/h3>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000;text-align: center\">\r\n<h4 style=\"text-align: center\">Area<\/h4>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000;text-align: center\">\r\n<h4 style=\"text-align: center\">Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000;text-align: left\">Monitoring of patient after medication administration<\/td>\r\n<td style=\"border: 1px solid #000000;text-align: left\">Be diligent in post-assessments of all IV medications. However, be particularly aware of high-alert medications, such as insulin, opioids, and anticoagulants.\r\n\r\nMany incident reports state that timely observation by a health care provider or family member prevents a bad outcome.\r\n\r\nMany overdoses can be reversed if caught in a timely manner.<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000;text-align: left\">IV infusion pump errors<\/td>\r\n<td style=\"border: 1px solid #000000;text-align: left\">Errors can include:\r\n<ul>\r\n \t<li>Lack of available IV pumps<\/li>\r\n \t<li>Transcription errors such as:\r\n<ul>\r\n \t<li>Decimal point omitted<\/li>\r\n \t<li>Decimal point moved<\/li>\r\n \t<li>Concentration input<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li>Incorrect drug selection<\/li>\r\n \t<li>Multiple line confusion<\/li>\r\n \t<li>Pump setup<\/li>\r\n<\/ul>\r\nTo decrease patient harm, hospitals need additional funding to purchase more IV pumps.<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000;text-align: left\">Health care technology<\/td>\r\n<td style=\"border: 1px solid #000000;text-align: left\">Computer-prescribed order entry (CPOE), automated dispensing cabinets (ADC), and other tools seek to improve patient safety and decrease errors.\r\n\r\nProtocols and force functioning need to be developed to minimize potential errors and to identify potential gaps in the system process.<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000;text-align: left\">Reporting, analysis, and knowledge translation<\/td>\r\n<td style=\"border: 1px solid #000000;text-align: left\">The collection and analysis of incident reports is the backbone to further improvements. Without a robust system, there cannot be the identification of contributing factors to medication incidents.\r\n\r\nAlways report near misses, adverse reactions, and medication errors to ensure investigation and improvement is initiated.\r\n\r\nIn addition, shared learning and strategies are vital for safer health care.<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Data source: Clayton et al., 2010; ISMP Canada, 2014a<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<div class=\"bcc-box bcc-info\">\r\n<h3 style=\"text-align: center\">Critical Thinking Exercises<\/h3>\r\n<ol>\r\n \t<li>List four complications of IV medications, and preventive measures for each one.<\/li>\r\n \t<li>Name two strategies to reduce the risk of harm from high-alert medications.<\/li>\r\n<\/ol>\r\n<\/div>","rendered":"<p>Safe medication administration requires special attention to transition points where medication errors are more likely to occur. For example, many errors occur in the ordering and preparing phase. Many parenteral medications are considered high-alert medications because of the potential significant harm when used in error. Therefore, these medications require special safeguards to reduce the risk of error.\u00a0ISMP (2014) lists IV medications classified as high alert. All parenteral routes of insulin (SC\/IV) are considered high alert (ISMP, 2014). Specific safeguards may include:<\/p>\n<ul>\n<li>Know the safe dosage range for each medication you administer.<\/li>\n<li>Label all medications that are prepared away from the bedside and not in the original container.<\/li>\n<li>Refer to the ISMP lists for high-alert medications:\u00a0do not crush, do not use any error-prone abbreviations or look-\/sound-alike drugs and symbols.<\/li>\n<li>Never assume an ordered medication dose is the correct medication or correct dose. Know your medications.<\/li>\n<\/ul>\n<p>In addition, complications may occur if medication is injected incorrectly, if incorrect equipment (needle or syringe) is used to prepare the medication, or if an error occurs in preparing (calculation, selection of the med), administration, or post-assessment of the patient receiving the medication.\u00a0Additional complications may include nerve or tissue damage, medication being absorbed too fast or too slow, wrong location for the medication (i.e., heparin given IM instead of SC), pain, bleeding, or a sterile abscess (Perry et al., 20148.<\/p>\n<p>Despite safe medication administration practices, an adverse reaction may happen to a patient for a variety of complex reasons and contributing factors (College of Nurses of Ontario, 2015). An <strong>adverse reaction, <\/strong>also known as an<strong> adverse event<\/strong>, is an undesirable effect of any health product such as prescription and non-prescription pharmaceuticals, vaccines, serums, and blood-derived products; cells, tissues, and organs; disinfectants; and radiopharmaceuticals. An adverse reaction may occur under normal use and conditions of the product. Reactions may be evident within minutes or years after exposure to the product and may range from minor reactions, like a skin rash, to serious and life-threatening events such as a heart attack or liver damage (Health Canada, 2012). For example, some IV bolus medications may cause a sudden drop in blood pressure or\u00a0heart rate, or hives may result.<\/p>\n<h2>Complications of Intravenous Medications<\/h2>\n<p>Complications may result from direct, continuous, or secondary IV medications. The complications are not specific to one medication. It is important for the health care provider to know which adverse event may occur with each individual medication. For example, the administration of an IV opioid (narcotic) medication could result in respiratory depression. Table 7.9 provides a list of possible complications and related interventions.<\/p>\n<table style=\"height: 666px\">\n<tbody>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000;text-align: left\" colspan=\"4\">\n<h3 style=\"text-align: center\">Table 7.9 Possible Complications related to IV medications and Related Interventions<\/h3>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\n<h4 style=\"text-align: center\">Complications<\/h4>\n<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\n<h4 style=\"text-align: center\">Related Interventions<\/h4>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\"><strong>Speed shock<\/strong>: A systemic reaction caused by the rapid injection of a medication into the circulation, resulting in toxic levels of medication in the plasma. Symptoms can include cardiac arrest, flushed face, headache, irregular pulse, shock, syncope, and tightness in the chest.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Use a peripheral IV site, if possible, to allow for maximum hemodilution before the medication reaches the heart\/brain. Stay with the patient and observe for symptoms or changes in vital signs and level of consciousness during and after administration. Stop the injection immediately if the patient develops signs or symptoms of circulatory (drop in BP), respiratory (dyspnea), or neurological (decrease in LOC) deterioration during administration.<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000\" colspan=\"2\"><strong>IV medication is incompatible with IV fluids or residual meds in the same IV line<\/strong>: Results in chemical or physical changes in their composition. Precipitates may form, colour may change (e.g., IV fluid becomes cloudy in the IV tubing), or the change may not be visible. Therapeutic effect of the medication may be reduced, obliterated, or potentiated. Toxic substances may be formed.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Always follow the guidelines in the PDTM.\u00a0Do not mix medications in one syringe and only give one medication at a time. Never add medications to blood, blood products, or\u00a0 parenteral nutrition. To avoid mixing of medications, ensure IV tubing and injection ports are flushed adequately between medication administrations.<\/p>\n<p>If precipitates are noted in the tubing, stop the infusion. Prime a new IV line and change at the cannula site. Flush IV catheter with normal saline.<\/p>\n<p>Document\u00a0 and notify prescriber. Report incident as per agency policy.<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">IV site shows signs of <strong>phlebitis or irritation<\/strong>: Injection of medication into a vein may cause inflammation or roughening of the endothelial lining (phlebitis), which can result in thrombus formation.<\/p>\n<div id=\"pagecontroller\">\n<div>\n<section class=\"ContentButtons\">\n<div>\n<article>Septic thrombophlebitis can result from poor aseptic technique.<\/article>\n<\/div>\n<\/section>\n<\/div>\n<\/div>\n<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Dilute and administer IV meds according to PDTM. WArm compress may encourage vasodilation and provide patient comfort.Monitor for signs and symptoms of phlebitis: redness, swelling, pain, blanching, and streaking. If these signs are present, stop infusion immediately. Discontinue access device and restart in another site.\u00a0 If required, provide extravasation care as per agency policy.<\/p>\n<p>Sepsis may present as fever, chills, general malaise. Report symptoms to prescriber and investigate cause of symptoms.<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000\" colspan=\"2\"><span style=\"font-size: 16.8px\">Medication may also be inadvertently injected into surrounding tissue (<\/span><strong style=\"font-size: 16.8px\">infiltration<\/strong><span style=\"font-size: 16.8px\">) and cause tenderness, swelling and pain. Some agents when infused into tissue cause these symptoms plus tissue necrosis and \/or nerve damage. The later is referred to as\u00a0<\/span><strong style=\"font-size: 16.8px\">extravasation.\u00a0<\/strong><span style=\"font-size: 16.8px\">Agents that can cause extravasation include chemotherapeutic agents<\/span><\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\n<p style=\"font-size: 16.8px\">Ensure IVs are patent prior to administering IV medication. Monitor for signs and symptoms of infiltration.<\/p>\n<p style=\"font-size: 16.8px\">Sites that are infiltrating must be stopped. Check to determine if the medication is a vesicant and follow agency protocols if infiltration has occurred..<\/p>\n<p style=\"font-size: 16.8px\">Document and notify prescriber. Report incident as per agency policy.<\/p>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"4\">Data source: Alberta Health Services, 2009;\u00a0Children\u2019s Hospitals and Clinics of Minnesota, 2018; Lynn, 2011<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>Table 7.10 lists five\u00a0steps to manage an adverse reaction.<\/p>\n<table>\n<tbody>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000;text-align: left\" colspan=\"4\">\n<h3 style=\"text-align: center\">Table 7.10 Managing Adverse Reactions to IV Medications<\/h3>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\n<h4 style=\"text-align: center\">Step<\/h4>\n<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\n<h4 style=\"text-align: center\">Additional Information<\/h4>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\u00a01.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Immediately stop the injection (or infusion) of the medication. Keep syringe of medication for further investigation of the reaction.<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\u00a02.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Assess and monitor vital signs. Alert other members of the health care team and ask for assistance as required. Provide reassurance to the patient about the event.<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\u00a03.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Notify responsible health care provider.<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\u00a04.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Perform interventions (CPR, O<sub>2<\/sub> support) as required. Ensure patient has a patent IV site for any required medications to manage the adverse reaction.<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\u00a05.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Document and report the event through PSLS or agency-specified reporting system.<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"4\">Data source: Alberta Health Services, 2009; Clayton et al., 2010; College of Nurses of Ontario, 2015; Health Canada, 2012<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2>Reporting Medication Errors<\/h2>\n<p>Medication errors are the leading cause of preventable errors in Canada (ISMP Canada, 2014a). A <strong>medication incident<\/strong>\u00a0is &#8220;any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer. Medication incidents may be related to professional practice, drug products, procedures, and systems, and include prescribing, order communication, product labelling \/ packaging \/ nomenclature, compounding, dispensing, distribution, administration, education, monitoring, and use&#8221; (ISMP Canada, 2014a, p. 8).<\/p>\n<p>Most of the critical incidents reported to the ISMP occurred during administration of a medication with the wrong quantity of medication. The top five medications were hydromorphone, desmopressin, epinephrine, heparin, and morphine. Opioids continue to be the top medication classes associated with harmful incidents reported. Most of the opioid-related deaths involved overdoses, overlapping drug toxicities, administration of opioids to people who should not have received them, and use of hydromorphone (ISMP Canada, 2014b).<\/p>\n<p>Overall, the top three contributing factors were communication, independent check processes, and insufficient knowledge (ISMP Canada, 2014a).\u00a0Table 7.11 lists areas for improvement to prevent IV medication errors.<\/p>\n<table style=\"height: 664px\">\n<tbody>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000;text-align: left\" colspan=\"2\">\n<h3 style=\"text-align: center\">Table 7.11 Areas for Improvement to Prevent IV Medication Errors<\/h3>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000;text-align: center\">\n<h4 style=\"text-align: center\">Area<\/h4>\n<\/td>\n<td style=\"border: 1px solid #000000;text-align: center\">\n<h4 style=\"text-align: center\">Additional Information<\/h4>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000;text-align: left\">Monitoring of patient after medication administration<\/td>\n<td style=\"border: 1px solid #000000;text-align: left\">Be diligent in post-assessments of all IV medications. However, be particularly aware of high-alert medications, such as insulin, opioids, and anticoagulants.<\/p>\n<p>Many incident reports state that timely observation by a health care provider or family member prevents a bad outcome.<\/p>\n<p>Many overdoses can be reversed if caught in a timely manner.<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000;text-align: left\">IV infusion pump errors<\/td>\n<td style=\"border: 1px solid #000000;text-align: left\">Errors can include:<\/p>\n<ul>\n<li>Lack of available IV pumps<\/li>\n<li>Transcription errors such as:\n<ul>\n<li>Decimal point omitted<\/li>\n<li>Decimal point moved<\/li>\n<li>Concentration input<\/li>\n<\/ul>\n<\/li>\n<li>Incorrect drug selection<\/li>\n<li>Multiple line confusion<\/li>\n<li>Pump setup<\/li>\n<\/ul>\n<p>To decrease patient harm, hospitals need additional funding to purchase more IV pumps.<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000;text-align: left\">Health care technology<\/td>\n<td style=\"border: 1px solid #000000;text-align: left\">Computer-prescribed order entry (CPOE), automated dispensing cabinets (ADC), and other tools seek to improve patient safety and decrease errors.<\/p>\n<p>Protocols and force functioning need to be developed to minimize potential errors and to identify potential gaps in the system process.<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000;text-align: left\">Reporting, analysis, and knowledge translation<\/td>\n<td style=\"border: 1px solid #000000;text-align: left\">The collection and analysis of incident reports is the backbone to further improvements. Without a robust system, there cannot be the identification of contributing factors to medication incidents.<\/p>\n<p>Always report near misses, adverse reactions, and medication errors to ensure investigation and improvement is initiated.<\/p>\n<p>In addition, shared learning and strategies are vital for safer health care.<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Data source: Clayton et al., 2010; ISMP Canada, 2014a<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div class=\"bcc-box bcc-info\">\n<h3 style=\"text-align: center\">Critical Thinking Exercises<\/h3>\n<ol>\n<li>List four complications of IV medications, and preventive measures for each one.<\/li>\n<li>Name two strategies to reduce the risk of harm from high-alert medications.<\/li>\n<\/ol>\n<\/div>\n","protected":false},"author":397,"menu_order":8,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":"cc-by"},"chapter-type":[],"contributor":[],"license":[50],"class_list":["post-908","chapter","type-chapter","status-publish","hentry","license-cc-by"],"part":809,"_links":{"self":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/908","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/users\/397"}],"version-history":[{"count":23,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/908\/revisions"}],"predecessor-version":[{"id":5143,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/908\/revisions\/5143"}],"part":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/parts\/809"}],"metadata":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/908\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/media?parent=908"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapter-type?post=908"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/contributor?post=908"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/license?post=908"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}