Nurse In Australia » Medication Related

Are nurses injecting incorrectly?

Ross — Tue, 20 Oct 2009 05:17:27 +0000

This week’s interesting video comes from Western Polytech Hospital in America, where hundreds of people recently lined up for flu vaccinations in a makeshift clinic.

What’s interesting about it is that a news story on the clinic sparked some calls from nurse viewers, who were concerned about the injection techniques displayed & queried whether or not in some cases the correct vaccine dose was even being administered.

Watch the video below:

Click to view video if unable to view correctly.

Performing injections correctly takes a bit of practice, and clearly the video shows some pretty sloppy injection techniques. A spokesperson for the clinic stated the injections were performed by RN’s, LPN’s and Physicians.

Having been fairly closely involved with Australian nursing students over the years, personally I’d have to say that their injection techniques in general are of a fairly consistently high standard. Which begs the question – why are the people in the video slackening off? Are they simply not well trained, or is it the repetition of mass injections causing people to slacken off by the time they perform hundreds of injections back to back? Would we expect to see a certain percentage of sloppy injection techniques like this in our mass vaccination clinics also?

Medication Errors: Behind closed doors

Ross — Tue, 09 Jun 2009 05:54:07 +0000

credit: Andres Rueda

Medication errors seems to be a hot topic that is revived from time to time. Often it comes up in a slightly sensationalised form in the media, with grim statistics accompanying a photo of a busy hospital, and comments made on the negative outcomes for recipients of such errors.

Exactly how often do medication errors happen in hospitals?

Statistics paint pictures that make remarkable claims, yet it’s very difficult to validate or construct exact data on the frequency and severity of errors. For instance, according to The Australian, mistakes happen more frequently in Queensland than any other state or territory of Australia.

Delve a little deeper into that claim, however and you’ll find that they are only commenting on 187 deadly or damaging lapses in judgment or procedures that were made public, and working out which state had the most of those… So what they are referring to are situations like when patients have died through medication errors, had surgical instruments left in place or had the wrong blood transfused.

But what of your everyday, run of the mill mistake?

Whilte I’ve been fortunate enough to get by without making any mistakes in the last 10 years (that I know of!), I have been familiar with a few cases that happened in places I’ve worked, for instance:

Someone drew up and gave 10 times the correct amount of short-acting insulin
A nurse drew up suxamethonium and gave the syringe to another nurse who injected it, thinking it was metoclopramide
Nurses drew up a massive amount of potassium to give to a patient in a short time frame according to the order where a new, junior doctor had calculated the doses wrong
Water for injections is used as a flush instead of saline

Most of the errors I’ve come across or heard about have been due to either people working tired, understaffing, junior staff not picking up on erroneous medication dosages, momentary lapses in judgment or failure to follow procedures (ie two staff checking drugs etc).

While errors like these happen from time to time, I’m not so sure they happen quite as frequently as people might assume. Certainly long periods of time go by without any errors being made, and most errors are fairly minor, with little or no consequences.

I’d also like to mention that most errors I have seen have been swept under the rug. By this, I mean covered up, not mentioned to the hospital, or in some cases the order gets changed to reflect what was really given. I’ve seen instances where the patient has been told, but more commonly the patient is not. There has been a definite swing from how things used to be however; it’s easier to report situations now and the ramifications seem to not be as dire for staff involved.

In serious cases everything is made a little more public – the error gets reported to the hospital, goes on the patient’s file, the patient gets told, and disciplinary action goes ahead with the staff member if necessary. Often times however the hospital or greater management disagree with front line staff as to who is responsible and why mistakes have occurred.

How often do errors occur where you work? Is there a foolproof system that exists?!

Sharps and needlesticks

Ross — Mon, 20 Oct 2008 14:09:42 +0000

I’ve been fortunate enough to make it this far in my career without having a needlestick injury.

credit: pikimota

Correction, as a student nurse I discovered that 23g needles for intramuscular injections have caps that are very tight sometimes! So (pre-mastering of technique) I pulled from the end of the cap until it flung off, and I jabbed myself with a clean needle.

Not such a big deal: lesson learned, technique improved!

But thankfully I’ve never had the misfortune of being stuck with a dirty needle. I’ve come across some terrible, terrible work practices though which have left me quite amazed that I made it through without being stuck!

The last hospital I worked at had one doctor in particular (using older style cannula’s with no retractable sharp) who was notorious for putting an IV in, pulling out the sharp, and tossing it wherever he felt like at the time (IV trolley, hidden under gauze, on the floor, in the patients bedding – I’m not kidding). He then proceeded to take bloods and wander off, leaving his mess behind (including the hidden sharp for some lucky finder!)

I’ve seen a few people get stuck from trying to recap, particularly when using small needles.

credit: mendrakis

For the last few years my health facility has used IVC’s with retractable needles, so you press a button after you withdraw the sharp and it retracts into itself. Lately though we’ve been trialling a different type where the withdrawn stylet is covered by a cap as it’s pulled out.

This type also includes an extension set that primes itself with the patient’s blood, so there’s less setup time and a lower risk of needlestick injury.

What are your experiences with sharps? Have you had better or worse experiences with different style IVC’s?

Inotropes and peripheral lines

Ross — Sun, 12 Oct 2008 22:23:57 +0000

I’d be interested to hear of other people’s experience on this subject. Do people run inotropes like noradrenaline (norepinephrine) through peripheral lines at all?

credit: ZaldyImg

Best practice suggests use of a central line to avoid peripheral ischaemia, though I’m aware of several situations recently where peripheral lines were used for inotropes – one argument I’ve seen is that a large bore IV in the cubital fossa region is sufficient (for at least short term) in emergency patients waiting transfer to ICU.

Another situation where I’ve seen it used recently (also cubital fossa) is post arrest.

I haven’t personally been involved in any extravasation issues with inotropes, however I have seen this happen with other infusions (like an IV that tissued at CT, the whole contrast scan 150mls was thrown into the tissues of the arm – not so good!). I can image that inotrope leakage into the tissues would not go over too well..