Patient Care
Orders for the Initiation and Management of Infusion Therapy
Policy
Orders are clear, concise, legible, and complete prior to initiating, changing, or discontinuing infusion therapy.
The use of standing orders or order sets is established by the organization.
Verbal or telephone orders are to be signed within a time frame established by the organization.
Procedure
Obtain and review licensed independent practitioner’s (LIP’s) order for:
Patient name
Solution type or medication to be administered
Medication dose
Volume to be infused
Administration route
Infusion rate
Frequency of administration
Special considerations, if applicable
Contact LIP for clarification if the order is not complete or legible.
Determine appropriateness of the order, using the nursing process.
Use only those abbreviations that are standard for the organization.
Limit use of verbal or telephone orders from LIPs to only when medically necessary.
Always “read-back” a verbal or telephone order to verify order.
Bibliography
National Quality Forum. Safe Practices for Better Healthcare, 2009. Update: A Consensus Report. Washington, DC: National Quality Forum; 2009.
Perucca R. Peripheral venous access devices. In: Alexander M, Corrigan A, Gorski L, Hankins J, Perucca R, eds. Infusion Nursing: An Evidence-Based Approach. 3rd ed. St Louis, MO: Saunders/Elsevier; 2010: 456-478.
Reckmann MH, Westbrook JI, Koh Y, Lo C, Day RO. Does computerized provider order entry reduce prescribing errors for hospital inpatients? A systematic review. J Am Med Inform Assoc. 2009;16(5):613-623.
Shamliyan T, Duval S, Du J, Kane R. Just what the doctor ordered: review of the evidence of the impact of computerized physician order entry system on medication errors. Health Serv Res. 2008;43(1):32.
Tully MP, Ashcroft DM, Dornan T, Lewis PJ, Taylor D, Wass V. The causes of and factors associated with prescribing errors in hospital inpatients: a systematic review. Drug Saf. 2009;32(10):819-836.
Patient Assessment
Policy
Patient assessment is performed to establish a baseline for monitoring reactions and response to therapy.
Assessment findings that impact the delivery of care will be reported to appropriate members of the health care team in a timely manner.
Procedure
Obtain and review licensed independent practitioner’s (LIP’s) orders for infusion therapy.
Review the patient’s permanent medical record for:
Age
Allergies
Clinical diagnosis, primary and secondary
History of chronic kidney disease
History of breast cancer and treatment
Complications or conditions that may affect therapy
Previous or current infusion therapy, including transfusion history
Medications, including over-the-counter and herbal preparations
Review pertinent laboratory and imaging studies.
Verify patient’s identity using 2 independent identifiers, not including the patient’s room number or bed number.
Inform patient of the assessment process.
Place patient in a comfortable position and provide privacy during the assessment.
Perform physical assessment.
Vital signs
Temperature, pulse, respiration
Blood pressure
Body weight
Height
Fluid volume status
Intake and output
Skin turgor
Tongue turgor
Moisture in oral cavity
Thirst
Tearing and salivation
Appearance of skin
Facial appearance
Edema
Neck veins
Body systems as appropriate for the therapy
Vascular assessment (see Site Assessment and Selection)
Patient age, condition, and diagnosis
Condition, size, and location of vessel
Type and duration of therapy
Perform psychological assessment.
Patient’s ability to comprehend and understand therapy
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