Practices of IV Therapy Part 1

Slide 1: 

2010 Central Valley Medical Welcome to IV Therapy Thank you

Slide 2: 

Chapter 1 Introduction to IV Therapy

Learning Objectives: 

Learning Objectives Define intravenous ( IV ) therapy. Discuss IV practice and regulation. Identify your role and responsibility for IV therapy. Describe four reasons for administering IV therapy. Compare peripheral and central IV therapy. 3 When you have completed Chapter 1, you will be able to:

Learning Objectives (cont): 

Learning Objectives (cont) Describe and discuss Standard of Ethics Describe and discuss Legal issues Affecting IV Therapy Describe and Discuss Safety Guidelines Differentiate between laws, morals, values, and ethics Describe Standard of Care Describe Scope of Practice Describe Incompetence Describe Negligence 4

Legal and Ethics: 

Legal and Ethics

Know Your LEGAL: 

Know Your LEGAL Your Life Your License Your Decision

What are Laws?: 

What are Laws? Criminal Law – designed to protect members of our society from certain harmful acts of others. Civil Law – concerned with private rights and remedies. Examples: Contract violation. Slander or libel. Trespassing.

Laws Continued: 

Laws Continued Tort A tort is broadly defined as a civil wrong committed against a person or property, excluding a breach of contract. Torts may be intentional (willful) or unintentional (accidental) and, if intentional, may also be crimes

Assault: 

Assault Is a violent crime committed against another person. It may also include intentional physical contact without their consent.

Battery(crime): 

Battery (crime) Use of force against another person typically including physical and harmful contact

What is Malpractice?: 

What is Malpractice? Professional misconduct in the performance of a professional service that results in a liability for negligence or damage.

The 3 D’s: 

The 3 D’s An unintentional tort is caused by negligence. Negligence is also called medical malpractice . Malpractice The 3 Ds must be present for negligence to occur: Duty – health care provider/patient relationship exists. Derelict – health care provider did not live up to the obligation of caring for a patient. Damage – the breach of duty results in damages to the patient or plaintiff.

What are Values: 

What are Values Personal Cultural Set of principals or measurements Social, Political, Moral Identify objects, conditions or characteristics that members or individuals consider important

What are Morals?: 

What are Morals? Individual Societal Principles of Right and Wrong Morals have a greater social element to values and tend to have a very broad acceptance. Morals are far more about good and bad

What are Ethics?: 

What are Ethics? Combination of Morals and Values Rules of conduct Philosophy

ANA Code of Ethics: 

ANA Code of Ethics Provision 1 1.1 Respect for human dignity 1.2 Relationships to patients 1.3 The nature of health problems 1.4 The right to self-determination 1.5 Relationships with colleagues and others Provision 2 2.1 Primacy of the patient's interests 2.2 Conflict of interest for nurses 2.3 Collaboration 2.4 Professional boundaries

ANA Code of Ethics (cont): 

ANA Code of Ethics (cont) Provision 3 3.1 Privacy 3.2 Confidentiality 3.3 Protection of participants in research 3.4 Standards and review mechanisms 3.5 Acting on questionable practice 3.6 Addressing impaired practice Provision 4 4.1 Acceptance of accountability and responsibility 4.2 Accountability for nursing judgment and action 4.3 Responsibility for nursing judgment and action 4.4 Delegation of nursing activities

ANA Code of Ethics (cont): 

ANA Code of Ethics (cont) Provision 5 5.1 Moral self-respect 5.2 Professional growth and maintenance of competence 5.3 Wholeness of character 5.4 Preservation of integrity Provision 6 6.1 Influence of the environment on moral virtues and values 6.2 Influence of the environment on ethical obligations 6.3 Responsibility for the health care environment

ANA Code of Ethics (cont): 

ANA Code of Ethics (cont) Provision 5 5.1 Moral self-respect 5.2 Professional growth and maintenance of competence 5.3 Wholeness of character 5.4 Preservation of integrity Provision 6 6.1 Influence of the environment on moral virtues and values 6.2 Influence of the environment on ethical obligations 6.3 Responsibility for the health care environment

ANA Code of Ethics (cont): 

ANA Code of Ethics (cont) Provision 7 7.1 Advancing the profession through active involvement in nursing and in health care policy 7.2 Advancing the profession by developing, maintaining, and implementing professional standards in clinical, administrative, and educational practice 7.3 Advancing the profession through knowledge development, dissemination, and application to practice Provision 8 8.1 Health needs and concerns 8.2 Responsibilities to the public

ANA Code of Ethics (cont): 

ANA Code of Ethics (cont) Provision 9 9.1 Assertion of values 9.2 The profession carries out its collective responsibility through professional associations 9.3 Intra-professional Integrity 9.4 Social Reform

Infusion Nurses Society: 

Infusion Nurses Society Independence Doing right for the Patient Do no harm Honesty Loyalty Righteousness Obligation to the patient Obligation to the profession Obligation to society

Legal Issues Affecting IV Therapy: 

Legal Issues Affecting IV Therapy Can you think of something that may affect IV Therapy?

Incorrect Medications: 

Incorrect Medications Confused Drug Names Like Names Like Labels Regular vs. Lantus

Incorrect Dose: 

Incorrect Dose Mg’s instead of Mcgs 10 Units instead of 100 units

Incorrect Time: 

Incorrect Time Gave in the AM vs. PM Did not hold Feedings Did not hold IV Fluids

Incorrect Patient: 

Incorrect Patient Same Name Same Room Mother vs. Child

Improper Technique: 

Improper Technique Repeat Sticks Use of wrong arm Use of feet Reuse of same needle

Causing Further Harm: 

Causing Further Harm Arterial damage Nerve Damage Skin and tissue damage Circulatory Damage Infection

What Can You Do?: 

What Can You Do? Communicate Effectively Document Well Follow Scope of Practice Follow Policies and Procedures Maintain HIPPA

Safety Guidelines: 

Safety Guidelines Follow Safety Guidelines

Slide 32: 

Obtain Knowledge Learn to Use equipment correctly Obtain Correct Orders Know why you are using IV Therapy Know your Medications Assess your patient Maintain your IV Know standards of care Document INS Safety Guidelines

LVN Standards of Practice: 

LVN Standards of Practice Performance Standards . Nurses should safeguard patients'/clients' health and safety by actions that include but are not limited to the following: (1) Reporting to the Board acts specified in Sections 2878 and 2878.5 of the Business and Professions Code; (2) Documenting patient/client care in accordance with standards of the profession; and Nurses should adhere to standards of the profession and shall incorporate ethical and behavioral standards of professional practice which include but are not limited to the following: (1) Maintaining current knowledge and skills for safe and competent practice; (2) Maintaining patient/client confidentiality; (3) Maintaining professional boundaries with the patient/client;

Scope of Practice(cont): 

Scope of Practice(cont) Working outside your scope of practice can make you liable. Working within your scope of practice ensures that you: Do not injure patients or put them at risk by performing procedures that are beyond your ability. Will not be held liable for a standard of care that is beyond your training, experience, and job description if a legal situation arises.

Negligence: 

Negligence Gross Negligence . "gross negligence" means a substantial departure from the standard of care which, under similar circumstances, would have ordinarily been exercised by a competent licensed vocational nurse, and which has or could have resulted in harm to the consumer. An exercise of so slight a degree of care as to justify the belief that there was a conscious disregard or indifference for the health, safety, or welfare of the consumer shall be considered a substantial departure from the above standard of care.

Incompetence: 

Incompetence Incompetence . "incompetence" means the lack of possession of and the failure to exercise that degree of learning, skill, care and experience ordinarily possessed and exercised by responsible licensed vocational nurses.

Abuse Reporting : 

Abuse Reporting Child Abuse Reporting . Nurses are mandated to report known or suspected child abuse cases to a child protective agency. Failure to make a child abuse report as required shall constitute unprofessional conduct Elder Abuse Reporting . Nurses are mandated to report any known or suspected instance of elder physical abuse to an elder protective agency. Failure to make an elder physical abuse report as required shall constitute unprofessional

Employer Reporting: 

Employer Reporting 2520.5. Employer Mandatory Reporting . Employers of licensed vocational nurses shall report, in writing, to the Board the suspension or termination for cause (as defined in Business and Professions Code Section 2878.1(c)) of any licensed vocational nurse in its employ. The report shall be made within 30 calendar days from the effective date of the suspension or termination. Failure to make a report to the Board as required under this section shall constitute a violation of Business and Professions Code Section 2878.1. Note: Authority cited: Sections 2854, Business and Professions Code. Reference: Sections 2859, 2878, 2878.1, and 2878.5, Business and Professions Code. History: 1. New section filed 9-11-2007; operative 10-11-2007 (Register 2007, No. 37).

Licensure and Certification: 

Licensure and Certification

Licensure: 

Licensure Gained by attending an accredited program Sitting for State of National Examination Must be renewed every two years Must obtain 30 CEU’s every 2 years

Certification: 

Certification Optional (CRNI) Recommended for professional advancement Award for recognition Often have to maintain with continuing education

National or Local Organizations: 

National or Local Organizations INS AHA Journal of Nursing

Challenge Your Knowledge: 

Challenge Your Knowledge You are monitoring an IV. The client complains of pain at the insertion site. The skin is cool, pale, and edematous. What are the possible complications that might be occurring? If your client had either phlebitis or thrombosis, what data would you obtain to distinguish one from the other?

What does Intravenous Mean?: 

What does Intravenous Mean? 44 Intravenous ( IV ) means “within a vein” IV therapy is a treatment that infuses products into a vein Products that can be infused include Fluids Medications Nutrients Blood or blood products The IV route permits accurate dosing and a more rapid effect that is necessary during emergencies

IV Therapy Practice and Regulation: 

IV Therapy Practice and Regulation 45 IV therapy practice is closely regulated and monitored Joint Commission for Accreditation of Healthcare Organizations ( JCAHO ) Health Insurance Portability and Accountability Act ( HIPAA ) Centers for Disease Control ( CDC ) National Institute of Occupational Safety and Health ( NIOSH ) Occupational Safety and Health Administration ( OSHA )

Joint Commission for Accreditation of Healthcare Organizations (JCAHO) : 

Joint Commission for Accreditation of Healthcare Organizations (JCAHO) Accredits healthcare facilities to ensure quality patient care Establishes standards published in National Patient Safety Goals Reviews and revises them annually 46 Q UALITY

JCAHO: National Patient Safety Goals: 

JCAHO : National Patient Safety Goals 47 JCAHO Patient Safety Goals that apply to the practice of IV therapy are Goal 1 - Improve the accuracy of patient identification Goal 2 - Improve the effectiveness of communication among caregivers Goal 3 - Improve the safety of using medications Goal 7 - Reduce the risk of infections associated with health care Goal 8 - Reconcile medications accurately and completely across the continuum of care Source: Joint Commission on Accreditation of Healthcare Organizations www.jcaho.org Web site

Health Insurance Portability and Accountability Act (HIPAA) : 

Health Insurance Portability and Accountability Act (HIPAA) Chapter 1 48 Federal law passed in 2003 Protects the privacy and confidentiality of patient information Requires the patient’s permission to discuss health-care issues with a third party

HIPAA & You: 

HIPAA & You Guidelines for care of patients with an IV Close patient room doors when providing care or discussing health issues Do not talk about patients in public places Turn computer screens so passers-by cannot see patient information Log off computer when you finish charting Do not leave patient medical records open for unauthorized viewing 49

Centers for Disease Control (CDC): 

Centers for Disease Control (CDC) 50 Federal agency with the mission to prevent and control Infectious and chronic diseases, including infections related to IV therapy Injuries Workplace hazards Disabilities Environmental threats

National Institute of Occupational Safety & Health (NIOSH): 

National Institute of Occupational Safety & Health (NIOSH) 51 A division of CDC Responsible for conducting research and making recommendations for the prevention of work-related injuries Research into needlestick injuries by NIOSH resulted in the use of safer medical devices such as needleless systems

Occupational Safety and Health Administration (OSHA): 

Occupational Safety and Health Administration (OSHA) Chapter 1 52 Division of the Department of Labor Mission – to assure the safety and health of workers by: Setting and enforcing standards Providing training, outreach, and education Establishing partnerships Encouraging continual improvement in workplace safety and health Established universal and standard precautions and the blood-borne pathogen standard

Needlestick Safety & Prevention Act: 

Needlestick Safety & Prevention Act Chapter 1 53 Became law in 2001 through the combined efforts of NIOSH and OSHA Mandates the use of safety devices shown to be effective in the reduction of needlestick injuries in the clinical setting Authorizes OSHA to impose monetary fines on health-care facilities not using safe-needle devices

Apply Your Knowledge: 

Apply Your Knowledge 54 What is IV therapy, and what products can be given intravenously? ANSWER: IV therapy is a treatment that infuses fluids, medications, nutrients, and blood or blood products into a vein.

Apply Your Knowledge: 

Apply Your Knowledge 55 What law or agency requires health-care facilities to use safety devices to reduce needlestick injuries in the clinical setting? ANSWER: Needlestick Safety & Prevention Act of 2001 Excellent

Roles and Responsibilities: 

Roles and Responsibilities Role and responsibility in the practice of IV therapy are regulated by Scope of practice Training and education Regulatory laws in state of employment The policies of the organization or facility of employment 56

Roles and Responsibilities: 

Roles and Responsibilities Your individual responsibilities Knowing the laws that regulate your practice Knowing whether you have the knowledge and skills to perform the procedure Chapter 1 57

Roles and Responsibilities: 

Roles and Responsibilities Practicing outside your scope could result in injury to the patient and possible malpractice lawsuits. 58 Remember!

Apply Your Knowledge: 

Apply Your Knowledge 59 What are your responsibilities before performing any aspect of IV therapy? ANSWER: You must know the laws that regulate your practice and whether or not you have the knowledge and skills to perform the procedure.