Study Protocol and Statistical Analysis Plan
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Intravenous Therapy Procedure Manual
INTRAVENOUS THERAPY PROCEDURE MANUAL - 1 - LETTER OF ACCEPTANCE __________________________________________ hereby approves (Facility) the attached Reference Manual as of _____________________. (Date) The Intravenous Therapy Procedure Manual will be reviewed at least annually or more often when deemed appropriate. Revisions will be reviewed as they occur. Current copies of the Intravenous Therapy Procedure Manual shall be maintained at each appropriate nursing station. I have reviewed this manual and agree to its approval. __________________________ (Administrator) __________________________ (Director of Nursing) __________________________ (Medical Director) - 2 - TABLE OF CONTENTS TABLE OF CONTENTS INTRODUCTION A. Purpose 1 B. Local Standard of Practice 1 RESPONSIBILITIES A. Responsibilities: M Chest Pharmacy 1 B. Responsibilities: Administrator 1 C. Responsibilities: Director of Nursing Services (DON/DNS) 1 D. Skills Validation 2 AMENDMENTS GUIDELINES A. Resident Candidacy for IV Therapy 1 B. Excluded IV Medications and Therapies 1 C. Processing the IV Order 1 D. IV Solutions/Medications: Storage 2 E. IV Solutions/Medications: Handling 3 F. IV Solutions and Supplies: Destroying and Returning 4 G. IV Tubing 5 H. Peripheral IV Catheters and Needles 6 I. Central Venous Devices 7 J. Documentation and Monitoring 8 K. IV Medication Administration Times 9 L. Emergency IV Supplies 10 I TABLE OF CONTENTS PROTOCOLS A. IV Antibiotic 1 1. Purpose 2. Guidelines 3. Nursing Responsibilities B. IV Push 2 1. Purpose 2. Guidelines C. Anaphylaxis Allergic Reaction 4 1. Purpose 2. Guidelines 3. Nursing Responsibilities and Interventions 4. Signs and Symptoms of Anaphylaxis 5. Drugs Used to Treat Anaphylaxis 6. Physician Protocol PRACTICE GUIDELINES A. Purpose 1 B. Personnel 1 C. Competencies 1 D. -
An Overview On: Sublingual Route for Systemic Drug Delivery
International Journal of Research in Pharmaceutical and Biomedical Sciences ISSN: 2229-3701 __________________________________________Review Article An Overview on: Sublingual Route for Systemic Drug Delivery K. Patel Nibha1 and SS. Pancholi2* 1Department of Pharmaceutics, BITS Institute of Pharmacy, Gujarat Technological university, Varnama, Vadodara, Gujarat, India 2BITS Institute of Pharmacy, Gujarat Technological University, Varnama, Vadodara, Gujarat, India. __________________________________________________________________________________ ABSTRACT Oral mucosal drug delivery is an alternative and promising method of systemic drug delivery which offers several advantages. Sublingual literally meaning is ''under the tongue'', administrating substance via mouth in such a way that the substance is rapidly absorbed via blood vessels under tongue. Sublingual route offers advantages such as bypasses hepatic first pass metabolic process which gives better bioavailability, rapid onset of action, patient compliance , self-medicated. Dysphagia (difficulty in swallowing) is common among in all ages of people and more in pediatric, geriatric, psychiatric patients. In terms of permeability, sublingual area of oral cavity is more permeable than buccal area which is in turn is more permeable than palatal area. Different techniques are used to formulate the sublingual dosage forms. Sublingual drug administration is applied in field of cardiovascular drugs, steroids, enzymes and some barbiturates. This review highlights advantages, disadvantages, different sublingual formulation such as tablets and films, evaluation. Key Words: Sublingual delivery, techniques, improved bioavailability, evaluation. INTRODUCTION and direct access to systemic circulation, the oral Drugs have been applied to the mucosa for topical mucosal route is suitable for drugs, which are application for many years. However, recently susceptible to acid hydrolysis in the stomach or there has been interest in exploiting the oral cavity which are extensively metabolized in the liver. -
Vaccine Administration Joellen Wolicki, BSN, RN and Elaine Miller, RN, BSN, MPH
Vaccine Administration JoEllen Wolicki, BSN, RN and Elaine Miller, RN, BSN, MPH This chapter summarizes best practices related to vaccine administration, a key factor in ensuring vaccination is as safe NOTES and effective as possible. Administration involves a series of actions: assessing patient vaccination status and determining needed vaccines, screening for contraindications and precautions, educating patients, preparing and administering vaccines properly, and documenting the vaccines administered. Professional standards for medication administration, manufacturer instructions, and organizational policies and procedures should always be followed when applicable. 6 Staff Training and Education Policies should be in place to validate health care professionals’ knowledge of, and skills in, vaccine administration. All health care professionals should receive comprehensive, competency- based training before administering vaccines. Training, including an observation component, should be integrated into health care professionals’ education programs including orientation for new staff and annual continuing education requirements for all staff. In addition, health care professionals should receive educational updates as needed, such as when vaccine administration recommendations are updated or when new vaccines are added to the facility’s inventory. Training should also be offered to temporary staff who may be filling in on days when the facility is short-staffed or helping during peak periods of vaccine administration such as influenza season. Once initial training has been completed, accountability checks should be in place to ensure staff follow all vaccine administration policies and procedures. Before Administering Vaccine Health care professionals should be knowledgeable about appropriate techniques to prepare and care for patients when administering vaccines. Assess for Needed Vaccines The patient’s immunization status should be reviewed at every health care visit. -
Ultrasound-Guided Fascia Iliaca Compartment Block (FICB)
Ultrasound-Guided Fascia Iliaca Compartment Block (FICB) Hip Fracture Any of the following present? 1) Neurologic deficit 2) Multisystem Trauma 3) Allergy to local anesthetic Yes *Anticoagulated patients – physician No discretion Standard Care Procedure Details 1) Document distal neurovascular exam in EPIC 1) PO acetaminophen 2) Consult ortho (do not need to await callback) (1,000mg) 3) Obtain verbal consent from patient 2) Consider 0.1 mg/kg 4) Position Patient and U/S Machine morphine or opioid 5) Order Bupivacaine (dose dependent) a. Max 2 mg/kg equivalent b. i.e. 100 mg safe for 50 kg patient 3) Screening labs, CXR, 6) Standard ASA monitoring (telemetry during procedure with ECG, type and screen continuous pulse oximetry, BP measurement, and IV access) 7) Perform FICB 4) Consult orthopedics and medicine as 8) Inform patients on block characteristics: a. Onset ~ 20 minutes necessary b. Duration ~ 8-12 hours Equipment Required Counseling Ultrasound Machine 1) Linear/Vascular Probe set to “Nerve” Benefits setting for best results Decreases: Anesthetic: 1) Pain 1) 0.5% Bupivacaine (20-30 cc) 2) 1% Lidocaine (3-5 cc) 2) Delirium 3) Opioids Saline (10 cc) 4) Hypoxia Syringes: 1) 30 cc 2) 3-5 cc Risks Needles: 1) Pain at injection site 1) Blunt fill 2) Temporary nerve palsy 2) 25G 3) 18G LP needle 3) Intravascular injection Chloroprep or Alcohol swab(s) 4) Local Anesthetic Systemic Toxicity * (LAST) * LAST (local anesthetic systemic toxicity) 1) Rare and only with intravascular injection which an ultrasound guided approach prevents. 2) Signs include arrhythmias, seizures, convulsions 3) Treatment a. -
Herestraat 49, B-3000 Leuven Yves Kremer, CU Saint-Luc, Av
Editor | Prof. Dr. V. Bonhomme CO-Editors | Dr. Y. Kremer — Prof. Dr. M. Van de Velde ACTA ANAESTHESIOLOGICA JOURNAL OF THE BELGIAN SOCIETY OF ANESTHESIOLOGY, RESUSCITATION, PERIOPERATIVE MEDICINE AND PAIN MANAGEMENT (BeSARPP) BELGICA Indexed in EMBASE l EXCERPTA MEDICA ISSN: 2736-5239 Suppl. 1 202071 Master Theses www.besarpp.be Cover-1 -71/suppl.indd 1 12/01/2021 12:37 ACTA ANÆSTHESIOLOGICA BELGICA 2020 – 71 – Supplement 1 EDITORS Editor-in-chief : Vincent Bonhomme, CHU Liège, av. de l’Hôpital 1, B-4000 Liège Co-Editors : Marc Van de Velde, KU Leuven, Herestraat 49, B-3000 Leuven Yves Kremer, CU Saint-Luc, av. Hippocrate, B-1200 Woluwe-Saint-Lambert Associate Editors : Margaretha Breebaart, UZA, Wilrijkstraat 10, B-2650 Edegem Christian Verborgh, UZ Brussel, Laarbeeklaan 101, B-1090 Jette Fernande Lois, CHU Liège, av. de l’Hôpital 1, B-4000 Liège Annelies Moerman, UZ Gent, C. Heymanslaan 10, B-9000 Gent Mona Monemi, CU Saint-Luc, av. Hippocrate, B-1200 Woluwe-Saint-Lambert Steffen Rex, KU Leuven, Herestraat 49, B-3000 Leuven Editorial assistant Carine Vauchel Dpt of Anesthesia & ICM, CHU Liège, B-4000 Liège Phone: 32-4 321 6470; Email: [email protected] Administration secretaries MediCongress Charlotte Schaek and Astrid Dedrie Noorwegenstraat 49, B-9940 Evergem Phone : +32 9 218 85 85 ; Email : [email protected] Subscription The annual subscription includes 4 issues and supplements (if any). 4 issues 1 issue (+supplements) Belgium 40€ 110€ Other Countries 50€ 150€ BeSARPP account number : BE97 0018 1614 5649 - Swift GEBABEBB Publicity : Luc Foubert, treasurer, OLV Ziekenhuis Aalst, Moorselbaan 164, B-9300 Aalst, phone: +32 53 72 44 61 ; Email : [email protected] Responsible Editor : Prof. -
Chapter 1 Controlling Drug Delivery
chapter 1 Controlling drug delivery Overview In this chapter we will: & differentiate drug delivery systems according to their physical state & differentiate drug delivery systems according to their route of administration & differentiate drug delivery systems according to their type of drug release & discuss drug transport across epithelial barriers. Introduction KeyPoints & Continued developments in Pharmacotherapy can be defined as the treatment chemistry, molecular biology and prevention of illness and disease by means of and genomics support the drugs of chemical or biological origin. It ranks discovery and developments among the most important methods of medical of new drugs and new drug treatment, together with surgery, physical targets. & treatment, radiation and psychotherapy. There The drug delivery system are many success stories concerning the use of employed can control the pharmacological action of a drugs and vaccines in the treatment, prevention drug, influencing its and in some cases even eradication of diseases pharmacokinetic and (e.g. smallpox, which is currently the only subsequent therapeutic human infectious disease completely profile. eradicated). Although it is almost impossible to estimate the exact extent of the impact of pharmacotherapy on human health, there can be no doubt that pharmacotherapy, together with improved sanitation, better diet and better housing, has improved people’s health, life expectancy and quality of life. Tip Unprecedented developments in genomics Combinatorial chemistry is a way to and molecular biology today offer a plethora of build a variety of structurally related new drug targets. The use of modern chemical drug compounds rapidly and synthetic methods (such as combinatorial systematically. These are assembled chemistry) enables the syntheses of a large from a range of molecular entities number of new drug candidates in shorter times which are put together in different ‘ ’ than ever before. -
Drug Administration
Chapter 3: Drug Administration 2 Contact Hours By: Katie Ingersoll, RPh, PharmD Author Disclosure: Katie Ingersoll and Elite do not have any actual or Questions regarding statements of credit and other customer service potential conflicts of interest in relation to this lesson. issues should be directed to 1-888-666-9053. This lesson is $12.00. Universal Activity Number (UAN): 0761-9999-17-079-H01-P Educational Review Systems is accredited by the Activity Type: Knowledge-based Accreditation Council of Pharmacy Education (ACPE) Initial Release Date: April 1, 2017 as a provider of continuing pharmaceutical education. Expiration Date: April 1, 2019 This program is approved for 2 hours (0.2 CEUs) of Target Audience: Pharmacists in a community-based setting. continuing pharmacy education credit. Proof of participation will be posted to your NABP CPE profile within 4 to 6 To Obtain Credit: A minimum test score of 70 percent is needed weeks to participants who have successfully completed the post-test. to obtain a credit. Please submit your answers either by mail, fax, or Participants must participate in the entire presentation and complete online at Pharmacy.EliteCME.com. the course evaluation to receive continuing pharmacy education credit. Learning objectives After completion of this course, healthcare professionals will be able Discuss the administration of medications in patients using enteral to: and parenteral nutrition. Describe the eight rights of medication administration. Discuss special considerations for administering medications in Explain the administration of enteral and parenteral medications. pediatric and geriatric patients. Introduction Medication errors that occur at the point of drug administration poised to reduce the frequency of medication administration errors. -
Inhalation Therapy - Approaches and Challenges
Online - 2455-3891 Vol 11, Issue 4, 2018 Print - 0974-2441 Review Article INHALATION THERAPY - APPROACHES AND CHALLENGES SAYANI BHATTACHARYYA*, BHARANI S SOGALI Department of Pharmaceutics, Krupanidhi College of Pharmacy, No: 12/1 Carmelaram Road, Chikka Bellandur, Varthur, Hobli, Carmelaram Post, Bengaluru – 560 035, Karnataka, India. Email:[email protected] Received: 05 December 2017, Revised and Accepted: 02 January 2018 ABSTRACT Inhalation therapy is an effective way for local and systemic delivery of miscellaneous drugs for pulmonary and non-pulmonary diseases. The inhalation therapy aims to target specific cells or regions of the lung, bypassing the lung’s clearance mechanisms and thereby providing high retention of the drug for longer periods. It helps in improved penetration of intravenously administered antibiotics into lung parenchymal tissue and bronchial secretions, and as a result, their potential systemic toxicity is reduced when given over prolonged periods of time. The advancement in device technology supports the development of more efficient therapy in the form of delivering finer particles into the lung in large doses. Therefore, meticulous daily management of lung disease, together with prompt, aggressive treatment of exacerbations can be achieved through inhalation to preserve lung function. This review summarizes the features of inhalation delivery devices, their advantages and limitations, challenges in formulation and brief description of novel technologies currently marketed. Keywords: Lung, Inhalation, Target, Local delivery, Systemic delivery, Novel technologies. © 2018 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4. 0/) DOI: http://dx.doi.org/10.22159/ajpcr.2018.v11i4.24117 INTRODUCTION while drug localized at the upper airways are removed by ciliated cells in the epithelial region. -
Medication Administration Manual
Medication Administration Course HOW TO USE THIS MANUAL Notes to the instructor have been incorporated into instructor’s note pages that follow the chapter format of the manual and are located at the end of the section. Testing forms are provided for the practicum as well as the written test. There are two versions of the written test with corresponding answer sheets and answer keys. MEDICATION ADMINISTRATION COURSE BACKGROUND Innovations Nursing & Residential Medication Administration Course is designed to accurately administer medications to individuals in DIDD/CDPHE Services approved programs: Group Residential Services and Supports (GRSS), Individual Residential Services and Supports (IRSS), Day Habilitation Services and Supports (DHSS), State certified adult day programs, Adult Supported Living Services (SLS), Children’s Extensive Services (CES). Residential Child Care Facilities Assisted living residences and Alternative care facilities. Any paid staff or provider who administers medications must complete this course and pass the competency evaluation that has been approved. This Medication Administration course will prepare participants for this testing. The course also allows each agency to add agency specific materials and procedures to the information provided. If you work for a different agency, some materials may not apply to you. The material also includes a chapter on ‘Medication Administration from Medication Reminder Boxes.’ This chapter will be taught as part of the initial Medication Administration Course. The training for paid staff or providers that will be filling medication reminder boxes is a separate packet and may only be taught to staff or providers that have passed the Medication Administration Course. INSTRUCTOR REQUIREMENTS To teach this course, the instructor must: • Be a Licensed Nurse (e.g. -
Unit 4: Medication Administration Fundamental of Nursing
Unit 4: Medication Administration Fundamental of Nursing Unit 4: Medication Administration: Medication: Is a substance administered for the diagnosis, cure, treatment, relief, or prevention of disease. Six Rights of Medication Administration After paramedics have received the medication or fluid order, they should then administer the drug in question. In performing drug administration, pre-hospital care providers adhere to the six rights of medication administration: 1. Right patient 2. Right medication 3. Right dose 4. Right route 5. Right time 6. Right documentation Basic principle of nurse on drugs administration 1. The nurse must know the drug's prescribed dose, method of administration, actions, expected therapeutic effect, possible interactions with other drugs, and adverse effects. 2. The nurse must know the institution's administration procedures for the client's welfare and the nurse's legal protection. 3. The nurse must Review physician's order for completeness the client's name, date of the order, name of the drug, dose, rout, time of administration, and the physician's signature. 1 Unit 4: Medication Administration Fundamental of Nursing 4. The nurse discusses the medication and its actions with the client; recheck the medication order if the client disagrees with the dose or the physician's order. 5. The nurse must check the physician's order against the client's medication administration record for accuracy. 6. The nurse gives the patient the right to know about the medication he is receiving and the right to refuse it. Routes of Administration A: Enteral Tract Routes The common enteral routes of administration used in general medical practice are as follows: 1. -
Medication Administration
MEDICATION ADMINISTRATION GENERAL CONSIDERATIONS A. Before administering any medication, the EMT should know: 1. What is the medication being used? 2. Does the patient have an allergy to this medication? 3. What is the safe and effective dose? 4. What is the correct administration route? 5. What are the indications? (Why are you using is?) 6. What are the contraindications? (Why or when would you NOT use this medication?) 7. What are the expected effects? 8. What are the adverse effects / side effects? 9. Is the medication expired? B. The “Six Rights” of medication administration: 1. Right patient – is the medication indicated for this patient; no contraindications; no allergies 2. Right drug – the correct name (trade name vs. generic name); correct concentration 3. Right dose 4. Right route 5. Right time – slow IVP vs. rapid IVP 6. Right documentation C. Correct documentation of medications administered and/or IV/IO placement will include: 1. Time of medication administration; IV/IO placement 2. Route of administration 3. Size of catheter (IV/IO) 4. Site location for IV/IO and SQ, IM medication (include unsuccessful IV/IO attempt locations) 5. Dose or volume infused 6. Time of infusion as indicated (e.g., rapid IVP, infused over 10 minutes, etc.) 7. Name of EMT responsible 8. Any complications and steps made to correct 9. Patient’s response to treatment D. Use of a medication simply because it is in the protocol is not an acceptable standard of medical care. When there are questions about medication administration, consult medical control. ORAL ADMINSTRATION To administer an oral (PO) medication ensure that the patient has an intact gag reflex and place the patient in a seated or semi-seated position. -
Fascia Iliaca Block in the Emergency Department
The Royal College of Emergency Medicine Best Practice Guideline Fascia Iliaca Block in the Emergency Department 1 Revised: July 2020 Contents Summary of recommendations ...................................................................................................... 3 Scope ..................................................................................................................................................... 4 Reason for development ................................................................................................................. 4 Introduction .......................................................................................................................................... 4 Considerations ..................................................................................................................................... 4 Safety of FIB ...................................................................................................................................... 4 Improving safety of FIB .................................................................................................................. 5 Controversies regarding FIB ......................................................................................................... 5 Efficacy of FIB ................................................................................................................................... 6 Procedures within ED ....................................................................................................................