1 Skill Checklists for Taylor's Clinical Nursing Skills. A Nursing Process Approach, 5th edition Name Date Unit Position Instructor/Evaluator: Position SKILL 5-11 Administering Medications by Intravenous Bolus or Push Through a Medication or Drug-Infusion Lock Goal: The medication is delivered via the IV route and the Excellent Satisfactory Needs Practice patient experiences the intended effect of the medication. Comments 1. Gather equipment. Check the medication order against the original order in the health record, according to facility policy. Clarify any inconsistencies. Check the patient’s health record for allergies. Check a drug resource to clarify whether medication needs to be diluted before bolus administration. Verify the recommended administration rate. 2. Know the actions, special nursing considerations, safe dose ranges, purpose of administration, and adverse effects of the medications to be administered. Consider the appropriateness of the medication for this patient. 3. Perform hand hygiene. 4. Move the medication supply system to the outside of the patient’s room or prepare for administration at the medication supply system in the medication area. Alternatively, access the medication administration supply system at or inside the patient’s room. 5. Unlock the medication supply system or drawer. Enter pass code and scan employee identifcation, if required. 6. Prepare medication for one patient at a time. 7. Read the eMAR/MAR and select the proper medication from medication supply system or the patient’s medication drawer. 8. Compare the label with the eMAR/MAR. Check expiration dates and perform calculations, if necessary. Scan the bar code on the package, if required. 9. If necessary, withdraw medication from an ampule or vial. 10. Depending on facility policy, the third check of the label may occur at this point. If so, when all medications for one patient have been prepared, recheck the labels with the eMAR/MAR before taking the medications to the patient. However, many facilities require the third check to occur at the bedside, after identifying the patient. 11. Lock the medication supply system before leaving it. 12. Transport medications and equipment to the patient’s bedside carefully, and keep the medications in sight at all times. Copyright © 2019 Wolters Kluwer. 2 SKILL 5-11 Administering Medications by Intravenous Bolus or Push Through a Medication or Drug-Infusion Lock (Continued) Excellent Satisfactory Needs Practice Comments 13. Ensure that the patient receives the medications at the correct time. 14. Perform hand hygiene and put on PPE, if indicated. 15. Identify the patient. Compare the information with the eMAR/ MAR. The patient should be identifed using at least two of the following methods (The Joint Commission, 2018): a. Check the name on the patient’s identifcation band. b. Check the identifcation number on the patient’s identifcation band. c. Check the birth date on the patient’s identifcation band. d. Ask the patient to state his or her name and birth date, based on facility policy. 16. Close the door to the room or pull the bedside curtain. 17. Complete necessary assessments before administering medications. Check the patient’s allergy bracelet or ask the patient about allergies. Explain the purpose and action of the medication to the patient. 18. Scan the patient’s bar code on the identifcation band, if required. 19. Based on facility policy, the third check of the label may occur at this point. If so, recheck the labels with the eMAR/ MAR before administering the medications to the patient. 20. Assess IV site for presence of infammation or infltration. 21. Put on clean gloves. 22. Remove the passive disinfection cap from the needleless connector or access port of the medication lock. Alternatively, if a passive disinfection cap is not in place, use an antimicrobial swab to vigorously scrub the needleless connector or access port of the medication lock and allow to dry. 23. Uncap saline fush syringe. Stabilize the port with your nondominant hand and insert the saline fush syringe into the needleless connector or end cap on the access port of the medication lock. 24. Release the clamp on the extension tubing of the medication lock. Pull back on the syringe plunger to aspirate the catheter for positive blood return. If positive, instill the solution over 1 minute or fush the line according to facility policy. Observe the insertion site while inserting the saline. Remove syringe. Copyright © 2019 Wolters Kluwer. 3 SKILL 5-11 Administering Medications by Intravenous Bolus or Push Through a Medication or Drug-Infusion Lock (Continued) Excellent Satisfactory Needs Practice Comments 25. Use an antimicrobial swab to vigorously scrub the needleless connector or end cap on the access port of the medication lock and allow to dry. 26. Uncap the medication syringe. Insert the medication syringe into the needleless connector or end cap on the access port of the medication lock. Using a watch or clock with a second- hand to time the rate, inject the medication at the recommended rate. Do not force the injection if resistance is felt. 27. While administering the medication, observe the infusion site and assess patient for any adverse reaction. If signs of adverse reaction occur, stop infusion immediately and notify the primary health provider. 28. Remove the medication syringe from the access port. Use a new antimicrobial swab to vigorously scrub the needleless connector or end cap on the access port and allow to dry. Stabilize the port with your nondominant hand. Uncap the second saline fush syringe. Insert the saline fush syringe into the needleless connector or end cap on the access port. Instill the fush solution at the same rate as the administered medication (INS, 2016a). 29. If the medication lock is capped with positive pressure valve/device, remove syringe, and then clamp the extension tubing. Alternatively, to gain positive pressure if positive pressure valve/device is not present, clamp the extension tubing as you are still fushing the last of the saline into the medication lock. Remove syringe. 30. Using an antimicrobial swab, vigorously scrub the needleless connector or end cap on the access port of the medication lock and allow to dry. Attach a passive disinfection cap to the needleless connector or end cap on the access port of the medication lock. 31. Discard the syringe in the appropriate receptacle. 32. Remove gloves and additional PPE, if used. Perform hand hygiene. 33. Document the administration of the medication immediately after administration. 34. Evaluate the patient’s response to the medication within an appropriate time frame. Copyright © 2019 Wolters Kluwer..