ISMP Updates Safe Injection Practices for IV Push Medication
October 12th, 2016
The Institute for Safe Medication Practice (ISMP) recently published the 26-page “ISMP Safe Practice Guidelines for Adult IV Push Medications.” CMS, under tag 405 in the hospital conditions of participation, says hospitals must follow these standards of practice, ensuring their policies and procedures are consistent with these national recognized organizations with expertise in medication preparation and administration. Under the section on accepted standards of practice, ISMP is specifically referenced.
All hospitals should be familiar with this document and implement its recommendations. CMS has a standard on IV medication that was placed in the hospital manual effective June 6, 2014, and April 7, 2015, for Critical Access Hospitals (CAH).
The document is organized into factors that increase the risk of IV push medications in adults, current practices with IV injectable medications, developing consensus guidelines for adult IV push medication, and safe practice guidelines. There is also a conclusion, references, definitions, and a section on future inquiry.
About 90% of all hospitalized patients have some form of infusion therapy. IV medications were associated with 56% of preventable adverse drug events over a 5-year study. The publication lists many other studies that indicate IV medication errors are frequent. There is a lack of established safe practices associated with IV push medication. The ISMP put together an Adult IV Push Medication Safety Summit to identify and gain consensus on the most common risks associated with IV push medications and to standardize the safe administration of parenteral medication though the IV push route. This comes at a time where accreditation organizations like The Joint Commission and CMS are assessing safe injection practices. In fact, CMS issued a survey memo on safe injection practices and has a section on it in the infection control worksheet.
Recommendations included providing IV push medications in a ready-to-administer form. Healthcare facilities should use only commercially available or pharmacy prepared prefilled syringes of IV solutions to flush and lock vascular access devices. If the medication is available in a single-dose vial, then the facility should buy single-dose vials. This is also one of the 10 CDC safe injection practices. Aseptic technique should be used when preparing and administering IV medication, including hand hygiene before and after administration. The diaphragm on the vial should be disinfected even if newly opened. This is also contained in the CMS infection control worksheet section on safe injection practices. The top should be cleaned using friction and a sterile, 70% isopropyl alcohol, ethyl alcohol, iodophor, or other approved antiseptic swab for at least 10 seconds. Medication from a glass vial should be with a filter needle unless the specific drug precludes it. Medication should only be diluted when recommended by the manufacturer or in accordance with evidence-based practice or approved hospital policies. If IV push medication needs to be diluted or reconstituted, do it in a clean, uncluttered, and separate location. This is also a CMS pharmacy standard. Medication should not be withdrawn from a commercially available, cartridge-type syringe into another syringe for administration. It is also important that medication not be drawn up into the commercially prepared and prefilled 0.9% saline flushes.
Hospitals and other healthcare facilities should have a copy of this document, which is available here. The recommendations should be incorporated into policies and procedures. Staff should be trained on these policies in orientation and periodically down the road. IV injection safety is not only a nursing issue since others in the hospital may have responsibility for preparing and administering IV medication. Phlebitis and other complications from IVs have resulted in hospitals being penalized for readmissions.
The CDC 10 safe injection practices are in the CMS infection control worksheet issued Nov. 26, 2014, and the safe injection practices memo, dated June 15, 2012, can be accessed here.
Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, Section on Safe Injection Practices III.A.1.b., is here.
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