Author: Loretta K Dorn, MSN RN CRNI
Title: Director of Clinical Nurse Liaisons
Institution: Fresenius Kabi
Coauthors: • Elizabeth (Liz) Campbell, MSN RN, CRNI® Vascular access team Newton-Wellesley Hospital • Denise Dion, MSN, RN, CNE, PCCN Professor Nursing Program at Central Arizona College • Candy Cross MSN-Ed, RN Adjunct Faculty Chandler Gilbert Community College • Marlene M. Steinheiser, PhD, RN, CRNI® Director of Clinical Education Infusion Nurses Society • Susan Paparella, MSN, RN Vice President at the Institute for Safe Medication Practices (ISMP) • Michelle Mandrack, MSN, RN Director of Consulting Services at the Institute for Safe Medication Practices (ISMP) • Visnja Maria Masina, DNP, RN, AGCNS-BC, Adult Clinical Nurse Specialist Cleveland Clinic main campus • Christina Colvin, MSN, APRN, AOCNS, CRNI® Clinical Nurse Specialist Cleveland Clinic main campus • Heather Witek BSN RN Sr Medical Affairs Specialist ICU Medical
Evidence-Based Practice, Quality Improvement, Safety
New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, Staff Development
Clinical Setting, Skills or Simulation Laboratories
This checklist is designed as a tool to:
• Support the adoption of safe, standardized practices associated with IV push medication use.
• Assist nurse educators in performing a standard competency assessment for nursing students and practicing nurses related to IV Push medication administration.
There is a lack of standardized IV Push medication preparation and administration teaching strategies in nursing programs throughout the United States. This lack of standardization creates an alarming variation in clinical practice that places patients at a higher risk of harm. The goal of this practice strategy is to provide college nursing programs, hospital nursing residency programs, and any area of practice where IV Push medication is given, an Evidence-Based Practice guide and checklist of best practice standards to utilize in educating student nurses, novice nurses, and experienced nurses, to assess competency in skill acquisition related to IV push medication administration. The checklist when used in nursing will create best practices and reduce patient harm. Nurses that understand evidence-based practice create an environment of patient safety and a knowledgeable professional that can teach and mentor other nurses to ensure continued standardization.
The Checklist was created to provide easy access to the practice standards and competency checklist for all nursing programs through QSEN’s website, and the Patient Safety Task Force website, and to publish articles in educational journals of nursing and current nursing practice journals
Gorski, L., Hadaway, L., Hagle, M., Broadhurst, D., Clare, S., Kleidon, T., . . . Alexander, M. (2021). Infusion Therapy Standards of Practice. Journal of Infusion Nursing, 8th edition.
Institute for Safe Medication Practices. (2015). Safe Practice Guidelines for Adult IV Push Medications. Retrieved from Institute for Safe Medication Practices: https://www.ismp.org/sites/default/files/attachments/2017-11/ISMP97-Guidelines-071415-3.%20FINAL.pdf
In the pre-implementation phase, using the CCNE and ACEN distribution lists, the team conducted a national survey via survey monkey to assess the current educational curriculum related to the teaching of IV Push medication preparation and administration in nursing programs across the country. After researching the topic, the team noted a lack of a standardized blueprint for nursing programs that assess competency related to IV Push medication preparation and administration. The survey demonstrated there is a significant variation in what student nurses are being taught in nursing schools across the United States which creates an unsafe environment for patients. Of great concern, the survey results demonstrated that many nursing programs are teaching student nurses to unsafely, and unnecessarily dilute medications that are manufactured in ready-to-administer syringes which are meant to be used directly from a labeled manufacturer-provided syringe or system. Dilution and/or moving to another syringe can cause concentration errors, medication labeling errors, and potential contamination. Following the publication of this competency assessment tool, we will also send it to the CCNE and ACEN distribution list. A year from publication and dissemination, we will re-survey nursing programs using the same CCNE and ACEN distribution lists to evaluate the utilization of this practice strategy one year after implementation to give nursing schools time to incorporate the strategy into practice.