Dilution of IV Push Medications: Challenging Tradition

Diluting IV push medications has traditionally been considered best practice by many experienced nurses. On one adult medical-surgical unit, IV push medications are often transferred from single-use vials and pre-filled syringes into another syringe, such as a pre-filled saline flush, for dilution and administration. Nurses anecdotally cite common justifications for these practices, including difficulty measuring small doses, slow IV push rates, or nursing education/training. However, current evidence discourages these practices for patient safety and infection control reasons, and advocates against adding complexity to the medication administration process.

The purpose of this project is to eliminate three IV push medication administration practices commonly observed on the unit, including unnecessary dilution, syringe-to-syringe transfer of medications, and the use of saline flushes for dilution and administration.

A literature review was conducted on IV push medication administration that demonstrated the need for a practice change on the unit. Educational materials, including a PowerPoint presentation, post-test/knowledge check, and skills validation checklist on the Carpuject syringe system were developed. Pending managerial approval, these materials will be distributed to nursing staff via a variety of in-person and/or electronic methods. Staff will be encouraged to complete and submit the post-test and skills validation form to project coordinators. Brief qualitative surveys will also be conducted before and after implementation of the practice change campaign.

Results are pending implementation of an educational campaign to eliminate at-risk IV push medication administration practices observed on the unit. Completion of post-tests, skills validation forms for the Carpuject system, and qualitative surveys distributed before and after implementation will all be analyzed to determine outcomes.

Outdated IV push medication administration practices are still seen in everyday nursing practice despite established standards of care. Successful implementation of this practice change has the potential to improve the safety of patients and staff by preventing or reducing medication errors, infection risks, and needle stick injuries. While the scope of this project is focused on the nursing staff of one inpatient nursing unit, successful implementation could escalate facility-wide or even lead to system-level change.