NEONATAL CARE: ADMINISTRATION OF FLUIDS AND MEDICATION

NEONATAL CARE: ADMINISTRATION OF FLUIDS AND MEDICATION

Administration of oral medication

Adherence to the following principles in your professional and legal responsibility and will assist in safe practice (Griffith et al, 2003)

The Five Cs/Rs:

·        Correct/ Right Patient/ Child

·        Correct/ Right Medicine

·        Correct/ Right Dose

·        Correct/ Right Time

·        Correct/ Right Route

Double Checking

If double checking is required, all aspects of preparation, administration and documentation must be carried out from start to finish by both practitioners

Basic principles when administering oral medication

Child development considerations are important in the administration of medicines. Some basic principles include (Rationale 17).

·       Be confident

·       Approach the child/family with a positive attitude

·       Be honest and understanding

·       Allow the child to have control where appropriate.

·       Use appropriate language that the child understands.

·       Discuss with the child what they might taste/ smell/see/hear/feel.

·       Listen to all involved.

·       Explain the benefits of compliance with the medicine taking.

Age –appropriate considerations should always be taken into account during drug administration.

Drug Calculations

Paediatric dose calculation is usually based on either body surface area (mg/m²) or body weight (mg/ kg) of the child. Body weight is used more frequently for the case of calculation.

The calculation of body surface area (BSA) used to require body weight and height.

To calculate drug doses, use the following formula:

Dose required/ Present Standard Quantity of Drug  X  Present Quantity of Liquid in which Standard Quantity of Drug is Dissolved

In other words:

What you want/ What you have X What it is in (dilation)

For example: A child is prescribed 90mg of Paracetamol and the medication supplied is 120mg of Paracetamol in 5mls:

90 / 120 X 5 = 3.75mls

CONTRAINDICATIONS

o   Unconscious child

o   Absent gag reflex

o   Inability to swallow

o   Vomiting

CAUTIONS

R Digestive tract trauma/ illness

R Post gastro-intestinal surgery

R Nil-by-mouth

R Nausea

R Diarrhoea

IV CANNULAE INSERTION

Before cannula insertion, use aseptic techniques by doing the following:

     Wash hands aseptically

     Wear sterile gloves

     Disinfect the skin

     Use no-touch technique

IV THERAPY

Each NICU should designate persons to be trained in the preparation of IV fluids, peripheral additional fluids. They should establish a dedicated area for preparation of medications and IV fluids. This area should not be used to store/ place any biologic material (eg. tubes of blood, formula and others). Preparation of IV fluids, preparation of IV medications or drugs and administration of medications or drugs are important activities that have to be performed safely to prevent infections inside NICUs. Therefore, task analysis was performed where all steps required are described in details to avoid any contamination. Three main critical activities will be described:

A.    Preparation of IV fluids

B.    Preparation of IV medications or drugs

C.    Administration of IV medications or drugs

A.    Critical Steps in Preparation of IV fluids

1.     Perform routine/ hygienic hand wash.

2.     Prepare and clean working area with a disinfection

3.     Gather necessary materials (IV fluids, drugs, syringes, needles, disinfecting materials, etc) and place them in the clean area of possible on a clean cloth/ towel.

4.     Inspect IV fluid containers for expiry date, cracks, leaks, cloudy/turbid etc.

5.     Wash hands with an antiseptic for 2-3 minutes. Dry hands with paper towel or fresh cloth towel or perform alcohol hand rub.

6.     Disinfect the port of IV bottles/bags with appropriate disinfectant (70% alcohol) immediately before removing/adding fluids.

7.     Wear sterile gloves.

8.     Use a sterile base needle/syringe for each IV fluids (the container that has the largest volume of the mixture wanted i.e. adding the smaller amount of fluids to the larger amount which will be the base)

B.    Critical Steps in Preparation of IV medications or drugs

1.     Use single-dose ampoules rather than multi-dose vials. If multi-dose vials must be used, always pierce the septum with a sterile needle. Never enter multi-dose vials with a needle or syringe that has been used on a patient. Use a new needle every time you stick into the multi-dose vial.

2.     If a multi-dose vial needs to be resolved, the used needle/syringe must be disposed. For each draw from the vial a new sterile needle and syringe must be used.

3.     Before filling a syringe from an ampoule or multi-dose vial, inspect for any contamination, turbidity, cracks, leaks and expiry date.

4.     Between each draw the top of the vial should be wiped once with alcohol and a cotton pad.

5.     Use for each vial/ampoule a new sterile needle and syringe.

6.     Any medication left in the vital should be kept in a fridge for no more than 24 hours or less if the manufacturing instruction doesn’t allow 24 hours storage.

7.     Aseptic hand washing or alcohol rub should be performed before each use of a multi-dose vial/ampoule.

C.    Critical Steps in Administration of IV medications or drugs

A.    Every step must follow strict aseptic techniques.

B.    Maintain a closed system at all times.

C.    Do not mix medications together.

D.    If medications are not compatible with IV fluids, the IV line needs to be stopped and flushed before administration as follows:

a.      Stop the IV fluid first.

b.     Flush the cannula with saline solution.

c.      Infuse the medication.

d.     Flush again.

e.      If needed infuse the second medication and flush again.

f.      Restart the routine IV fluid.

BIBILIOGRAPHY

1.     Armitage G, Knapman H (2003). Adverse events in drug administration: a literature review. J Nurs Manag 11 (2): 130-140.

2.     Aronsen J (2003) Nurse Prescribers and Reporters, British Journal of Clinical Pharmacology 56 (6): 585-587.

3.     BMJ Group (2009) BNF for Children. London, RPS Publishing.

4.     Cope J (2006) Administration of medicines Operational Policy. London, Great Ormond Street Hospital

5.     Copping C (2005) Preventing and reporting drug administration errors. Nurs Times 101 (33): 32-34.

6.     Galbraith, A. Bullock, Sand Manias, E (2001) Fundamentals of Pharmacology, French Forest, Pearson Education Australia.

7.     Gibson F (2003) Nurse prescribing: children’s nurses views. Paediatr Nurs 15(1): 20-25.

8.     Griffith R, Griffith H, Jordan SD (2003) Administration of medicines. Part1: The law and nursing. Nurs Stand 18(2): 47-53; quiz 54, 56.

9.     Kanneh A (2002) Paediatric pharmacological principles: an update. Part 1: Drug development and pharmacodynamics. Paediatr Nurs 14 (8): 36-42.

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11.  King RL (2004) Nurse perceptions of their pharmacology educational needs. J Adv Nurs 45 (4): 392-400.

12.  Leathard (2001) Understanding medicines: conceptual analysis of nurses needs for knowledge and understanding of pharmacology (Part 1). Nurse Education Today 21: 266-271.

13.  Manias E, Aitken R, Dunning T (2004) Medication management by graduate nurses: before, during and following medication administration. Nurs Health Sci 6 (2): 83-91.