I.V Infusion 2021

NATIONAL NURSING AUDIT MINISTRY OF HEALTH
MALAYSIA
ELEMENT 5: CONTINUUM OF CARE ADMINISTRATION
OF INTRAVENOUS (I.V) INFUSION
DISEDIAKAN OLEH
ICHA CHIIM
PENYELIA JURURAWAT
U36
08.03.2021
5: 2 ADMINISTRATION OF
INTRAVENOUS (I.V) INFUSION
AUDIT CAN BE DESCRIBED AS A CYCLE
Identify and
Implement Set standards
change
Measure
Compare Practice
Current
With Standard
Performance
STAGE ONE
Preparing for audit
STAGE TWO
Selecting criteria
STAGE THREE
Using the TOOL Measuring performance Creating the
environment
STAGE FOUR
Analysis Data
STAGE FIVE
Making improvements
STAGE SIX
Sustaining improvement
STAGES OF AUDIT
1.INTRODUCTION
Intravenous infusion through peripheral venous

access is the most common procedure
performed on patients. Care of patient with
intravenous infusion is now an integral part of
the majority of nurses’ professional practice. It
can range from caring for an individual with a
peripheral cannula in situ, to nursing a patient
requiring multiple parenteral drugs/infusions
in the critical care environment. Whatever the
route, peripheral or central, infusion therapy
is not without risk
(Scales 1999).
2.STANDARD
Patient receives safe administration of

intravenous infusion and does not develop
infusion error during hospital stay
3.OBJECTIVES
3.1. All intravenous infusions are

administered as prescribe
3.2. Patient receive safe administration of
intravenous infusion
3.3 Accurate and correct documentation.
4.CRITERIA
Structure Process Outcome

1. Each patient has current written 1. Acknowledge / Greet patient. 1. Patient receives safe
prescription 2. Identify right patient administration of intravenous
3. Verify prescription infusion during hospital stay
2. There is a Standard 4. Prepare schedule for I.V.
Operating Procedure regime. 2. Patient is informed of his
(SOP)/ manual procedure 5. Prepare and check IV infusion regime.
for administration of solution.
intravenous infusion. 6. Inform and explain to 3. Patient receives the IV regime
patient. as
3. The nurse has knowledge 7. Listen and responds promptly and prescribed.
on care and maintenance politely to patient’s questions.
of I.V. infusion. 8. Regulate flow rate as 4. IV infusion misadventures are
prescribed. detected early and appropriate
9. Check for patency of line. measures taken timely
10. Assess infusion site for signs of
Thrombopheblitis ; (swelling, 5. Documentation is accurate and
redness, warm, pain) and complete.
dislodgement
11. Monitor patient’s response and
document
12. Take appropriate measure
if adverse reaction
identified
13. Document fluid infused in
intake-output chart.
5.METHODOLOGY
Direct observation of I.V. line and gathering of
information from documents.
Setting : All wards
Convenient Sampling
Sample Size
200 for each Specialist hospital, to be equally
divided to each discipline and 100 for non
specialist hospital.
Time frame
6 weeks
AUDIT GUIDE FOR ADMINISTRATION OF
INTRAVENOUS INFUSION
INCLUSION CRITERIA
All patients on intravenous infusions including
those with infusion devices.
EXCLUSION CRITERIA
 Patients receiving blood transfusion.
 On controlled analgesia (P.C.A.)
 With central venous lines (CVL)

INSTRUMENT
Audit form (E5 AF 5.2) – every
line must have one audit form.
Version 6/2019
6.DEFINITION OF OPERATIONAL TERMS
6.1 CONCURRENT IV REGIME - A 24-hour plan

that informs the fluid type and time frame
for prescribed infusion.
6.2 WRITTEN PRESCRIPTION–

any legal orders of I.V. regime must be
endorsed in the patient’s case notes/relevant
Hospital/ Unit policy on IV infusion.

6.DEFINITION OF OPERATIONAL TERMS
6.3 VERIFICATION OF INFUSION IN PROGRESS INCLUDES

THE FOLLOWING
6.3.1 Right solution
6.3.2 Intravenous bottle in progress must indicate
time commence and time complete.
6.3.3 Valid solution (not expired)
6.3.4 No change in color
6.3.5 Contains no sediments / particles
6.3.6 Titration of flow rate accordingly. Right flow
rate : ± 2 to 5 drops per minute is acceptable.
6.3.7 Fluid balance – A difference of ± 50 mls
remaining in the bottle is acceptable.
6.3.8 Dry infusion - Fluid level in IV bottle is below
spike / less than half in chamber.
DEFINITION OF OPERATIONAL TERMS
6.4 LINE INSITU AND PATENT –
refers uninterrupted flow with no signs of tissue
infiltration / thrombophlebitis /air bubbles or blood
clot along line.
6.5 ACCURATE AND COMPLETENESS OF

DOCUMENTATION INCLUDES:
6.5.1 Current IV schedule available
6.5.2 Accurate and complete recordings in
the I/O chart.
6.5.3 Name and registration number of
patient written on the I/O chart.
RATING SYSTEM :
TECHNICAL COMPONENT
Infusion compliances for technical component include all of the following:

7.1.1 Schedule for I.V. regime is concurrent with the latest prescription.
(T2.1)
7.1.2 Has indication of time commenced and time completed on bottle
in
progress.
7.1.3 Solution infused: Correct and valid ( not expired )
7.1.4 No sediments /particles and no change in color. Titrated
accordingly
to correct flow rate.
7.1.5 Remaining fluid balance correspond to amount infused.
7.1.6 Dry infusion – fluid level in IV bottle is below spike / less than half
in chamber
7.1.7 Line is in-situ and patent with no tissue infiltration/
thrombopheblitis / air bubbles or blood clot
DOCUMENTATION COMPONENT
Accurate and complete documentation compliance
includes all of the following :
7.2.1 Current IV schedule available .
7.2.2 Accurate and complete recordings in
I/O chart.
7.2.3 Name and registration number of
patien the I/O chart.
7.3 SCORE
7.3.1 Conformance standard :>90% which
includes:
Technical skill : 100%
Documentation : 100%
**Overall marks(% of technical skill +%

documentation ÷2
8.AUDIT FORM
NATIONAL NURSING AUDIT MINISTRY OF HEALTH

MALAYSIA
VERSION 6/2019
ELEMENT 5 : CONTINUUM OF CARE
TOPIC : 5.2 ADMINISTRATION OF
INTRAVENOUS INFUSION
DATE : 11 April 2019
DOCUMENT NO : E5 AF 5.2
8.AUDIT FORM
8.1 STANDARD
Patient receives safe administration of
intravenous and does not developed intravenous
error during hospital stay
8.2 OBJECTIVES
8.2.1 All intravenous infusion are administered as
prescribed.
8.2.2 Patient receive safe administration of
intravenous infusion
8.2.3 Accurate and complete documentation.
8.AUDIT FORM
Date of audit :
Locality :
Auditors
1 ……………
2 ……………
INSTRUCTIONS TO AUDITORS
1. Tick (√) at appropriate column

2. T/D indicate technical skill/ documentation
respectively.
S/N ITEM SOURCE OF INFORMATION YES NO N/A
T1.
Infusion in progress :
Check I.V bottle to validate correct solution.

T1.1 Is concurrent with
prescribed regime.
Check label on IV bottle.
T1.2 Has indicator of time
The time is to be written on the label only.
commence and
complete on IV bottle.
Check expiry date on IV bottle.
T1.3 Is valid (Not expired)
Check solution for any change in color.

T1.4 Is clear :
1.4.1. No change in
color
1.4.2 No sediments / Check solution for any sediments /
particles particles.
Check flow rate.
T1.5 Is titrated as scheduled.
Fluid level in IV bottle is Check fluid level in IV bottle.

T1.6
above spike / more than
half in chamber.
T2. Line in-situ and patent. Inspect line and site of infusion.
D3. Accuracy and completeness of Check documents.

documentation.
RATING
(PLEASE (√) THE APPROPRIATE BOX)
Criteria Item Conformance Non N/A
conformance
Technical
Documentation
Total
Remark :
Auditor 1 ( Name and signature)
Auditor 2 (Name and signature)

CALCULATION:
 ITEM CONFORMANCE X 100
TOTAL ITEM-Item N/A
Calculation:
Technical: 8 x100=800=100%
8 8
Documentation: 1 x100=100=100%
1 1
RATING
Criteria Item Conformance Non N/A

conformance
Technical 8 100% 0 0
Documentation 1 100% 0 0
Total 9 100+100÷2 0 0
=100%
THANK YOU

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NATIONAL NURSING AUDIT MINISTRY OF HEALTH

Intravenous infusion through peripheral venous

Patient receives safe administration of

3.1. All intravenous infusions are

Structure Process Outcome

 With central venous lines (CVL)

6.1 CONCURRENT IV REGIME - A 24-hour plan

6.2 WRITTEN PRESCRIPTION–

Hospital/ Unit policy on IV infusion.

6.3 VERIFICATION OF INFUSION IN PROGRESS INCLUDES

6.5 ACCURATE AND COMPLETENESS OF

Infusion compliances for technical component include all of the following:

**Overall marks(% of technical skill +%

NATIONAL NURSING AUDIT MINISTRY OF HEALTH

1. Tick (√) at appropriate column

Check I.V bottle to validate correct solution.

Check solution for any change in color.

Fluid level in IV bottle is Check fluid level in IV bottle.

D3. Accuracy and completeness of Check documents.

Auditor 1 ( Name and signature)

Auditor 2 (Name and signature)

Criteria Item Conformance Non N/A

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