Goal: The medication is delivered safely to the patient via the intravenous route using sterile technique.
1. Gather equipment. Check each medication order against the original order in the medical record, according to facility policy. Clarify any inconsistencies. Check the patient’s chart for allergies.
2. Know the actions, special nursing considerations, safe dose ranges, purpose of administration, and adverse effects of the medications to be administered. Consider the appropriateness of the medication for this patient.
3. Perform hand hygiene.
4. Move the medication cart to the outside of the patient’s room or prepare for administration in the medication area.
5. Unlock the medication cart or drawer. Enter pass code and scan employee identification, if required.
6. Prepare medications for one patient at a time.
7. Read the CMAR/MAR and select the proper medication from the patient’s medication drawer or unit stock.
8. Compare the label with the CMAR/MAR. Check expiration dates. Confirm the prescribed or appropriate infusion rate. Calculate the drip rate if using gravity system. Scan the bar code on the package, if required.
9. When all medications for one patient have been prepared, recheck the label with the MAR before taking them to the patient.
10. Lock the medication cart before leaving it.
11. Transport medications to the patient’s bedside carefully, and keep the medications in sight at all times.
12. Ensure that the patient receives the medications at the correct time.
13. Perform hand hygiene and put on PPE, if indicated.
14. Identify the patient. Usually, the patient should be identified using two methods. Compare information with the CMAR/MAR.
a. Check the name and identification number on the patient’s identification band.
b. Ask the patient to state his or her name and birth date, based on facility policy.
c. If the patient cannot identify him- or herself, verify the patient’s identification with a staff member who knows the patient for the second source.
15. Close the door to the room or pull the bedside curtain.
16. Complete necessary assessments before administering medications. Check the patient’s allergy bracelet or ask the patient about allergies. Explain the purpose and action of the medication to the patient.
17. Scan the patient’s bar code on the identification band, if required.
18. Assess the IV site for the presence of inflammation or infiltration.
19. Close the clamp on the short secondary infusion tubing. Using aseptic technique, remove the cap on the tubing spike and the cap on the port of the medication container, taking care to avoid contaminating either end.
20. Attach infusion tubing to the medication container by inserting the tubing spike into the port with a firm push and twisting motion, taking care to avoid contaminating either end.
21. Hang piggyback container on IV pole, positioning it higher than primary IV according to manufacturer’s recommendations. Use metal or plastic hook to lower primary IV fluid container. (See the Skill Variation in your skills book for information on administering an intermittent IV medication using a tandem piggyback setup.)
22. Place label on tubing with appropriate date.
23. Squeeze drip chamber on tubing and release. Fill to the line or about half full. Open clamp and prime tubing. Close clamp. Place needleless connector on the end of the tubing, using sterile technique, if required.
24. Use an antimicrobial swab to clean the access port or stopcock above the roller clamp on the primary IV infusion tubing.
25. Connect piggyback setup to the access port or stopcock. If using, turn the stopcock to the open position.
26. Open clamp on the secondary tubing. Set rate for secondary infusion on infusion pump and begin infusion. If using gravity infusion, use the roller clamp on the primary infusion tubing to regulate flow at prescribed delivery rate. Monitor medication infusion at periodic intervals.
27. Clamp tubing on piggyback set when solution is infused. Follow facility policy regarding disposal of equipment.
28. Replace primary IV fluid container to original height. Check primary infusion rate on infusion pump. If using gravity infusion, readjust flow rate of primary IV.
29. Remove PPE, if used. Perform hand hygiene.
30. Document the administration of the medication immediately after administration.
31. Evaluate the patient’s response to medication within appropriate time frame. Monitor IV site at periodic intervals.
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