Start Date

7-3-2025 8:00 AM

End Date

7-3-2025 3:15 PM

Description

Title:

Effects of a Clinical Nursing Protocol on Intravenous Piggyback Infusion Practice

Purpose:

The purpose of our study was to review whether the introduction of a nursing protocol policy impacted adherence to best practice in utilizing secondary tubing as an Intravenous Piggyback (IVPB) set up for the administration of IV antibiotics in a 483-bed tertiary urban facility.

Background:

Without a nursing protocol policy in place, nurses did not have a standardized method for administering IVPB antibiotics prior to March 2023. Practice variability could lead to violation of the medication rights, RNs practicing outside of their scope, and cause potential patient harm. Literature identifies best practice as utilizing a primary infusion with secondary set up as IVPB to ensure the full dose is administered.

Methods:

This retrospective quality improvement project looked at the proportion of the top ten administered antibiotics that were programmed into the IV pump using a primary setting, compared to those programmed using a secondary setting in the six months pre- and six months post-policy implementation. To test whether the proportion of primary infusions had changed after policy implementation in March 2023, we used Wilcoxon rank-sum tests on the total counts of antibiotics programmed during these time frames.

Results:

We accounted for monthly variability in the total number of IVPB infusions by using the proportion of secondary infusions, relative to the total count of primary and secondary. We detected a significant increase in the proportion of secondary infusions post-policy (p = 0.026).

Conclusions:

Analysis of the results showed adherence to a nursing protocol policy as evidenced by an increase in the proportion of secondary infusions programmed after policy implementation. With this policy in place, nurses are more likely to follow best practice for administering IV antibiotics. More studies are needed to evaluate policies on supporting nursing evidence-based practice, nursing administration of IV antibiotics, and the overall patient impact.

Comments

References

Branco, A., Lourençone, E. M. S., Monteiro, A. B., Fonseca, J. P., Blatt, C. R., & Caregnato, R. C. A. (2020). Education to prevent ventilator-associated pneumonia in intensive care unit. Revista Brasileira De Enfermagem, 73(6), e20190477. https://doi.org/10.1590/0034-7167-2019-0477

Carrico, R. M., Arnold, F., & Goss, L. K. (2005). Antimicrobial Resistance: A Primer for the Infusion Specialist. Journal of Infusion Nursing, 28(3), 183–187. https://doi.org/10.1097/00129804-200505000-00006

Dang, D., Dearholt, S.L., Bissett, K., Ascenzi, J., & Madeleine Whalen, M. (2022). Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, 4th edition. Sigma.

Ernstmeyer, K., & Christman, E. (2023). IV Therapy Management. Chapter 23. In Nursing Skills [Internet]. 2nd edition. Chippewa Valley Technical College. https://www.ncbi.nlm.nih.gov/books/NBK596734/

Harding, M., Stefka, S., Bailey, M., Morgan, D., & Anderson, A. (2020). Best Practice for Delivering Small-Volume Intermittent Intravenous Infusions. Journal of Infusion Nursing, 43(1), 47–52. https://doi.org/10.1097/NAN.0000000000000355

Kang, P., Kang, J., & Monsen, K. A. (2023). Nurse Information Security Policy Compliance, Information Competence, and Information Security Attitudes Predict Information Security Behavior. Computers, Informatics, Nursing: CIN, 41(8), 595–602. https://doi.org/10.1097/CIN.0000000000000981

Karttunen, M., Sneck, S., Jokelainen, J., & Elo, S. (2020). Nurses’ self-assessments of adherence to guidelines on safe medication preparation and administration in long-term elderly care. Scandinavian Journal of Caring Sciences, 34(1), 108–117. https://doi.org/10.1111/scs.12712

Kelly, U., Edwards, G., & Shapiro, S. E. (2021). Nursing Policies and Protocols: Do Nurses Really Use Them? Journal of Nursing Care Quality, 36(3), 217–222. https://doi.org/10.1097/NCQ.0000000000000532

Kim, O., Lee, H., Jung, H., Jang, H. J., Pang, Y., & Cheong, H. (2019). Korean nurses’ adherence to safety guidelines for chemotherapy administration. European Journal of Oncology Nursing: The Official Journal of European Oncology Nursing Society, 40, 98–103. https://doi.org/10.1016/j.ejon.2019.04.002

Labrague, L. J. (2024). Nurses’ adherence to patient safety protocols and its relationship with adverse patient events. Journal of Nursing Scholarship: An Official Publication of Sigma Theta Tau International Honor Society of Nursing, 56(2), 282–290. https://doi.org/10.1111/jnu.12942

Lin, F., Gillespie, B. M., Chaboyer, W., Li, Y., Whitelock, K., Morley, N., Morrissey, S., O’Callaghan, F., & Marshall, A. P. (2019). Preventing surgical site infections: Facilitators and barriers to nurses’ adherence to clinical practice guidelines-A qualitative study. Journal of Clinical Nursing, 28(9–10), 1643–1652. https://doi.org/10.1111/jocn.14766

Rout, J., Essack, S., & Brysiewicz, P. (2019). Are nursing infusion practices delivering full-dose antimicrobial treatment? The Journal of Antimicrobial Chemotherapy, 74(12), 3418–3422. https://doi.org/10.1093/jac/dkz365

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Mar 7th, 8:00 AM Mar 7th, 3:15 PM

Effects of Clinical Nursing Protocol on Intravenous Piggyback Infusion (IVPB) Practice

Title:

Effects of a Clinical Nursing Protocol on Intravenous Piggyback Infusion Practice

Purpose:

The purpose of our study was to review whether the introduction of a nursing protocol policy impacted adherence to best practice in utilizing secondary tubing as an Intravenous Piggyback (IVPB) set up for the administration of IV antibiotics in a 483-bed tertiary urban facility.

Background:

Without a nursing protocol policy in place, nurses did not have a standardized method for administering IVPB antibiotics prior to March 2023. Practice variability could lead to violation of the medication rights, RNs practicing outside of their scope, and cause potential patient harm. Literature identifies best practice as utilizing a primary infusion with secondary set up as IVPB to ensure the full dose is administered.

Methods:

This retrospective quality improvement project looked at the proportion of the top ten administered antibiotics that were programmed into the IV pump using a primary setting, compared to those programmed using a secondary setting in the six months pre- and six months post-policy implementation. To test whether the proportion of primary infusions had changed after policy implementation in March 2023, we used Wilcoxon rank-sum tests on the total counts of antibiotics programmed during these time frames.

Results:

We accounted for monthly variability in the total number of IVPB infusions by using the proportion of secondary infusions, relative to the total count of primary and secondary. We detected a significant increase in the proportion of secondary infusions post-policy (p = 0.026).

Conclusions:

Analysis of the results showed adherence to a nursing protocol policy as evidenced by an increase in the proportion of secondary infusions programmed after policy implementation. With this policy in place, nurses are more likely to follow best practice for administering IV antibiotics. More studies are needed to evaluate policies on supporting nursing evidence-based practice, nursing administration of IV antibiotics, and the overall patient impact.