Medicines management, clinical interventions, procedures
IV medication errors are the most common type of Never Event in the NHS. Always check: correct drug, correct concentration, correct diluent, correct rate, correct route. Never assume a pre-prepared syringe is correct without checking it yourself.
Right patient · Right drug · Right dose · Right route · Right time. Some add: right documentation and right reason. Always check all 5 before administering.
Require 2 nurses to check · Must be recorded in CD register (date, patient, drug, dose, balance) · Stored in double-locked cupboard · Discarded in presence of witness · CD register inspected regularly.
Identify Key Parts (anything entering the patient or touching a Key Site) and Key Sites (any entry point to the body). Never touch Key Parts, even with gloves. Applies to: IV access, catheterisation, wound care, injections.
0=no sign · 1=slight pain or redness · 2=pain + redness + swelling · 3=hard/streaky vein · 4=tenderness + pus · 5=thrombophlebitis. Remove cannula at score ≥2.
Most patients: 94–98% · COPD/hypercapnia risk: 88–92% (prescribed as Scale 2 on NEWS2). Use Venturi mask for COPD to control FiO2 precisely.
D-R-S-A-B-C-D · Chest compressions first · 30:2 ratio · Rate 100–120/min · Depth 5–6cm · Allow full chest recoil · AED as soon as available.
Within 1 hour: (1) High-flow O2 (2) Blood cultures (3) IV antibiotics (4) IV fluid challenge 500ml (5) Measure lactate (6) Monitor urine output. All 6 are a bundle — none optional.
Two nurses must check: patient ID wristband, blood product label, blood group compatibility, expiry date, blood bag integrity. Baseline obs before starting; then at 15 min, 1 hr, end.