1. Administration of medication:
• Procedure is explained to the patient.
• The name and ID number of the patient on the treatment chart is counterchecked with wrist band and/ or verbally by the patient.
• The patient is asked if he/she suffers from any allergies and counterchecked with treatment chart.
• While preparing the treatment, it is ensured that the right drug and dose is being prepared at the right time. The drug is prepared without, as far as possible, handling it. All drugs are checked for expiry date and that they are signed by the doctor.
• During administration of treatment, it is ensured the drug is given via the right route.
• The patient has every right to refuse.
• Make sure that treatment is swallowed.
• Apply alcohol hand rub.
• Sign on the treatment chart.
• Monitor patient for any possible side effects.
Intravenous management
• In addition to following the former procedure, check that the outer wrapping (if present) and the container are still intact.
• If the IV drug is a fluid, check for any leakage, particles and cloudiness.
• Aseptic technique and infection control is maintained throughout the procedure.
• Prior to infusion, the cannula is checked for any signs of phlebitis, redness, swelling or infiltration. Findings are recorded on the Peripheral Intravenous Catheter Chart.
• The cannula is flushed with 0.9% Normal Saline prior to infusion. If bolus drug to be given, it must also be flushed afterwards.
• If a new infusion line is to be used, it should be primed first.
• Proper disposal of equipment is done – any needles in the sharp box, plastic bottles in the domestic waste bin and any glass bottles in the glass waste bin.
2. Documentation
Nurses have a professional responsibility to ensure that health care records provide an accurate account of treatment, care planning, and delivery. It should be considered as a tool of communication within the team and there should be clear evidence of the decisions made, the care delivered and the information shared. Entries should be factual, consistent, accurate and not containing any jargon words or abbreviations. Each entry must include the date and time, and must be followed by a signature, the printed name and job role. Records should be written in blue ink and correction fluid should not be used at all. When a mistake is done it should be cut off neatly by a single line and signed.
3. Adherence with infection control/universal precautions.
According to WHO “Standard precautions are meant to reduce the risk of transmission of blood borne and other pathogens from both recognized and unrecognized sources. They are the basic level of infection control precautions which are to be used in the care of all patients.” Over the years there has been ongoing education on how to improve compliance with infection control policies and consequently risk reduction.
• Hand hygiene/ Decontamination
Hand hygiene refers to any action of hand cleansing, such as hand washing or hand rubbing. It is considered as the basis of infection control and essential in the prevention of spread of infections. The purpose of hand hygiene is to reduce the number of any transient flora which presents the greater risk of cross-infection.
The hands can be cleaned by either washing with soap and water, which is recommended for visibly soiled hands, or hand rubbing with an alcohol-based hand rub which is the preferred method to be used when hands are not visibly soiled.
According to the World Health Organisation (WHO), hand hygiene should be carried out before and after touching a patient, before and after performing a procedure, after exposure to body fluids, and after touching the area around the patient.
• Personal Protective Equipment (PPE)
PPE includes items that are worn as a means of protection for the skin, respiratory tract and clothing from infectious agents. Such items include gloves, gowns, aprons, masks, goggles and face shields. The recommended PPE to be worn depends on the interaction the healthcare member will have with the patient and the way the infection can be transmitted. As suggested by infection control policies, PPEs should be appropriately removed immediately after the procedure is carried out and disposed of accordingly.
Gloves should be worn when there is a risk of contact with blood or body fluids. They are for single use only and therefore should be changed between procedures on the same patient and, obviously, between different patients. Alcohol hand rub cannot be applied on gloves in a bid to avoid having to change them, nor can they be considered as an alternative to hand hygiene. In fact, hand hygiene has to be carried out before wearing and after removing the gloves. Sterile gloves should only be worn for aseptic invasive procedures.
Gowns and aprons are to be worn when the skin and clothing are likely to be exposed to body fluids and secretions. The choice between a gown or an apron depends on the procedure that is to be performed. The gown or apron should be rolled up immediately after use to prevent contamination to the clothing or skin. In addition, it should be changed between patients.
Masks, eye protection, and face shields are to be used to protect the eyes, nose, and mouth from any risk of splashes or sprays of body fluids or secretions.
• Prevention of needle stick injury
Needles should be handled attentively and with care in order to prevent injury to oneself and to others. In addition, being precautious with needles reduces the risk of exposure to possible blood borne pathogens. Needles should be discarded immediately after use in the yellow sharps box and never recapped or otherwise manipulated for more than a single use. Sharps containers should not be over filled and left open.
• Cleaning and disinfection
Reusable communal care equipment is considered as another agent for cross-infection. It should be cleaned and disinfected accordingly after use. In addition, if the equipment is being used for a patient who has or had an infection, that equipment should labelled and be used for that particular patient only.
Domestics should routinely clean areas, surfaces, or objects that are potentially contaminated and are frequently used by staff and patients, such as doorknobs and bedrails. On the other hand, it is suggested that walls and floors do not need to be disinfected unless soiled with blood or body fluids.
Furthermore, isolation rooms should be cleaned last to reduce the risk of transmission of any infections to other areas and the cleaning personnel should wear apron and gloves for protection. Separate cleaning equipment should be used as cross-infection may result from shared cleaning equipment.
• Respiratory etiquette
Individuals with respiratory symptoms should always cover their nose and mouth with a tissue or mask when coughing or sneezing. The tissue or mark should, in turn, be disposed of appropriately. In addition, hand hygiene should be performed after contact with any respiratory secretions or objects contaminated with the secretions. It is also suggested that spatial separation of people with respiratory symptoms aids in the prevention of cross-contamination. Last but not least, health care workers, patients, and visitors are educated on the importance of respiratory hygiene.
• Laundry Handling
Clean laundry should be stored in a designated area which is kept clean and used for this purpose only. Both when applying clean sheets and stripping the bed of used sheets, the sheets should never be shaken in order to prevent any risk of cross-contamination and dust particles circulating in the air.
Any used linen should be disposed of in the white laundry bags. In order to prevent the likeliness of placing used linen on the floor, the receptacle must be as close as possible to the point of use for immediate deposit. In addition, laundry bags should never be overfilled.
Linen that is soiled or used by a patient who is known to have an infection, should be secured in water-soluble bags before being deposited in the laundry bags. Furthermore, health care members should wear the required PPEs while handling the soiled sheets.
