2.50
Hdl Handle:
http://hdl.handle.net/10755/203175
Type:
Presentation
Title:
Changing Practice to Enhance Patient Safety: Promethazine administration
Abstract:
(Summer Institute) Problem: A 300 bed County Teaching Hospital Risk Management department had received patient complaints regarding the administration of Promethazine. The current practice of intravenous (IV) administration of Promethazine was to give up to 25mg IVP as ordered. An investigation into the administration led by the Professional Practice/Quality Shared Governance Council found no standard procedure for the safe administration of Promethazine. Evidence: A literature search revealed recommendations from the Federal Drug Administration (FDA) and the Institute for Safe Medication Practices (ISMP). Strategy: The FDA and ISMP recommendations were reviewed by members of the Professional Practice Shared Governance Council. The Council outlined recommendation and a multidisciplinary team consisting of front line nurses, physicians, education department, pharmacy, and nursing informatics identified barriers to a successful practice change and strategized how to overcome these barriers. Practice Change: Adoption and implementation of ISMP Promethazine Administration Guidelines to suggest alternative administration route or use of an 5-HT3 receptor Antagonist, administer slowly over 10 minutes, dilute the drug in 20ml normal saline, limiting the available concentration to 25mg/ml, limiting the dose to 6.25mg to 12.5mg starting IV dose and using large patent veins by avoiding hand or wrist veins when possible, verifying patency of site prior to administration, patient education to report burning or pain immediately, and to notify physician of adverse effects. Evaluation: Grol and Wensing Effective implementation model was followed. Outcomes measured were number of patient complaints, and nursing practice was monitored for emergence of work arounds. Results: No patient complaints related to Promethazine administration since practice change. No nursing work arounds have emerged. Recommendations: Continuous evaluation of practice change and adaptation when necessary. Lessons Learned: Multidisciplinary team was key to a successful practice change. The group worked together to overcome unpredicted barriers to the implementation of the practice change. Bibliography: Institute for Safe Medication Practices (2006). Action needed to prevent serious tissue injury with IV Promethazine. Retrieved May 2010 from http://www.ismp.org/newsletters/acutecare/articles/20060810.asp Federal Drug Administration (2008). Severe tissue injury with IV Promethazine FDA Patient Safety News: Show # 72, February 2008 retrieved May 2010 from http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/PSN/printer.cfm?id=739 Grol, R., & Wensing, M. (2005). Effective implementation: a model. In R. Grol, M. Wensing, & M. Eccles (Ed.), Improving patient care: The implementation of change in clinical practice (pp.41-58). London: Elsevier Limited. Van Achterberg, T., Schoonhoven, L. and Grol, R. (2008), Nursing implementation science: How evidence-based nursing requires evidence-based implementation. Journal of Nursing Scholarship, 40: 302–310. doi: 10.1111/j.1547-5069.2008.00243.x [© Academic Center for Evidence-Based Practice, 2011. http://www.acestar.uthscsa.edu]
Keywords:
Safety; Promethazine
Repository Posting Date:
16-Jan-2012
Date of Publication:
3-Jan-2012
Sponsors:
UTHSCSA Summer Institute

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleChanging Practice to Enhance Patient Safety: Promethazine administrationen_GB
dc.identifier.urihttp://hdl.handle.net/10755/203175-
dc.description.abstract(Summer Institute) Problem: A 300 bed County Teaching Hospital Risk Management department had received patient complaints regarding the administration of Promethazine. The current practice of intravenous (IV) administration of Promethazine was to give up to 25mg IVP as ordered. An investigation into the administration led by the Professional Practice/Quality Shared Governance Council found no standard procedure for the safe administration of Promethazine. Evidence: A literature search revealed recommendations from the Federal Drug Administration (FDA) and the Institute for Safe Medication Practices (ISMP). Strategy: The FDA and ISMP recommendations were reviewed by members of the Professional Practice Shared Governance Council. The Council outlined recommendation and a multidisciplinary team consisting of front line nurses, physicians, education department, pharmacy, and nursing informatics identified barriers to a successful practice change and strategized how to overcome these barriers. Practice Change: Adoption and implementation of ISMP Promethazine Administration Guidelines to suggest alternative administration route or use of an 5-HT3 receptor Antagonist, administer slowly over 10 minutes, dilute the drug in 20ml normal saline, limiting the available concentration to 25mg/ml, limiting the dose to 6.25mg to 12.5mg starting IV dose and using large patent veins by avoiding hand or wrist veins when possible, verifying patency of site prior to administration, patient education to report burning or pain immediately, and to notify physician of adverse effects. Evaluation: Grol and Wensing Effective implementation model was followed. Outcomes measured were number of patient complaints, and nursing practice was monitored for emergence of work arounds. Results: No patient complaints related to Promethazine administration since practice change. No nursing work arounds have emerged. Recommendations: Continuous evaluation of practice change and adaptation when necessary. Lessons Learned: Multidisciplinary team was key to a successful practice change. The group worked together to overcome unpredicted barriers to the implementation of the practice change. Bibliography: Institute for Safe Medication Practices (2006). Action needed to prevent serious tissue injury with IV Promethazine. Retrieved May 2010 from http://www.ismp.org/newsletters/acutecare/articles/20060810.asp Federal Drug Administration (2008). Severe tissue injury with IV Promethazine FDA Patient Safety News: Show # 72, February 2008 retrieved May 2010 from http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/PSN/printer.cfm?id=739 Grol, R., & Wensing, M. (2005). Effective implementation: a model. In R. Grol, M. Wensing, & M. Eccles (Ed.), Improving patient care: The implementation of change in clinical practice (pp.41-58). London: Elsevier Limited. Van Achterberg, T., Schoonhoven, L. and Grol, R. (2008), Nursing implementation science: How evidence-based nursing requires evidence-based implementation. Journal of Nursing Scholarship, 40: 302–310. doi: 10.1111/j.1547-5069.2008.00243.x [© Academic Center for Evidence-Based Practice, 2011. http://www.acestar.uthscsa.edu]en_GB
dc.subjectSafetyen_GB
dc.subjectPromethazineen_GB
dc.date.available2012-01-16T11:01:32Z-
dc.date.issued2012-01-03en_GB
dc.date.accessioned2012-01-16T11:01:32Z-
dc.description.sponsorshipUTHSCSA Summer Instituteen_GB
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.