Chapter 7. Parenteral Medication Administration
7.8 IV Medications Adverse Events and Management of Adverse Reactions
Safe medication administration requires special attention to transition points where medication errors are more likely to occur. For example, many errors occur in the ordering and preparing phase. Many parenteral medications are considered high-alert medications because of the potential significant harm when used in error. Therefore, these medications require special safeguards to reduce the risk of error. ISMP (2014) lists IV medications classified as high alert. All parenteral routes of insulin (SC/IV) are considered high alert (ISMP, 2014). Specific safeguards may include:
- Know the safe dosage range for each medication you administer.
- Label all medications that are prepared away from the bedside and not in the original container.
- Refer to the ISMP lists for high-alert medications: do not crush, do not use any error-prone abbreviations or look-/sound-alike drugs and symbols.
- Never assume an ordered medication dose is the correct medication or correct dose. Know your medications.
In addition, complications may occur if medication is injected incorrectly, if incorrect equipment (needle or syringe) is used to prepare the medication, or if an error occurs in preparing (calculation, selection of the med), administration, or post-assessment of the patient receiving the medication. Additional complications may include nerve or tissue damage, medication being absorbed too fast or too slow, wrong location for the medication (i.e., heparin given IM instead of SC), pain, bleeding, or a sterile abscess (Perry et al., 20148.
Despite safe medication administration practices, an adverse reaction may happen to a patient for a variety of complex reasons and contributing factors (College of Nurses of Ontario, 2015). An adverse reaction, also known as an adverse event, is an undesirable effect of any health product such as prescription and non-prescription pharmaceuticals, vaccines, serums, and blood-derived products; cells, tissues, and organs; disinfectants; and radiopharmaceuticals. An adverse reaction may occur under normal use and conditions of the product. Reactions may be evident within minutes or years after exposure to the product and may range from minor reactions, like a skin rash, to serious and life-threatening events such as a heart attack or liver damage (Health Canada, 2012). For example, some IV bolus medications may cause a sudden drop in blood pressure or heart rate, or hives may result.
Complications of Intravenous Medications
Complications may result from direct, continuous, or secondary IV medications. The complications are not specific to one medication. It is important for the health care provider to know which adverse event may occur with each individual medication. For example, the administration of an IV opioid (narcotic) medication could result in respiratory depression. Table 7.9 provides a list of possible com