Table 2.
Examples of nurses ensuring that system goals are managed safely and effectively in intravenous infusion therapy.
| Example | Resilience themes |
|---|---|
| Greater attention is given to medications some nurses perceived as being higher risk, such as insulin and chemotherapy. | Anticipatory Nurses performing own risk assessment |
| Using a blood giving set to run fluids when they are anticipating a patient may need blood. | Anticipatory Responsive |
| Nurses adjust their action (e.g. 2 × 500 ml bags of fluid) if the product ordered by the prescriber (e.g. a 1000 ml bag of fluid) is not available. | Responsive |
| Nurses may increase the concentration of an infusion if needing to reduce the amount of fluid the patient is receiving. | Responsive Past experience |
| Nurses sometimes question prescribers if they perceive mistakes are being made in prescribing. | Responsive |
| Nurses are resourceful in searching through different charts when patients are transferred from one area of the hospital to another, as any infusions already in progress might be prescribed on different charts or different systems. Nurses use their clinical judgement in continuing fluids as in the best interest of the patient while waiting for doctors to write a new prescription. | Anticipatory Past experience |
| Keeping a medication order active when it is no longer required, such as for noradrenaline in critical care, in case the blood pressure falls and the medication needs to be restarted. | Anticipatory Responsive |
| Labelling of giving sets is seen as making practice safer in critical care areas where patients have multiple infusions, even if not required by local policy. | Anticipatory Responsive Past experience |
| Following verbal orders (for example a verbal decision on a ward round to start a medication) although the medication order will not be written until the prescriber has time. | Responsive |
| Adjusting the times at which infusions are given in order to space infusions at appropriate intervals when an earlier infusion started or finished late. | Responsive Nurses performing own risk assessment |
| Working around policies perceived to be impractical (e.g. giving small volume sodium chloride flushes without a medication order, as it was perceived to be impractical for them to be individually prescribed). | Workarounds |
| Additive labels not being fully completed, such as with details of batch numbers, if the infusion is only due to be up for a matter of minutes. | Workarounds Nurses performing own risk assessment |
| Nurses perceive it is less important/risky for patients not to be wearing an identity band if they are oncology day case patients who can communicate effectively, if they are known to staff, or only receive fluid replacement rather than other medications, and therefore might choose to focus on getting higher risk patients to wear them. | Nurses performing own risk assessment |