To: Massachusetts Nursing and Professional Healthcare Organizations
From: Laurie Talarico, MS, RN, NP, Nursing Practice Coordinator
Re: Preparation and Administration of Intravenous Solutions
The Board of Registration in Nursing (Board) received an inquiry from a hospital seeking guidance regarding their practice of preparing intravenous (IV) solutions for administration at a future point in time. Preparation of the solution involves removing the solution container from the outer sealed wrapper or removing the seal, spiking the solution container and, priming the tubing. The situation described involved nurses who prepare intravenous solutions for another nurse to administer to a patient.
A summary of relevant Board regulations and other relevant regulations, advisory rulings, earlier opinions, recommendations from the Board's Nursing Practice Advisory Panel, current position statements issued by professional organizations and a review of the current literature was completed.
Professional nurse organizations and Boards of Nursing espouse the concept of the five rights of medication administration as valued concepts that set the standard for safe medication administration practices. The five rights of medication safety are a universal technique used in health care facilities to reduce and prevent medication errors. Once a medication has been prescribed for a patient, the nurse follows the five rights to ensure safe medication administration. The U.S. Department of Health and Human Services recognizes the five rights as an important goal for safe medication practices ; the right patient, the right drug, the right dose, the right route, and the right time. When examining the process to ensure "right drug", the nurse must verify the medication three times: once when the medication is removed from the drug storage area, once during the preparation of the medication, and again before giving the medication to the patient.
In order to fully comply with "right drug" protocol, the nurse would be responsible to evaluate the integrity of the medication. A nurse can not ensure a substance that has been visibly altered by an individual other than his/her self is in fact the right drug.
On March 9, 2011, by unanimous vote, the Board found that the administration of an intravenous solution by a nurse who had not prepared the solution is not consistent with current standards of nursing practice.