Today’s healthcare industry is ever-growing and demanding. Nurses, doctors, nursing assistants and other health care workers must be knowledgeable and able to adapt to the ever-changing trends. It is imperative that each patient is given the best and safest quality of care. It is a nurse’s duty to provide the best quality of care to every patient. The following sections will discuss the use of prefilled saline flushes verses manually drawn flushes. Using prefilled flushes not only drastically decreases nosocomial infections, it also decreases medication errors.
These factors increase the patient’s safety and satisfaction. In the research conducted, two protocols in use at different hospitals were examined. Evidence demonstrates the use of a prefilled flush is not only convenient, accurate, and sterile, but also the safest and most efficient. Current Protocols In medical society today, hospitals are using either prefilled flushes or manually drawn flushes. A prefilled flush is manufactured with various specified amounts of sterile normal saline in each syringe.
A manually drawn flush involves accurate measuring of solution drawn from a bag containing normal saline by a staff member at a hospital. Currently there are no national standards. The choice of using prefilled flushes or manually drawn flushes is at the hospital’s discretion. One local hospital’s protocol for flushing involves the use of prefilled flushes. The flushes are kept in an omnicell on each unit in the hospital. The syringes can be scheduled, PRN, or both. To retrieve a prefilled flush, the staff nurse must use his or her log-in information, scroll through the patient list and select the desired patient.
The patient’s scheduled and PRN medications appear. The nurse selects the prefilled flush and claims it from the specified area in the omnicell. Once the nurse secures the prefilled flush, he or she needs an alcohol swab to PREFILLED VERSUS MANUALLY 3 cleanse the patient’s IV port before flushing the IV. Upon entering the patient’s room, the nurse checks identifiers and pulls up the EMAR. Lastly, to prevent errors and ensure correct dosage time, the nurse scans the flush’s barcode. At another local hospital, the protocol is quite different. It involves the use of manually drawn flushes.
In each unit, bags of normal saline are kept at the nurses’ station, medication room and on the nurses’ portable computer carts. These bags are labeled with date and time of opening and expiration. Each bag can be utilized for up to twenty-four hours. If any fluid remains beyond this time frame, it will be properly disposed. Nurses must obtain a sterile flush and two alcohol swabs. One swab is used to clean the port before uncapping the syringe. Once the port is clean, the nurse draws the desired amount of fluid and recaps the syringe. Next, the port is swabbed again.
Once the flush is drawn and the port of the bag cleaned, the nurse enters to the patient’s room. The nurse checks patient identifiers and scans both the patient’s bracelet and barcode of flush. Practical Application In today’s healthcare system, nurses depend on evidence based practice. “Evidence based practice is a synthesis of evidence drawn from research, multiple forms of clinical expertise, expert consensus and patient preference to guide clinical practice and decision-making” (UC Davis Health System).
Nurses use evidence based practice to provide the best care possible to the patient. Evidence based practice is the basis for changes in protocols. “Nurses who incorporate high-quality research evidence into their clinical decisions and advice are being professionally accountable to their clients” (Beck & Polit, 2004). Every nurse’s professional practice can be improved by understanding nursing research. After conducting PREFILLED VERSUS MANUALLY 4 research, prefilled flushes are a better fit in most nursing practice settings. Advantages include being more cost and time efficient, having a lower infection risk, and minimal risk of medication errors.
Hospital administrators should support the new guideline based on cost efficiency of prefilled syringes. Nurses will embrace the change due to prefilled flushes being more time efficient and having less risk of medication errors. Doctors would accommodate the guideline because of the lower the risk of infection. However, changing the guideline must be approved by several personnel. These include: the hospital administrators, director of nursing, physicians, nursing supervisors and the quality assurance team.
Comparison and Contrast When hospitals are determining whether to use a prefilled flush or manually drawn flush several points are considered: cost, time efficiency, infection risk and medication error risk. David Dobbs, a local pharmacist, quoted the following prices: a box containing sixty prefilled flushes costs sixteen dollars, a single ten mL flush costs seven cents, a 1000 mL bag of normal saline costs one dollar and a box of 200 alcohol swabs costs one dollar and thirty-one cents (Dobbs, 2014). It may appear manually drawn flushes are more cost efficient. In each unit of the local hospital referenced, several bags of saline were being used during each shift.
Within a 24-hour period from initial use, the remaining fluid would be wasted. Also, treatment of infection caused by contamination of manually drawn flushes will diminish savings (Bertoglio, 2013). Prefilled flushes are considered, by most healthcare professionals, to be more time efficient. In an interview Amanda Jones, RN, BSN, MSNc, stated, “I feel prefilled saline flushes PREFILLED VERSUS MANUALLY 5 are more time efficient for nurses. We can easily attain one and do not have to spend time drawing it manually.
This allows a nurse to spend more time with his or her patients. ” (Jones,2014) While newer nurses tend to prefer prefilled flushes due to convenience and time savings, more experienced nurses often favor the manually drawn flushes based on familiarity with the protocol. Prefilled flushes may allow for more medication errors than anticipated. According to the article Misuse of prefilled flush syringes: Implications for medication errors and contamination, the most common misuse of prefilled flushes is the use of the flush to reconstitute or dilute a medication. While the intent is to save the hospital time and/or money, this practice can have very grave consequences for patients.
Based on a study conducted in 2007 by the American Nurses Association, sixty-eight percent of the participating nurses stated improved labeling of the flushes would greatly decrease the risk of medication errors. (Hadaway) Contrary to popular belief, both prefilled flushes and manually drawn flushes have a risk of causing infection. Manufactured prefilled flushes are encased in a transparent plastic wrap. The fluid and the pathway of fluid are sterile. However, the outside of the flush is not considered sterile (Hadaway, 2012). Manually drawn flushes have a greater risk of infection (Bertoglio, 2013).
There are several points in the process when contamination can occur. Initial contamination could occur once the cap of the flush is removed and the flush is attached to the bag. If the port of the bag is not cleaned sufficiently, the flush can become contaminated. Both prefilled and manually drawn flushes are at risk for contamination if the tip of the syringe is touched. Without careful attention, contamination could also easily occur as the flush is attached to the patient’s port.
PREFILLED VERSUS MANUALLY 6 Process for Implementation The guideline will be implemented by hospital administrators.
After adoption, the change would be accompanied by in-services training. Nurse educators will educate the staff on the new protocol. Meetings will need to be scheduled at the end of each shift to prevent staff coming to the hospital on an unscheduled work day. The in-services should include reasons for the change, benefits of the change, and a detailed report of the updated or revised protocol. An involved staff is more open to change. Expenses involved may include research costs and insurance reimbursement changes.
Evaluation 1To monitor and measure the effectiveness of the new prefilled flush protocol, many areas will need to be monitored and evaluated. The costs, infection control, medication errors and time efficiency will need to be compared. A month after the implementation of prefilled normal saline flush protocol, the results for this time are compared to the previous month’s data involving use of manually drawn flushes. In addition to checking costs, random chart audits will be performed to determine if hospital acquired infections decreased after implementing pre-filled normal saline flushes. Also, interviews with nursing staff on each unit will be conducted to determine how effective the change has been.
The final point would be to talk with the Director of Nursing to determine if medication error reports had decreased during the month using the prefilled normal saline flushes. Comparison of data results will determine if the change implemented was a benefit or detriment to the hospital.
PREFILLED VERSUS MANUALLY 7 References Beck, C. , & Polit, D. (2004). Nursing research principles and methods. Retrieved from http://books. google. com/books? id=5g6VttYWnjUC&printsec=frontcover&source=gbs_ge_summary_r&hl=en Bertoglio, S. (2013). Pre-filled normal saline syringes to reduce totally implantable venous access device-associated bloodstream infection: a single institution pilot study.
Journal of Hospital Infection , Retrieved from http://www. researchgate. net/publication/236052771_Pre-filled_normal_saline_syringes_t o_reduce_totally_implantable_venous_access_device-associated_bloodstream_infection_ a_single_institution_pilot_study/file/e0b4951642fb5330dc. pdf Dobbs, D. (2014, March 11). Interview by C. Cobb []. Price quote of supplies. Hadaway, L. (n. d. ). Misuse of prefilled flush syringes implications for medication errors and contamination. Infection Control Resource, 4(4), 2-4.
Retrieved from http://www. hadawayassociates. com/Misuse_of_Prefilled_copy. pdf Hadaway, L. (2012). Sterile prefilled saline syringes for acute care patients: A review of clinical evidence, cost-effectiveness, evidence-based guidelines, and safety. Rapid Response Report: Summary with Critical Appraisal, 4(4), 2-5. Retrieved from http://www. cadth. ca/en/products/rapid-response? q=Sterile Jones, A. (2014, March 11). Interview by A. Baddley, B. Brooks. Prefilled flushes vs saline bags. UC Davis Health System. (n. d. ). Retrieved from http://www. ucdmc. ucdavis. edu/cnr/evidence_based_practice/.