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Improving Patient Safety by Labeling IV Tubing

Marylynn Adamski

Ferris State University

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Abstract

Safety and quality of care given to the patient is an important part of a nurses job. The

intravenous route is one of the most frequent ways in which medication and fluids are given to

patients. The author examined the ways in which IV tubing is label and what the quality

improvement team is going to recommend be done to ensure patient safety when dealing with

IVs tubing. The model used in this paper is that of the Plan-Do-Study-Act change strategy.

This process is explained in detail and will help determine patient outcomes. The final step was

to evaluate the change that took place and see if the patient has benefitted from the change.
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Improving Patient Safety by Labeling IV Tubing

Quality and safety initiatives have always been of importance in providing patient care.

Quality health care is defined as the degree to which health services increase the likelihood of

desired health outcomes and are consistent with professional personal knowledge (Hughes,

2012). Nursing is the frontline of health services and works to bring about the desired outcomes.

To provide proper safety initiatives, it is important that various process improvement techniques

are used to identify ineffective care and preventable errors.

The strategy that is used is to look at the current practice in labeling and changing IV

tubing. By looking at the way that the process is being done or not done will give us a realistic

basis for the creation of a strategy that we will use to implement the changes. Once the change

has been determine we will educate all staff so that we can all work towards the desired outcome

and ensure patient safety.

Analysis of labeling and changing IV tubing

Intravenous (IV) tubing is use to supply medication and fluids directly into a peripheral

vein, central line, med port or a peripherally inserted central catheter (PICC) line. The

medications are sometime attached to a port on the IV tubing that allows the medication to be

infused along with the fluids given. It can also be attached to the top of the IV and given as what

is called a piggyback. The medications that are attached to the lower port are usually on their

own IV channel. Each channel is programmed independently but flows together. Many of these

medications are incompatible with other medications. Some of the IV fluids that are given may

have additive such as Potassium and Sodium Bicarbonate. These may not be compatible with

other medication that maybe be given IV push. There can sometimes be more than one IV site or

connector site available. If there is more than one site with tubing attached there is a chance of
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what is called Spaghetti syndrome. Spaghetti syndrome is the name given to the tangling of IV

lines and requires the nursing staff to untangle and reorganize the tubing thus represents an

operational inefficiency.

Presently at West Shore Medical Center every IV site and tubing is changes every 3 days

for peripheral IVs. The tubing on a central line, med ports and PICC line needs to be changed

every 3 days. The tubing is labeled with the day that they are to be changed. The tubing with a

medication that is being given in a piggyback or on its own pump need to have the tubing

changed daily. While the Charge nurse keeps track of the date when the IV needs to be changed;

there is nowhere on the chart to keep track of when the IV tubing has been changed or for nurses

to chart that the tubing was changed. Medications that are connected to the tubing do not have a

label that shows what day or time the tubing needs to be changed.

Because nurses hang various medication several times a day it is important that the nurse

knows what is running in the tubing that they are connecting the medication to and whether it is

compatible. Also in the case of a code if the tubing is labeled the nurse can administer the

medications without fear of them not being compatible. This is a huge patients safety concern

that sometimes gets over looked.

Quality Improvement Team

Once an activity has been selected for improvement a multidisciplinary team should be

established and should represent a cross section of the workers who are involved with the

problem (Yoder-Wise, 2011, p 395). For this group it is important that we have the Manager of

the units involved. We will also need at least three nurses from each unit. The units that are most

involved are the Medical Surgical (Med/Surg) and Critical Care Unit (CCU). By having three

nurses on the team from each unit it will be easier to monitor how and when the tubing is
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changed and if medications and tubing are being labeled. We would also involve Risk

Management to get their input on the changes that we would like to make. We would also ask

for a representative from Surgery on their thoughts about the process change. Since many of the

patient from Med/Surg and CCU go to surgery it will be important to get their input on how

labeling the tubing and medication would affect them.

Data Collection Method

It is important to have accurate information on the frequency of IV tubing being label and

how often the IV tubing is changed when infusing medications. The data collection method that

we will use is that of a chart that the Registered Nurses will fill out for a three weeks period.

They will mark if there was a label on the IV tubing indicating the solution or medication and

when it needs to be changed. By doing this we will be able to determine what needs to be done

to bring about compliance to labeling IV tubing and changing tubing. Each unit will use the

same form so that we will have accurate data which will be easy to interpret. We will have the

quality improvement team critique the form to be used and make any changes that are needed.

Outcomes

After examining the data the quality improvement team will set goals. These goals can be

established in a number of ways but always involves a standard of practice and nursing sensitive

outcomes (Yoder-Wise, 2011, p 399). Nurse sensitive indicators are displayed by looking at the

process used and the outcomes of the nursing care that is provided. The goal that we will be

working towards is the 100% compliance with the labeling and changing of IV tubing.

Plan-Do-Study-Act Change Strategy

Quality improvement projects and studies aimed at making positive changes in health

care processes to affect favorable outcomes can use the Plan-Do-Study-Act (PDSA) model
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(Berwick, 1998). One of the unique features of this model is the cyclical nature of impacting and

assessing change. This is most effectively accomplished through small frequent PDSA. This

method of change is well suited to the changes that we would like to make. There are 3 questions

that need to be asked before you using the PDSA. The questions are what is the goal of the

project, how will it be known whether the goals are reached and what will be done to reach the

goal (Langley, 1996). The PDSA cycle starts with determining the nature and scope of the

problem, what changes can be and should be made, a plan for a specific change, who should be

involved, what should be measured to understand the impact of change, and where the strategy

will be targeted.

The nature and scope of the problem is that IV tubing is not always being labeled with

the solution or medication or when they need to be changed. When connecting any new

medication or solution it is important to trace the tubing from the patient to the point of origin

(American Nurse Training Association, 2007). Before attaching any tubing to a patient, it is

important that the tubing be labeled near the connections point with the name of the fluid you are

infusing. The light should be turn on so that you can see to which port you are connecting the

tubing. Check connections and trace all patient tubes to their connection site when receiving or

sending a patient to a new unit. One change that can be implemented is that of using colored

label to identify the solution in the tubing (American Nurse Training Association, 2007). Maybe

white for plain IV fluids and colored for fluids that contain medications.

All nurses should be involved in following the policies that will instruct them on how to

label the tubing. There will be a daily checks by the charge nurse after the change has taken

place and nurses whose patients do not have the IV tubing labeled will be reminded that it needs

to be done. If it is found that the nurse is still not compliant with the policy the issue will be
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referred to the manager for further education of the nurse. The safety of the patient is the reason

that this change is going to take place, so it is a major part of the nurse job to protect the patient

from harm. The three main area that the change will take place is Med/Surg, CCU, and Surgery.

When a patient is received from the Emergency room the tubing should be label immediately.

The findings will be presented from the quality improvement team at staff meetings and

an email will be sent out about the policy. There will be a poster board that will show the overall

compliance with labeling the tubing and the risk associated with not doing it. There will be

labels present that are going to be used. All areas will have the same labels and will learn how

they should be filled out.

Evaluation of Effectiveness

Once the plan is implemented the team will continue to meet and evaluate data to

document that the outcomes are being met (Yoder-Wise, 2011, p 401). After the plan is

implemented it is important to get feedback from the nurses that the policy affects. It is

important that staff comments and suggestions be taken into consideration when evaluating the

effectiveness of the change. The manager should evaluate the work that the Quality

Improvement team has done and how they have worked together as a team. Once the study is

done the team may disband or they may stay together to work on other patient care issues.

Conclusion

There is always a need for quality improvement and it is the responsibility of each of us

to follow through when we see something that needs to be improved. By improving how we do

our job we are improving patient outcomes. The PLAN-DO-STUDY-ACT model was the

method use to bring about the change that we wanted. It is a very easy and useful model that can
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be used for various changes that need to be made. By using this model change can be brought

about in a short amount of time.

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References

American Nurse Training Association. (2007). Tubing Misconnections. Retrieved From:

http://www.americannursetrainingassociation.com/tubing%20misconnections.html

Berwick, D. M., (1998). Developing and testing changes in the delivery of care. Annals of

Internal Medicine. 128 (8) 651-656.

Hughes, R. G., (2008) Tools and strategies for quality improvement and patient safety. Patient

Safety and Quality: An Evidence-Based Handbook for Nurses. Retrieved From:

http://ncbi.nim.hin.gov/books/NBK2682/

Langley, J. G., Nolan, K. M., Nolan, T. W., (1996) The improvement guide: a practical

approach to enhancing organizational performance. New York. Jossey-Boss

Lipstern, Evan. (2009) Color safe Intravenous lines combat deadly IV tubing and catheter

misconnection errors. Retrieved From: http://www.ereleases.com/pr/colorsafe-

intravenous-lines-combat-deadly-iv-tubing-catheter=missconnection-errors-28842

Yoder-Wise, P. S. (2011) Leading and Managing in Nursing. (5th ed.). Mosby, St Louis, MO