Skills Day at the Hospital

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Yesterday, we had our first Skills Day! It’s been 5 months since I started working at the hospital. Basically, we got paid to learn more. Sweet!

In the morning, we had discussions about medication errors.
After lunch, we learned how to put IV’s in.

Medication Errors
We watched a video about Josie King, who was a young child who died due to medication errors at Johns Hopkins. Her mother was angered, and instead of retaliation, she was determined to decrease the number of deaths caused by medication errors. She created the Josie King Foundation.

Medication errors do not occur due to one person. Rather, it is caused by a system error. It’s caused by miscommunication among the healthcare providers (prescribers, dispensers, and administers), not listening to the patient’s or family’s concern especially relating to change in mental status, and more.

It’s important to report potential and actual medication errors so that a ‘root cause analysis’ can be conducted to understand and fix the problem.

IV Insertion
When new graduates are just starting off, they are not to do IV’s at my hospital. This is to allow them to focus on nursing assessments, giving medications, and coordinating care. When an IV has to change (every 72 hours), they often ask the assistant nurse manager, charge, or another experienced nurse.

It is a very technical skill with specific steps.
1. Assess: Ask the patient what other providers have said about their veins and where they have previously put it in. Look at the arm. It’s always better to start from the hand and move up the arm. Those needing short term therapy can start higher on the arm.
2. Preparation: Prep the saline flush and IIA. Tie the tourniquet on (left on for 90 seconds or less!). Find a vein that is soft and palpable. Clean the site with chlorhexidine. Prep the needle. Use left hand to pull down on vein so that it doesn’t roll.
3. Insertion and Dressing: Use right hand to hold needle. Insert until flashback is seen. Use right index finger to advance hub. Place gauze underneath hub. Get IIA ready. Retract needle and connect IIA. Pull back on syringe to make sure it’s in the vein. If blood is seen, then flush the line. Disconnect the saline flush. Dress the IV site.

Ok, I think I’m ready!!

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