Unit 1 (High alert medications and PINCH drugs)

What is a sentinel event?

Errors that cause significant injury including death

What does each letter of PINCH stand for?

P- parental nutrition & potassium infusions

I- insulin

N-narcotics

C-chemotherapy

H-heparin

Describe Parental nutrition

• Hypertonic(less water) solution w/ high dextrose(sugar derived from starch) concentration

• Always on a pump

• 2 nurses should check TPN label

What is parental nutrition also known as?

TPN (total parental nutrition)

Describe Potassium infusions

• Can be given through various routes

• The route depends on the level of concern (feeding tube, PO, IV fluid)

• Always on a pump

• Premixed? Added by pharmacy? (No check)

• Added by nurse? (check with another RN)

Describe IVPB (Intravenous Piggy Back)

• Used when K+ levels are low so a small bag of K+ is given for a short period of time

• Always on a pump

• 2 nurses check patients identity, verify potassium level, & verify flow rate set on pump

What’s the difference IVPB and IVF?

IVPB: smaller

IVF: larger

Describe insulin infusions

• Understand patient BS FIRST

• Administered by injection (subcutaneous or IV)

• Always on pump

• 2 nurses check set up and rate change

• Constant infusion of insulin (used for more serious patients)

Can Insulin infusions sometimes be given as IV push?

YES!!!!

What is insulin infusions also known as?

Insulin drip (gtt)

Describe narcotics

• Can be administered through all routes

• 2 nurses verify and document amounts wasted

• Can be given using infusions and PCA

What 2 delivery methods are used for administering narcotcis?

• IVPB

• Syringes

Why do two nurses have to verify and document wasted narcotics?

Because they are controlled substances with legal requirements

What does PCA stand for?

Patient controlled analgesia

• Pt pushes a button to deliver ordered dose

What always need to be used during PCA for narcotics?

A locked pump

-This ensures the flow rate and prevents diversion of controlled substances

When it comes to infusions and PCAs for narcotics, what do 2 nurses need to check?

• Initial set up

• Bag/syringe change

• Rate change

• Every shift change

Describe chemotherapy

• Can be given PO (varies by agent and facility protocol)

• Can be given by IV infusions or IVP

What is chemotherapy also known as?

Antineoplastic agents (cytoxic in nature)

What are some things to know when given chemotherapy via IV infusions or IVP?

• Infusions are always on a pump

• 2 nurses need to check for labeling and infusion rate

• Must be chemotherapy certified at facility

Describe heparin

• Anticoagulant (blood thinner)

• Comes in different strengths

• Can be given via IVP or IV gtt (drip)

What would it look like for heparin to be given IVP?

• 2 nurses have to check prior administration

• Verify lab results prior to giving PTT lab (pertinent lab value)

What would it look like for heparin to be given IV gtt (Heparin drip) ?

• Always on a pump

• 2 nurses should check bag prior to hanging

• 2 nurses should check any rate change

• Verify lab results prior to any change

What does it mean to be given SQ heparin flush and heparin flush?

• This keeps the IV catheters patent (helps keep IV line flowing freely and open when not in use)

• Dilute form of heparin

What two ways can heparin be given?

• Subcutaneous

• IV