Uncertainty can arise regarding what medical, nursing and monitoring resources are required for particular drugs to be safely administered intravenously. This uncertainty can lead to delays in patient treatment, and inadequate or excess resource allocation.

To outline the administration, monitoring and resource requirements for the administration of intravenous drugs utilised within BHS. This will facilitate the safest possible administration of these drugs and assist in appropriate resource allocation.

AIDH – Australian Injectable Drugs Handbook (current edition)

BP – blood pressure

Bolus injection – an injection given rapidly over 2 minutes or less either directly into a vein or free flowing IV line. Usual fluid volumes are 20-30mL.

CCRN – Critical Care Registered Nurse- a registered nurse with recognised post graduate qualification in critical care nursing (e.g. Intensive Care, Coronary Care, Emergency, Peri-operative).

Critical Care Areas – Critical Care Unit, Emergency Department, Cardiovascular Suite, Theatre.

ECG – electrocardiogram

IV – intravenous

RN – Registered Nurse or Endorsed Enrolled Nurse (IV Medication certified)

This CPP excludes: Paedatrics, MET calls, Palliative Care Patients, Infusions to be administered at home (i.e. HITH), Code Blue & Obstetric Emergencies.

Drugs specfically not listed: Chemotherapy agents, Radiology specific pharmaceuticals.

Medical staff must exercise their clinical judgement, and may request a higher level of monitoring or nursing care for individual patients based on their condition.

Nursing staff involved in the preparation and administration of intravenous medications must follow all applicable BHS policies.

This document does not list all intravenous medications available on the market. The document will be updated periodically to reflect intravenous medications routinely stocked by BHS. Seek pharmacist advice for any unlisted drugs.

The document does not outline requirements for administration by other routes, and monitoring requirements should not be extrapolated.

Continuous ECG monitoring, telemetry, BP monitoring as outlined in the appendices or AIDH for individual drugs.

This document lists the minimum level of nursing care and monitoring required. Medical staff are to exercise their clinical judgement, and may request a higher level of monitoring or nursing care for individual patients based on their condition.

All infusions are to be administered by volumetric pump or syringe pump, following BHS Drug Guidelines where they exist.

For drugs without a drug guideline check the Australian Injectable Drugs Handbook- current edition (the ‘Yellow Book’) for further administration information, including if any monitoring (e.g. blood pressure, for anaphylaxis) is required. The approved Product Information should also be consulted if required.

Monitor all patients for any adverse reaction arising from the IV administration of any drug, including extravasation.

The following categories are used in the document

Appendix 1 lists drugs that can be given via the intravenous route on General Wards, together with any monitoring required.

Appendix 2 lists drugs that can only be given intravenously in Critical Care Areas, and the associated monitoring. This also includes midwifery specific listings. Exceptions may be granted for Appendix 2 medications, if the ICU consultant (if being discharged from ICU), receiving consultant and NUM agree for palliative care patients or patients who will be discharged home with an infusion of a medication listed in Appendix 2. This discussion must be noted in the patients progress notes.

Appendix 3 lists IV drugs administered only by Medical Staff or a MET Liaison Nurse on General Wards.