Digital Repository Masters Projects Spring 2023 Reducing Intravenous Medication Compatibility Errors in the Intensive Care Unit Sydnee Thorpe Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Thorpe, S. 2023. Reducing intravenous medication compatibility errors in the intensive care unit. Weber State University Masters Projects. https://dc.weber.edu/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact scua@weber.edu. 1 WSU REPOSITORY MSN/DNP Reducing Intravenous Medication Compatibility Errors in the Intensive Care Unit Project Title By Sydnee Thorpe Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY Ogden Utah 4/2/2023 Date Sydnee Thorpe Student Name, Credentials (electronic signature) Amber Fowler MSN Project Faculty (electronic signature) 3/28/2023 (date) April 4, 2023 (date) 05/25/2023 Melissa NeVille Norton (electronic signature) DNP, APRN, CPNP-PC, CNE Graduate Programs Director (date) 2 Reducing Intravenous Medication Compatibility Errors in the Intensive Care Unit Sydnee Thorpe, BSN, R.N., MSN Student Weber State University Annie Taylor Dee School of Nursing 3 Abstract Intravenous (IV) medication compatibility errors are a problem among critical care patients. This MSN paper will discuss the importance of preventing IV medication errors and strategies to do so. The literature review provides sources showing that patient safety is a priority for healthcare. It also provides statistics on IV medication compatibility and ways to prevent errors. This project is led by nurses, management, unit educators, and pharmacists to ensure that relevant and correct information is provided. The paper explains the plan to prevent future IV medication errors using the Iowa Model, and outlines specific details of the proposed interventions to prevent IV medication errors. The plan is based on equipping each room with a medication compatibility chart that nurses can access when dealing with critical patients. The goal of this project is to decrease medication errors through the use of IV compatibility charts. Keywords: medication, compatibility, pharmacist, incompatibility, error, patient safety, IV, nurse, education 4 Reducing Intravenous Medication Compatibility Errors in the Intensive Care Unit Understanding the purpose, mechanism of action, and adverse effects of medications is integral to safe patient care in the healthcare setting. It is a nurse’s role to know the effects of diseases and which medications treat those diseases so they can appropriately administer ordered medications. Patients in an intensive care unit (ICU) often receive multiple drugs via different routes. The most common route for administering medications in the ICU is intravenous (IV) injections or infusions. While IV administration is appropriate for delivering life-saving medications, giving multiple medications simultaneously through IV administration makes medication errors more probable. A common mistake nurses make is administering IV medications incompatible with each other. IV medications must be compatible to be given through the same IV line. According to Sriram et al. (2020), in a cross-sectional study involving 104 patients, 66 of them had an IV medication incompatibility event. An incompatibility event means IV medications that interact poorly were given together and can cause an adverse reaction. It is common in ICU settings for nurses to use a manifold when administering IV medications. A manifold is a device that can be used to Y-site together multiple medications in an organized approach (Hodges, 2018). When medications are Y-sited together, each separate medication tubing is connected to deliver the medications simultaneously. Using a manifold can be essential in minimizing the patient’s risk of infection by preventing unnecessary needle sticks (Hodges, 2018). IV incompatibility errors can occur in several ways. Examples of incompatibility errors may include infusing two or more continuous medications through an incompatible lumen or giving incompatible IV push medications after one another in a single lumen without a saline flush in between doses (Sriram et al., 2020). 5 Statement of Problem According to Hanifah et al. (2015), over 70% of medications are administered parenterally in critical care patients. Patients who receive medications infused through IV access have a higher rate of complications due to medication errors (MacDowell et al., 2021). IV medication compatibility errors are a common issue that could be significantly reduced if nurses have appropriate and accessible resources (Oduyale et al., 2020). Knowing if medications are compatible can be difficult since almost two-thirds of medication combinations have never been tested for compatibility (D’Huart et al., 2019). The likelihood of an incompatibility error increases with each medication added to the patient’s administration list. Patients in an ICU typically receive two times more medications than non-critically ill patients, leading to an increased risk of error (Kane-Gill et al., 2017). Nurses often lack the appropriate resources to prevent compatibility errors (Oduyale et al., 2020). The purpose of this MSN project is to improve intravenous medication compatibility education available to nurses in the ICU. ICU nurses typically have access to a pharmacist for consultation and online resources to check IV medication compatibility. However, it would be more beneficial for nurses to access a reliable bedside resource in each patient room to check IV medication compatibility, as ICU patients often need immediate interventions. Ways Project Contributes to Intended Recipients This project can benefit nurses, patients, and unit managers in several ways. Nurses working in the ICU will have easily accessible resources regarding IV medication compatibility to provide a higher quality of patient care by preventing IV medication compatibility errors and adverse events. According to Di Simone et al. (2018), nurses are the last safeguard to prevent medication errors from reaching patients, so nurses need to have adequate access to resources to 6 know how to prevent such errors. Patients will benefit from the increase in safeguarding against medication errors by preventing adverse events that may otherwise be harmful. Patient safety surrounding medication errors needs to be a top priority for all healthcare staff, specifically nurses, because critical care patients are more likely to experience drug-drug interactions (KaneGill et al., 2017). The ICU unit educator and management would be able to provide additional IV medication compatibility education and resources that can be readily available in each room. Giving these extra resources to nurses benefits management because they will have fewer IV medication compatibility errors made by their staff, resulting in fewer incident reports. Many nurses believe that medication protocols and informative brochures and posters concerning IV medications are beneficial in preventing errors (Di Simone et al., 2018). Rationale for Importance of Project This project is vital for several reasons. This project will build upon the nurses’ knowledge by giving them additional IV medication compatibility resources to prevent errors. This information will ensure that ICU nurses can use their knowledge and skills to avoid IV compatibility errors. Factors contributing to compatibility errors may be a lack of knowledge, lack of resources, and lack of IV accessibility (Oduyale et al., 2020). The most important reason for this project is to promote increased patient safety. Administration of multiple IV medications simultaneously through a manifold reduces the risk of infection by decreasing the number of IV access sites and needle sticks needed for patient care (Hodges, 2018). However, manifolds do not automatically make medications compatible. Compatibility errors can lead to adverse reactions for the patient. For example, when incompatible IV medications are administered together, it can alter the strength of the drug, which can cause the effectiveness to be either increased or decreased (Wolters Kluwer, 2022). 7 Suppose the effectiveness of IV medication is altered – in that case, the patient may not receive the full benefits from the medication or may cause the patient to go over the therapeutic index, which can cause toxicity (Ates et al., 2020). Understanding IV medication compatibility is necessary to prevent IV medication incompatibility events. Some medications may not have enough research or data to be labeled as compatible or incompatible, so those medications should not be given together (Wolters Kluwer, 2022). There are also different forms of compatibility. For example, some medications may be compatible if given simultaneously via a Y-site but not when given as an admixture (Wolters Kluwer, 2022). This literature supports this project because it provides data confirming that a lack of knowledge can lead to IV medication compatibility errors. One accessible resource in most ICUs is a pharmacist. Interdisciplinary collaboration between nurses and pharmacists leads to a reduction in medication errors (Manias, 2018). However, a pharmacist is not always available at the bedside, so nurses need access to another easily accessible resource. Some smaller or more rural hospitals may have a pharmacist that can only be reached by phone, causing another barrier to helping healthcare workers prevent IV medication errors. As a result of this project, ICU nurses should more easily know where to access additional IV medication education. Oduyale et al. (2020) stated that organizations should have resources focused on the compatibility of commonly used IV medications and that these resources should be reviewed with an interdisciplinary approach. Collaborating with pharmacists to create additional resources for ICU nurses on the unit would ensure accurate information. Literature Review and Framework This section will address the evidence-based practice (EBP) change model that will best benefit the project. The Iowa model will be used to implement this project and define guidelines 8 for determining the next steps. EBP frameworks typically involve several steps to help the project achieve the desired change, including gathering and evaluating evidence, implementing a change, and analyzing the change for effectiveness (Melnyk & Fineout-Overhold, 2022). The literature review will search for evidence that supports the rationale for additional IV medication compatibility education for ICU nurses. Framework The framework model used for implementing this project is the Iowa Model. This model identifies problems, searches the literature for potential solutions, and implements the proposed changes (Iowa Model Collaborative, 2017). The Iowa model is a multistep approach that includes evaluating each phase of the implementation strategy (Cullen et al., 2022). After each step of the Iowa Model, receiving feedback is crucial to ensure that the proposed change is effective. After identifying the problem - IV medication compatibility errors - the Iowa Model will create a team to resolve the issue. After synthesizing the evidence, the team will design a plan to implement the changes. Following the implementation and analysis of efficacy, project dissemination will occur as the final step of the Iowa Model (Cullen et al., 2022). The Iowa model applies to this project because it will promote efficiency, efficacy, and reliability throughout the project. The team will consist of unit nurses, unit educators and management, and pharmacists. After the changes, it will be evaluated by the unit management and educators for effectiveness and comparing IV medication compatibility error rates from before and after implementation. After unit management evaluates effectiveness, the results can be shared with bedside staff to gain more insight. Strengths and Limitations 9 A strength of the Iowa Model is the pilot test conducted before fully implementing the proposed solution. A pilot test means that after evidence has been collected and analyzed, the rollout of the solution will be implemented within a small group to test the changes and refine the process (Cullen et al., 2022). The pilot test takes place after determining if there is enough clinically relevant evidence to implement the project and if the change is feasible (Hooge, 2020). A pilot test first allows the team to refine and integrate the process smoothly A limitation of the Iowa Model specific to this project is that the pilot program will only be initiated in one ICU. Only running the pilot test in one ICU may be an issue because a pilot run tests the strategy to see its effectiveness and if additional changes are needed. Getting as much feedback from a trial run through only one ICU will be difficult. The Iowa Model steps create an advanced solution, and while it will be adequate for this project, it may work better if the solution were to have a pilot run in more ICUs (Cullen et al., 2022). Another limitation of this project is that it focuses on IV medication compatibility errors and does not consider any other medication errors. Analysis of Literature This literature search aims to determine the prevalence of IV medication compatibility errors in ICUs and will summarize information regarding IV compatibility-focused nurse education. Nurses are responsible for being educated on preventing medication errors and what to do in the event of a compatibility error. As IV medication incompatibility errors account for up to 25% of ICU medication errors (Braun, n.d.), this literature will support increased IV medication compatibility education. Search Strategies 10 A literature search was conducted to find current evidence using Google Scholar, Medline, CINAHL, and Weber State University Stewart Library OneSearch. To ensure that data was accurate and current, articles were only used in this review if they were from 2017 through 2022. The search included keywords such as medication errors, nurse medication education, medication safety, ICU medications, medication compatibility, compatibility education, ICU nurse education, medication error outcomes, IV medications compatibility, and medication resources. Several Boolean combinations were created with these keywords to broaden the search. The literature identified themes for this project, including IV medication compatibility, factors of IV medication compatibility errors, and IV medication compatibility resources. IV Medication Compatibility IV medication compatibility is essential for understanding which medications can be given simultaneously and which ones need separate IV access (Wolters Kluwer, 2022). Three types of incompatibility errors are possible when administering IV medications simultaneously. These three errors are chemical, physical, and therapeutic (Cayo, 2019). Administering incompatible IV medications can decrease drug effectiveness or cause harm to the patient (Wolters Kluwer, 2022). ICU nurses must understand drug compatibility because patients in an ICU are likely to receive twice as many IV medications as non-critical patients within the hospital (Kane-Gill et al., 2017). Additionally, patients receiving medications through an IV are more likely to experience complications due to medication errors (MacDowell et al., 2021). A quantitative study by Ayari et al. (2022) showed that out of the 75 IV medications tested, there was an average 68% compatibility rate. A higher rate means the medication is more likely to be compatible with other meds, and vice versa for a lower rate. Medications such as amiodarone had higher compatibility rates, while pantoprazole was incompatible with every 11 medication (Ayari et al., 2020). This literature shows that several IV medications cannot be administered together without causing an adverse event. Conversely, according to an experimental quantitative study by D’Huart et al. (2019; N=389), 62.7% of medication combinations have no data on compatibility. While administering medications is considered a multidisciplinary process, increased responsibility falls upon the nurses as they are the last line of defense against medication errors (Márquez-Hernández et al., 2019). The entire interdisciplinary team should be involved in medication administration, including the ordering provider, the pharmacist, and the nurse. Understanding pharmacology and compatibility is the entire team’s responsibility, and all parts of the team should be involved in actively preventing errors (Manias, 2018). Factors of IV Medication Compatibility Errors According to Márquez-Hernández et al. (2019), a leading cause of nurses making medication errors correlates with being overworked. A lack of knowledge also heavily contributes to IV medication compatibility errors (Márquez-Hernández et al., 2019). Similarly, Oduyale et al. (2020) state that IV medication compatibility errors may be due to staffing shortages, lack of resources, IV accessibility, and knowledge. When nurses are overworked or short-staffed, they are more likely to experience distraction, resulting in an increased probability of making an error while administering medications (Márquez-Hernández et al., 2019). Many nurses admit to needing additional IV access or switching around IV lines to ensure compatibility with various medications infusing simultaneously (Oduyale, 2020). Trying to find additional IV access or rearranging medication lines can lead to mislabeled medication lines. It can also prove problematic if there is limited time or additional IV access is not feasible. IV Medication Compatibility Resources 12 Several resources are already in place for nurses and other healthcare staff to prevent medication compatibility errors. However, most resources are not as readily available as would be necessary for critically ill patients in an ICU. Most ICUs' current resources include a pharmacist, online sources, and a nurse’s drug guidebook (Elovic & Pourmand, 2019). Lexicomp is an online resource available to most nurses that determines medication compatibility. However, this resource is not always up-to-date and has several understudied medications. Pharmacists are an expert resource for nurses to ask medication questions. However, not every ICU always has a pharmacist on the unit. Medication error prevention is paramount in promoting patient safety in nursing. According to an integrative review by Manias (N=30), interdisciplinary collaborations between nurses and pharmacists reduce med errors (2018). Additionally, a systematic review performed by Gilliani et al. (2021) has shown that pharmacistcentered interventions reduced the number of medication errors. Gilliani et al. (2021), Preston et al. (2019), and Manias (2018) all show a correlation between pharmacists helping prevent medication errors in a hospital setting. According to a quantitative study by Cheon et al. (2022), pharmacists should monitor IV medication compatibility in every unit, especially in ICUs. Having pharmacists available to help determine IV medication compatibility would decrease errors and increase patient safety (Cheon et al., 2022). If nurses can consult with pharmacists when they have questions or concerns, this will increase nurses’ knowledge regarding IV medication compatibility due to the communication between the interdisciplinary team. Pharmacology education for nurses has a crucial impact on safe medication administration (Jones et al., 2022). A qualitative study by Preston et al. (2019) studied nursing students and the best educational resources for medication compatibility and showed that a lack 13 of pharmacology content correlates with increased medication errors (Preston et al., 2019). Most students in this study stated that pharmacology courses positively impacted their ability to deliver medications safely to patients (Preston et al., 2019). New IV medications are consistently introduced for patient administration, thus increasing the risk of potential errors due to unknown compatibility and overall knowledge of the medication (Cayo, 2019). Continuing to provide resources for nurses about IV medication compatibility can decrease errors in an ICU. Nurses are the last line of protection for preventing a medical error from reaching a patient. Therefore, nurses must be continually updated on IV medication compatibility resources to stay up to date and promote patient safety (Di Simone et al., 2018). Summary of Literature Review Findings and Application to the Project A review of the literature regarding IV medication compatibility showed that IV medication compatibility errors might be directly correlated to nurses being overworked, lacking resources, and lacking knowledge. A common theme throughout the reviewed literature is that nurses need additional resources to decrease errors in order to increase patient safety. Evidence suggests that utilizing the interdisciplinary team is essential in preventing IV medication compatibility errors and reducing potential patient harm. Information found throughout this search has substantiated the rationale for increasing IV medication compatibility resources for ICU nurses. The evidence found will be used to develop continuing education and create resources for ICU nurses regarding IV medication compatibility. Project Methodology This section will discuss the steps to implement the planned change. This section will include details of deliverables, a timeline for each implementation step, and interdisciplinary 14 teamwork. Lastly, this section will discuss the ethical considerations of this project’s implementation. This project is vital because the literature review showed that several possible causes lead to IV medication errors. Implementing the proposed changes will take place over a period that allows the unit employees to adjust and understand the importance of the changes. Description and Development of Project Deliverables Deliverables for this project will include a brochure and individual cards for each room. The brochures will be given to ICU team members to incentivize buy-in to the plan. Meanwhile, nurses will use the cards to prevent IV medication compatibility errors while treating patients. Brochures Brochures will include information on the importance of understanding IV medication compatibility and statistics to make the nurses more inclined to agree to this change. The statistics will have information about the frequency of IV medication errors and the goals of this project. These brochures will be introduced to the staff before the individual cards are placed in each room to give the nursing staff adequate time to address concerns or provide input. The brochures will include input the team expects from the unit nurses and add how the next steps will be implemented. This deliverable is essential to help the staff understand the importance of patient safety regarding IV medication compatibility (See appendix A). Cards The cards will consist of a chart of several common medications given in the ICU and their compatibility with each other. These cards will be put in ICU rooms near the computer for the nurse to refer to in emergencies. An ICU pharmacist and scholarly medication sources will be advised when creating the chart to ensure accuracy on IV medication compatibility (See appendix B). 15 Evaluation Feedback from nurses on the unit will evaluate the effectiveness of deliverables. The nurses will be given a pre and post-survey to determine if they feel the cards in the room are helpful and how often they use them. Input from nurses on the medications they feel they give the most frequently will be considered when creating the cards. This input will be taken from the pre-surveys given to the nurses (See appendix C). Giving nurses and other ICU staff opportunities to share their thoughts on medications that should be on the card will help the staff use it since they helped with its creation. The nurses will be able to share their thoughts and ideas anonymously through the post-surveys (See appendix D). Also, staff will be asked about this project implementation during their quarterly check-in with management. The ICU employees have scheduled meetings with management once a quarter. So, the nurses will share their opinions on the changes in those meetings. Plan and Implementation Process To implement this project, the team will begin by achieving buy-in from the unit nurses and ancillary staff. Ensuring the unit staff understands the importance of IV medication compatibility will be crucial. Over time, the brochures will be dispersed among the ICU nurses to get them to agree to the plan. The brochures will help achieve buy-in by encouraging the nurses to prevent IV medication errors. Another strategy for buy-in is incentivizing the nurses by entering them in a drawing for a prize if they turn in the pre-survey. The post-surveys will be anonymous. However, the pre-surveys will not be anonymous, allowing this incentive opportunity. Once nurses receive the plan well and have their concerns and questions answered, the team will share the plans to follow through with the change. 16 First, the team will work with other healthcare professionals, such as a pharmacist and the ICU unit educator, to create a card to hang in each patient room. The cards will consist of a chart with common medications given in the ICU and their compatibility with each other. Once the cards have been created and reviewed for accuracy, they will hang in each ICU patient room. The cards will be by the computer to allow for easy access and high visibility during emergency care. The recipients of this plan are the ICU nurses and patients. The goal of this project is to encourage nurses to use resources that are available to them to prevent IV medication incompatibility errors. By putting a card full of essential information in a highly visible area, the nurses will gain quick access to the needed information in an emergent situation. This project also benefits patients because it reduces IV mediation incompatibility errors. By preventing errors, nurses can stop harm before it reaches the patient (Oduyale et al., 2020). For example, a patient in an ICU may only have two peripheral IVs. If an emergency occurs, and that patient already has medications currently infusing in both of their IVs, the nurse will need to decide which IV to use to administer the emergent medications. This card with compatibility information will help the nurse make a safe decision and prevent compatibility errors. Interdisciplinary Teamwork Implementation will involve ICU pharmacists, the unit educator, unit management, and ICU nurses. The nurses on this project's team will make the cards by combining the medications suggested by the ICU nurses and other staff to create an easy-to-read and professional chart. The pharmacists, unit educators, and nurses will review the information to produce the cards for each room. The Unit educator and management will work together to create the brochures for the 17 staff. Interdisciplinary teamwork must be employed in this project to ensure accurate and valuable information is on the brochures and cards. Timeline Implementation of this project will occur in several steps. Implementation will begin by getting buy-in from the ICU nurses. One strategy to achieve this will be giving the nurses the brochure of information on why this project is essential for the unit. The pre-survey will be given with the brochure. The staff will know about the drawing that coincides with turning in the presurvey. The survey will allow ICU nurses to give feedback, promoting buy-in and allowing nurses to have an active say in what is important. This portion of implementation will occur over approximately two weeks. The brochure creation will take place during these two weeks. The cards will be created and refined in three weeks. They will be checked for accuracy prior to being printed. The cards will then be dispersed into each room, and after one month of using the cards, the evaluation period will take place. Evaluation will occur within three months to allow time for post-surveys to be reviewed and meetings with management to occur (See Appendix E). Plan for Evaluation of Project Evaluation of this project is essential. The evaluation will determine if the implementation is successful, what needs to be changed, and what is working. After the cards have been in patient rooms for a month, staff will be given a post-survey. The survey will ask about how frequently the nurse uses the cards, the availability of the cards, and ease of use. The survey will be anonymous to encourage staff to share their thoughts freely. Along with surveys, the nursing staff will be asked their opinions, thoughts, and concerns during their quarterly check-in with management. 18 Ethical Considerations Ethical considerations of this project include healthcare workers’ responsibility for patient safety. Safety is something nurses should always consider. Implementing IV medication incompatibility prevention techniques is a way to help nurses continue to provide safe patient care. Patient safety is part of a nurse’s social responsibility (Di Simone et al., 2018). If there are staff members who do not wish to participate in the project, they will not receive any repercussions. Some nurses follow particular practices and may already use several resources to prevent IV medication incompatibility. As the post-survey will be anonymous, the team will not know who did or did not fill one out. Completing the post-surveys anonymously means no one can be punished for their responses and ensures privacy. Discussion This section of this MSN paper will discuss the strengths and limitations of this project, its recommendations, and how this advances the nursing profession. Overall, this project upholds nurses’ standards and protects patient safety by giving staff accessible IV medication compatibility resources. Implementing these changes can lead to a more focused future on sustainable ways to achieve patient safety. Evidence-based Solutions for Dissemination This project will be disseminated as a poster at the end of the school year. The school faculty, as well as peers, will view the presentation. The presentation will provide information from the literature review to back up the validity of this project. Information from this project will be dispersed among ICU nurses and ICU management at nearby hospitals. Significance to Advance Nursing Practice 19 Implementing this project will enhance the nursing profession, especially for ICU nurses and staff. This MSN project promotes patient safety by decreasing IV medication errors. Nurses are the last line of defense to prevent medication errors from occurring before they reach patients, so providing them with resources will increase safety (Di Simone et al., 2018). This project is significant because IV medication errors can quickly occur anytime. Patients in the ICU are especially vulnerable because they typically receive up to two times more medications than patients who are not in the ICU. So, ICU patients are more likely to experience adverse effects due to an IV medication error (Kane-Gill et al., 2017). Nursing staff having supplemental resources provides extra protection for their patients (Di Simone et al., 2018). This project will allow nurses to have those additional resources and prevent IV medication compatibility errors. Implications This MSN project portrays many strengths, including teamwork, evidence-based practice, and patient safety. However, there are also some limitations. These changes will only be implemented in one ICU, limiting the amount of feedback. Nursing knowledge is supported by including the staff's suggestions for adding medications. Providing the staff with increased access to IV medication compatibility information supports the nursing profession by offering reliable information sources to ensure patient safety. Quick access to IV compatibility allows nurses to make educated decisions in an emergency. Recommendations This project needs to increase the ICU nurse’s involvement in its implementation. The team should consider recommendations that have been suggested in order to improve the project where possible. The more the staff adds to the final project, the more likely they will use the 20 charts and give honest survey feedback. Following the project, staff can still provide feedback during their quarterly meetings with management. A suggestion was made to include pharmacists more throughout the implementation process. That advice was taken into account, and pharmacists were included in creating and reviewing the charts for the rooms. Further research may be necessary to make continued improvements. For example, the chart has information gaps where certain IV medications have not been tested for compatibility. Therefore, as new research about medication IV compatibility is introduced into the medical field, it should be considered and added to the charts in the rooms as appropriate. Conclusions Overall, this project will increase patient safety by giving nurses resources to decrease IV medication errors in the ICU. The literature review showed several vital factors that may cause nurses to make an IV medication error, such as lack of knowledge, resources, and overworked and short-staffed nurses. Putting an accessible resource that is legible in an area near patient care will allow nurses to administer IV medications with the assurance that they are compatible. This is especially important for patients with limited IV access or in an emergency. 21 References Ates, H. C., Roberts, J. A., Lipman, J., Cass, A. E., Urban, G. A., & Dincer, C. (2020). On-site therapeutic drug monitoring. Trends in Biotechnology, 38(11), 1262-1277. Ayari, G., d’Huart, E., Vigneron, J., & Demoré, B. (2022). Y-site compatibility of intravenous medications commonly used in intensive care units: laboratory tests on 75 mixtures involving nine main drugs. Pharmaceutical Technology in Hospital Pharmacy, 7(1). https://www.degruyter.com/document/doi/10.1515/pthp-2022-0002/html Braun. (n.d.). Drug incompatibility risk prevention. https://www.bbraun.com/en/products-andsolutions/therapies/infusion-therapy/b-braun-for-safety/drug-incompatibility.html# Cayo, L. (2021). Compatibility of commonly used IV drugs. 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Nurse Education Today, 74, 76-81. https://doi.org/10.1016/j.nedt.2018.12.006 Sriram, S., Aishwarya, S., Moithu, A., Sebastian, A., & Kumar, A. (2020). Intravenous drug incompatibilities in the intensive care unit of a tertiary care hospital in India: Are they preventable? Journal of Research in Pharmacy Practice, 9(2), 106–111. https://doi.org/10.4103/jrpp.JRPP_20_11 24 Wolters Kluwer. (2022). Trissel's I.V. compatibility databases in facts and comparisons. https://www.wolterskluwer.com/en/solutions/lexicomp/resources/facts-comparisons-useracademy/trissels-iv-compatibility-databases 25 Appendix A 26 Appendix B 27 Appendix C Pre-survey 1. Do you use any resources to look for IV medication compatibility? 2. If you answered yes to question 1, what resources do you use? 3. How accessible do you feel those resources are? 4. What IV medications do you give frequently? 5. On a scale of 1-10, 1 being never and 10 being daily, how often would you use a compatibility chart if there were one in each room? 28 Appendix D Post-survey 1. On a scale of 1-10, 1 being never and 10 being daily, how frequently have you used the compatibility charts since they were implemented in each room? 2. Would you add any medications to the compatibility chart? 3. Is the chart in an easily accessible area? 4. What recommendations or concerns do you have about the charts? 29 Appendix E Timeline