To Calculate or Not to Calculate: That is the Question
Suzan R. Miller-Hoover DNP, RN, CCNS, CCRN-K
With the inclusion of smart infusion pump devices, unit dosing, standardized admixtures, among other technological advances, the need for medication dosing calculations may be seen as an unnecessary task. However, medication safety is still a critical part of your job. Patients’ safety and lives depend on receiving the correct dose of medications.
Knowing that the medication dose, concentration, and infusion rate agree with your calculations is the best way to ensure that an overdose/under dose does not occur.
With the advent of smart technology infusion pumps, unit dose preparations and standardized concentrations by drug manufacturers and pharmacists; medication errors have been greatly reduced. Although the use of IV smart pumps has reduced the incidence of IV adverse drug events and medication administration errors, IV infusion continues to be associated with 54% of all adverse drug events, 56% of medication errors, and 61% of serious and life-threatening errors (Giuliano, 2016).
Smart infusion pumps have improved medication delivery using drug libraries, dose limits, hard and soft alarms, and guardrails. Despite these improvements, drug errors still occur. Human error is responsible for many of these errors. Unless the pump is malfunctioning, it will calculate the rate and dose of an infusion correctly, BASED ON USER INPUT. If the data programmed into the pump is incorrect, the pump will deliver incorrect medication doses and rates (Association for the Advancement of Medical Instrumentation (AAMI), 2016 & Giuliano, 2016).
Even when all systems are go – when the technology works well, and pharmacy support is optimal – the nurse remains responsible for safe administration of IV medications directly to patients. To fulfill this responsibility, the nurse must maintain competency in basic medication calculations.
As a healthcare provider, can you guarantee in court that the rate and the dose on the infusion pump is correct? Can you attest that the medication a child receives falls within the dosing recommendations? Do you know how to determine the maintenance fluid requirements of a child?
The answer yes, to any or all the questions above, portrays that you have calculated the doses, rates, and fluid needs and compared them with the orders, the pharmacy drug label, and the smart infusion technology you use.
Do you validate infusions by doing an independent calculation of the dose and rate of each drug infusing? If not, ask yourself why. If you don’t remember how, or you were never taught how to perform these vital calculations you can change that by learning and practicing your skills utilizing the RN.com course: Critical Thinking: Nursing Calculations Parts 1-3. Patient safety is everyone’s responsibility.
Association for the Advancement of medical Instrumentation (AAMI). (2016). Majority of IV medication errors linked to clinical practice not technology. Retrieved from: http://www.aami.org/newsviews/newsdetail.aspx?ItemNumber=3149
Giuliano, K.K. (2016). IV smart pumps: The impact of a simplified user interface on clinical use. Retrieved from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4850078/
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