Dr Karen Davies1,2,3, Mrs Sahra Ashley1, Mrs Amanda Sutherland1, Mr Ciaran Moloney1, Mrs Katherine Losinski1, Ms Sian McFarland1, Dr Peter Donovan1,3, Dr Elizabeth McCourt1,3
1Royal Brisbane and Women's Hospital, Herston, Australia, 2Herston Infectious Disease Institute, Herston, Australia, 3University of Queensland, Brisbane, Australia
Biography:
Dr Karen Davies works as CNC Safe Medication Practice at the RBWH and a Research Fellow in Herston Infectious Disease Institute and UQ. Combining a special interest in safe intravenous administration research and her postdoctoral studies implementing the MAEFT to evaluate nurses' medication administration standard of practice.
Abstract:
Background/Aim
Best practice for administering ≥2 intravenous (IV) medications involve using a 1 L Sodium Chloride 0.9% (saline) bag via a burette. Uptake at a quaternary hospital was low, with some nurses disconnecting IV lines between doses, increasing risks of infection and cannula failure. This implementation aimed to drive practice change to increase use of 1 L saline for IV intermittent medication administration.
Methods
A Standing Order (SO) for 1 L saline was introduced with staff education, stakeholder engagement, and patient resources. Audits were conducted at a quaternary hospital pre-implementation (1–30 September 2025) and post-implementation (2 April–20 May 2026) across medical, surgical, and critical care wards. Eligible patients were prescribed ≥2 IV medications. Data were extracted from medical records and analysed in Excel and using online statistical tools. A nursing survey evaluated perceptions of the SO.
Results
Eligibility remained stable (42% pre: 65/154; post: 119/281). Use of 1 L saline increased from 29% (19/65) to 76% (91/119), a significant improvement (risk difference 47%, 95% CI 34–61%; RR 2.62, 95% CI 1.77–3.88; p<0.001). Assuming three medication administrations daily, IV line disconnections decreased from 2.4 to 1.4 per patient (rate ratio 0.57, 95% CI 0.46–0.71; p<0.001), a 43% reduction. Survey responses showed strong support, with 98% (323/320) of nurses endorsing the SO and recognising reduced disconnections and infection risk.
Conclusion
Implementation of the SO significantly increased 1 L sodium chloride 0.9% use and reduced IV line disconnections, supporting improved infection prevention. Ongoing engagement will aim to sustain and enhance practice.