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Expert spotlight: Getting to the heart of cardiovascular medication

Nurse Leader Weekly, March 16, 2009

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This week, Jill Duncan, RN, MS, MPH, director of the IHI Open School for Health Professions in Cambridge, MA, shares some tips to increase staff understanding of pediatric cardiovascular medication.

Q: Do you have any advice to help my staff improve safety when administering cardiovascular medication to pediatric patients?

A: Administering cardiovascular medications to children pulls into play all aspects of current high-alert medication safety. Although not all cardiovascular medications are traditionally considered high-alert medications, their clinical significance, complex calculations, and, in many cases, their continuous infusion delivery route makes many medications at risk for potentially devastating outcomes if errors occur. Initiatives such as computerized physician order entry, standard concentrated drips, SmartPump technology, and independent double-check systems address the potentially dangerous steps in cardiovascular medication administration and are essential to improving pediatric cardiovascular medication safety.

Some administration and safety considerations for nurses include:

• Central lines are preferable for continuous infusions.
• Many of these drugs are incompatible with other medications commonly used to treat children with cardiac defects, diseases, or disorders. Nurses must be familiar with compatibility information prior to any drug administration.
• Frequent adjustment or titration is often necessary with these types of medications. Orders for titration should include a starting dose, clinical parameters for titration (such as "maintain MAP 30-40 mmHg"), and maximum drug doses to be titrated to.
• Nurses should allow time for drugs to take effect to avoid becoming caught in a "yo-yo" of titrating too quickly one way or the other.
• Continuous infusions should always be double-checked with a second nurse at the start of the infusion, as well as whenever a rate or dose change is made, or a new bag or syringe is hung.

Editor's note: Do you have a question for our experts? Email your queries to Editor Keri Mucci at kmucci@hcpro.com and see your name in print next week! In the meantime, head over to our Web site and view a growing collection of advice from our experts.

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