This essay sample essay on Civas offers an extensive list of facts and arguments related to it. The essay’s introduction, body paragraphs and the conclusion are provided below.

Centralized Intravenous Additive System (CIVAS) is found to be bringing numerous benefits to the nursing and medication field. There are numerous advantages in using Centralized Intravenous Additive System (CIVAS) in nursing. It is found to be eliminating majority of errors in the traditional system of medication and nursing.

Hospitals widely use intravenous drugs, but the preparation of drugs for intravenous use on the wards by nursing or medical staff is found to be linked with various problems.

Some of the risks associated with the usage of intravenous drugs are

Poor aseptic technique causes microbiological or particulate contamination of the dose and this result in further problems

Lack of time, restricted working and frequent interruptions lead to crucial mistakes in the administration and dose preparation

Iv Additive

Low quality aseptic techniques cause microbiological or particulate contamination of the dose (finally resulting in problems like septicaemia)

According to the recent reports, during the preparation of intravenous drugs there happens error at a rate of 26.

9 per cent. There were numerous cases that intravenous drug errors causes morbidity and mortality. This particular system also brings possible hazards to nursing staff; for example as a result of needle stick injury, risks associated with HIV (human immunodeficiency virus) and hepatitis virus transmission (transmitted from contaminated needles)

Moreover, aerosolized antibiotics that result in irritation and hypersensitivity may also cause problems like antibiotic resistance.

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Apart from this, the preparation of a single intravenous dose also results in problems related to time. Improper drug handling also causes intravenous medication errors. Nurses are required to be extra vigilant and alert during IV drug rounds.

Mistakes usually happen during the drug preparation; while preparing small volumes or the usage of unusual drug vial presentations. The complex structure and design of equipment and the lack of expertise in the preparation are the underlying problems of errors. Lack of perceived risk, unavailability of good technology and poor role models are also among the reasons for these frequently occurring intravenous medication errors.

The best solution to these problems in hospitals (that associated with the usage of intravenous drugs) is the usage of centralized intravenous additive (CIVA) services. Even though it is true that the usage of centralized intravenous additive (CIVA) services is expensive the numerous advantages of this system justify the expense.

The introduction of the CIVAS (Centralized Intravenous Additive System) has moved a difficult and risk prone aspect of drug administration away from the nurse and into the hands of those best suited for the role, a simple and cost effective, but valuable solution. The number of intravenous drugs supplied by the CIVAS service is currently limited and further study is required to investigate the implications of broadening the service to include all intravenous medications, thereby presumably further lowering the risk of error. Although providing pre-mixed drugs does remove some of the risk, it is still the responsibility of the nurse to consult the specific guidance for administering the drug, as they need to be aware of its actions as well as any possible side effects relevant to the individual patient and their current condition. No amount of pre-prepared drugs can absolve the nurse of the responsibility of correctly following guidelines and protocols for safe drug administration.

Intravenous medication errors are common events. They cause considerable harms most of them quite serious. Drug preparation and administration involves numerous drug errors. An example of such error is the violation of guidelines is the regarding of the crucial guidelines during the injection of bolus doses (when the injection is done faster than the recommended rate of 3-5 minutes. Even the concept of human error theory is not found to be that successful in finding out the real causes of intravenous errors.

Training needs and design issues must be seriously considered to reduce the rate of IV drug preparation and administration errors. All this require a coordinated approach from the staff, practitioners, regulators, doctors, nurses and the whole hospital administration.

The intravenous (IV) administration of drugs is extremely complex and tough to execute without error. A study conducted on ten wards in two hospitals in UK revealed that errors happen in nearly half of the intravenous drug preparations and administrations, out of which one percent is found to be severe and fifty-eight percent is of moderate nature.

An Intravenous medication error can be explained as any deviation in the preparation or administration of the Intravenous medication from the doctor’s prescription, the hospital’s Intravenous policy, or the manufacturer’s instructions. A simple carelessness from the nursing staff or a small medication error or misunderstanding can cause serious problems. Even though it is sure that the common causes of medication errors are communication problems, equipment problems, lack of experience and knowledge, lack of training, faults in the system, and personal problems, it is still unknown to what extent such factors contribute to intravenous medication errors. A thorough study of the details of the errors caused by intravenous medication errors reveal that the one and only solution to these problems (particularly from the nurse’s part) is the Centralized Intravenous Additive System (CIVAS).

Centralized Intravenous Additive System (CIVAS) is found to be eliminating maximum number of medication errors and is found to be indispensable for hospitals even though it is bit expensive. Investigations of large scale accidents and big medication error problems (in high risk areas) revealed that the design of systems, pre-existing organizational factors and the conditions, conventions and procedures for the use of sophisticated technology (operations) keep human operators in a position in which human errors mostly lead to nothing but disasters. A proper study about such active failures and accidents reveals that the working conditions (error and violation producing conditions) and the lack of time (and proper coordination) at the time of the accident and the organizational processes and management decisions are the reason behind the accident. Centralized Intravenous Additive System (CIVAS) is found to be eliminating majority of the errors like major medication errors, time related problems and coordination problems. Instances of poor aseptic technique, frequent interruptions, contaminated products and antibiotic aerosols and numerous other problems associated with intravenous system is found to be disappearing when Centralized Intravenous Additive System is properly implemented.

Since CIVAS is highly centralized and orderly (move as per the common assumption or schedule) it is found that this system is destroying the real skills of nurses. In the United Kingdom, as in most other European countries, nurses generally prepare and administer intravenous drugs prescribed by doctors. Doctors recorded prescriptions on formatted inpatient drug charts, and nurses used the charts to determine the doses due and record the administration of drugs. Ward pharmacists ordered drugs that were not stored on the ward and reviewed the appropriateness of prescribed drugs every weekday. Nurses usually prepared and administered intravenous drugs on the wards. Nurses are also given good training before they are allowed to give intravenous drugs. In Central Intravenous Additive Service nurses do not play a determining role. They just follow the prescribed pattern and do not use their judgment power and experience. This would ultimately make them unable to work in a hospital where there is no CIVAS. Nurse who work using CIVAS gradually lose the skills that they once had in their work. Nurses who work on CIVAS also need to be adhering to guidelines. They always look at the IV guidelines booklet that explains the process. For example, they always see the booklet and proceed the step by step preparation of IV. This would finally make them slaves to those manuals and demolish their skills.

However it is true that CIVAS is a highly useful technique for hospital to make their service error free. CIVAS was less vulnerable to unanticipated interruptions in work flow than ward-based preparation. Moreover there are other benefits to a CIVAS service in addition to financial ones. The most important benefit is increased patient safety. Errors in preparing and administering intravenous drugs can cause considerable harm to patients. Error always crept in during drug preparation and administration. The most common errors were giving bolus doses too quickly and mistakes in preparing drugs that required multiple steps. Other errors are errors happening during, preparation of wrong drug, preparation of an unauthorized drug. Errors in solvent/diluent (use of wrong solvent/diluent or wrong volume), preparation of wrong dose and omission of prescribed drug are also common. There are also administration errors including administration to wrong patient, fast administration of bolus dose through a peripheral line, fast administration of bolus dose through a central line and Incompatibility errors.

It is generally considered that Central Intravenous Additive Service (CIVAS) very expensive compared to the traditional ward-based preparation of intravenous doses. It is needed to analyze whether it would be beneficial for hospitals to use CIVAS because of its high cost. Consider the expenses of Central Intravenous Additive Service for a pediatric population. Labor costs were calculated from the timings of preparation of individual doses. The use of disposables and diluents was recorded and their acquisition costs apportioned to the expense that occurred in the preparation of each dose. As a part of the experiment, data were collected from 20 CIVAS sessions (501 doses) and 26 ward-based sessions (30 doses). Apart from that the costs avoided by the use of part vials in CIVAS was calculated. This cost was calculated from a total of 50 CIVAS sessions. The experiment revealed that the labor, disposable and diluent costs were much less for CIVAS compared with ward-based preparation. A major part of the expense can be avoided in CIVAS. CIVAS can be set up to the entire hospital sections only by spending more than £ 40,000. Even though it is true that CIVAS eliminate much wastage, setting up a CIVAS for the entire hospital cost more than any money you would save by eliminating wastage. Moreover CIVAS create other problems also. For example it demands an out of hours service, which would probably involve paying staff overtime and thus add to the overall cost. So the original idea of a CIVAS service may not be much profitable financially.

References

Needle R, Sizer T, editors. The CIVAS Handbook. Pharmaceutical Press, London, 2001

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Cousins, D H, Sabatier, B, Begue, D, Schmitt, C, Hoppe-Tichy, T (2005). Medication errors in intravenous drug preparation and administration: a multicentre audit in the UK, Germany and France. Qual Saf Health Care 14: 190-195

Shaw, R, Drever, F, Hughes, H, Osborn, S, Williams, S (2005). Adverse events and near miss reporting in the NHS. Qual Saf Health Care 14: 279-283

Han, P Y, Coombes, I D, Green, B (2005). Factors predictive of intravenous fluid administration errors in Australian surgical care wards. Qual Saf Health Care 14: 179-184

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Armitage, G., Holder, A., Hodgson, I. (2004). Using ethnography (or qualitative methods) to investigate drug errors: A critique of a published study. Journal of Research in Nursing 9: 379-387

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CIVAS system in nursing. (2019, Dec 07). Retrieved from https://paperap.com/paper-on-centralized-intravenous-additive-system-civas/

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