Synopsis
Calculate, prepare, check and administer infusions and intradermal, subcutaneous and intramuscular injections with route-specific technique, monitoring and response to error or reaction.
- Verify patient, medicine, concentration, dose, route, time, allergies, indication, monitoring and access against a valid prescription.
- Calculate with units and independently check high-risk medicines under local policy; a pump cannot legitimise an unchecked calculation.
- Inspect containers, diluent and expiry; use non-touch technique and label every prepared syringe or infusion immediately.
Key red flags
Pain, swelling, blanching, leakage or resistance requires immediate stop and drug-specific management.
Sudden airway, breathing or circulation compromise with allergic features requires immediate emergency treatment.
Reasoning priorities
Detect dose, concentration, unit and patient errors.
The checker reconstructs inputs and calculation rather than confirming the first answer.
Worked reasoning
At 10:00 a stable adult with poor oral intake starts a supplied prescription for sodium chloride 0.9%, 500 mL IV over 5 hours, with no additives. At 10:03 the pump shows 1,000 mL/hour and 50 mL delivered.
- Stop the incorrect infusion, preserve usable access and call the supervising clinician. Assess ABCDE, breathing, circulation and fluid status; verify the patient, bag, prescription, line and pump history. This is an existing patient-specific prescription used for calculation, not a universal fluid regimen.
- Calculate the intended rate: 500 mL ÷ 5 hours = 100 mL/hour. Three minutes is 0.05 hours, so 1,000 mL/hour × 0.05 hours = 50 mL delivered instead of 5 mL: excess 45 mL. Sodium chloride 0.9% is 9 mg/mL, so delivered sodium chloride is 450 mg versus intended 45 mg; these are salt masses, not elemental sodium.
- Reassess for harm and determine a revised fluid plan with the clinician. In this example observations and examination remain stable and the clinician authorises only the remaining 450 mL by the original 15:00 endpoint. Remaining time is 4 hours 57 minutes = 4.95 hours; 450 ÷ 4.95 = 90.9 mL/hour, rounded as authorised for the device, with volume to be infused capped at 450 mL.
- An independent checker reconstructs the inputs and reverse-checks 90.9 mL/hour × 4.95 hours ≈ 450 mL, plus the 50 mL already given. Restart only after the revised order and pump settings are checked. Observe delivery and fluid balance, record the exposure and clinical response, explain the incident, preserve evidence and complete reporting.