checklist

IV Administration & Smart Pump Safety Checklist (Bedside + Pump‑Library Governance)

An interactive bedside checklist to confirm safe IV medication preparation and pump programming, plus a pump-library governance checklist to keep libraries current, consistent, and tuned to local practice. Designed to align with barcode medication administration and to capture completed checks, deviations, and governance actions for later review.

Interactive Tool

IV Administration & Smart Pump Safety Checklist

Purpose

This interactive checklist helps bedside clinicians complete essential safety checks for IV medication administration using smart pumps and helps governance teams maintain a safe, current pump library. Use it at the bedside before starting an infusion and use the governance section for scheduled library reviews or after a reported medication/pump event.

When integrated with barcode medication administration and electronic medication records this form can pre-fill patient and medication fields, but it also works as a standalone bedside tool.

Enter the patient identifier.
Full name as shown on ID band
Name of person completing the bedside checks
Include concentration (e.g., Drug X 2 mg/mL)
Provide the prescribed dose or infusion rate (units as appropriate)
Label or ID on the pump being used
Scan both patient ID band and medication barcode when available.
Second clinician verifies medication, dose, route, and calculations per policy.
Confirm correct tubing, connectors, and clamps are used and labeled.
Confirm units (mL/hr vs mcg/kg/min), infusion mode, and any weight inputs.
If limits were overridden, document justification in the event notes.
Include start time, rate, boluses, and any changes.
Concise description: what happened, immediate action taken, patient impact (if any). Leave blank if not applicable.
1 = Not confident, 5 = Very confident
1.0 10.0
Governance fields are intended for scheduled reviews, post‑event reviews, or library change management.
Department or title (e.g., Pharmacy Clinical Informatics)
YYYY-MM-DD or local date format
How often the library should undergo a formal review (e.g., 90)
YYYY-MM-DD
List roles and names who participate in library reviews and approvals
Briefly describe the workflow for proposing, testing, approving, and deploying library changes.
Document any decision to change alarm thresholds, soft limits, or advisory alerts and why.
Where to find full change history and approvals.
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