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Taconet C, Hafiani EM, Daigne D, Camus F, Didier M, Paubel P, Siorat V, Tano M, Quesnel C. Potential cost savings and environmental benefits of prefilled syringes of suxamethonium in anaesthesia practice. Br J Anaesth 2024:S0007-0912(24)00145-4. [PMID: 38631943 DOI: 10.1016/j.bja.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/24/2024] [Accepted: 03/01/2024] [Indexed: 04/19/2024] Open
Affiliation(s)
- Clémentine Taconet
- Department of Anesthesiology and Critical Care Medicine, Tenon University Hospital, DMU DREAM, Sorbonne Université, Paris, France.
| | - El Mahdi Hafiani
- Department of Anesthesiology and Critical Care Medicine, Tenon University Hospital, DMU DREAM, Sorbonne Université, Paris, France
| | - Daisy Daigne
- Department of Anesthesiology and Critical Care Medicine, Tenon University Hospital, DMU DREAM, Sorbonne Université, Paris, France
| | - Françoise Camus
- Department of Pharmacy, Tenon Hospital, APHP Sorbonne Université, Paris, France
| | - Matthias Didier
- Sustainable Development Projects, Assistance Publique-Hôpitaux de Paris (AP-HP), Strategy and Transformation Department, Paris, France
| | - Pascal Paubel
- General Agency of Equipment and Health Products (AGEPS), Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Health Law and Health Economics Department, Faculty of Pharmacy, Paris University, Université Paris Cité, Paris, France; Health Law Institute, Inserm, Paris University, Université Paris Cité, Paris, France
| | - Virginie Siorat
- General Agency of Equipment and Health Products (AGEPS), Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Marion Tano
- General Agency of Equipment and Health Products (AGEPS), Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Health Law and Health Economics Department, Faculty of Pharmacy, Paris University, Université Paris Cité, Paris, France; Health Law Institute, Inserm, Paris University, Université Paris Cité, Paris, France
| | - Christophe Quesnel
- Department of Anesthesiology and Critical Care Medicine, Tenon University Hospital, DMU DREAM, Sorbonne Université, Paris, France
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Whitaker DK, Lomas JP. Time for prefilled syringes - everywhere. Anaesthesia 2024; 79:119-122. [PMID: 37971165 DOI: 10.1111/anae.16181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 11/19/2023]
Affiliation(s)
| | - J P Lomas
- Department of Anaesthesia and Intensive Care Medicine, Bolton NHS Foundation Trust, Bolton, UK
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Alsabri M, Eapen D, Sabesan V, Tarek Hassan Z, Amin M, Elshanbary AA, Alhaderi A, Elshafie E, Al-Sayaghi KM. Medication Errors in Pediatric Emergency Departments: A Systematic Review and Recommendations for Enhancing Medication Safety. Pediatr Emerg Care 2024; 40:58-67. [PMID: 38157396 DOI: 10.1097/pec.0000000000003108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
OBJECTIVE This systematic review aims to investigate the prevalence, preventability, and severity of medication errors in pediatric emergency departments (P-EDs). It also aims to identify common types of medication errors, implicated medications, risk factors, and evaluate the effectiveness of interventions in preventing these errors. METHODS A systematic review analyzed 6 primary studies with sample sizes ranging from 96 to 5000 pediatric patients in P-EDs. The review followed Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and included observational studies and randomized controlled trials involving patients aged 18 years and younger. Comprehensive searches in biomedical databases were conducted, and conflicts in record screening were resolved by a third reviewer using systematic review software. RESULTS Medication errors in P-EDs are prevalent, ranging from 10% to 15%, with dosing errors being the most common, accounting for 39% to 49% of reported errors. These errors primarily stem from inaccurate weight estimations or dosage miscalculations. Inadequate dosing frequency and documentation also contribute significantly to medication errors. Commonly implicated medications include acetaminophen, analgesics, corticosteroids, antibiotics, bronchodilators, and intravenous fluids. Most errors are categorized as insignificant/mild (51.7% to 94.5%) or moderate (47.5%). Risk factors associated with medication errors in P-EDs include less experienced physicians, severely ill patients, and weekend/specific-hour ordering. Human factors such as noncompliance with procedures and communication failures further contribute to medication errors. Interventions such as health information technology solutions like ParentLink and electronic medical alert systems, as well as structured ordering systems, have shown promise in reducing these errors, although their effectiveness varies. CONCLUSIONS Overall, this systematic review provides valuable insights into the complexity of medication errors in the P-ED, emphasizes the need for targeted interventions, and offers recommendations to enhance medication safety and reduce preventable errors in this critical health care setting.
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Affiliation(s)
- Mohammed Alsabri
- From the Department of Emergency Medicine, Al-Thawra Modern General Teaching Hospital, Sana'a City, Yemen
| | - Diane Eapen
- Saba University School of Medicine, Dutch Caribbean, Netherlands
| | | | | | | | | | - Ayman Alhaderi
- Department Of Emergency Medicine, McLaren Oakland Hospital, Pontiac, MI
| | | | - Khaled M Al-Sayaghi
- Department of Medical Surgical Nursing, College of Nursing, Taibah University, KSA
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4
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Whitaker MCA, Whitaker DK. The impact of using prefilled syringes on a standard operating procedure for preparing injectable medicines in clinical areas. Anaesthesia 2024; 79:98-99. [PMID: 37932965 DOI: 10.1111/anae.16166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/08/2023]
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Ojeda IM, Sánchez-Cuervo M, Candela-Toha Á, Serrano-López DR, Bermejo-Vicedo T, Alcaide-López-de-Lerma JM. Protocolization of Analgesia and Sedation Through Smart Technology in Intensive Care: Improving Patient Safety. Crit Care Nurse 2023; 43:30-38. [PMID: 37524366 DOI: 10.4037/ccn2023271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND The risk of medication errors in intensive care units is high, primarily in the drug administration phase. LOCAL PROBLEM Management of high-alert medications within intensive care units in the study institution varied widely. The aim of this quality improvement project was to protocolize and centralize the management of high-alert medications in acute care settings and to implement smart intravenous infusion pump technology in intensive care units. METHODS The project was conducted in 4 phases: (1) protocolization and standardization of intravenous mixtures, (2) centralization of intravenous mixture preparation in the Pharmacy Department, (3) programming of the smart pumps, and (4) dissemination and staged implementation of intravenous mixture protocols. Smart pumps (Alaris, CareFusion) were used to deliver the medicines, and the manufacturer's software (Alaris Guardrails, CareFusion) was used to analyze data regarding adherence to the drug library and the number of programming errors detected. RESULTS Morphine, remifentanil, fentanyl, midazolam, dexmedetomidine, and propofol were included. After implementation of the smart pumps, 3283 infusions were started; of these, 2198 were programmed through the drug library, indicating 67% compliance with the safety software. The pumps intercepted 398 infusion-related programming errors that led to cancellation or reprogramming of drug infusions. CONCLUSIONS Protocolization and centralization of the preparation of high-alert sedative and analgesic medications for critically ill patients and the administration of these drugs using smart pump technology decrease variability of clinical practice and intercept potentially serious medication errors.
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Affiliation(s)
- Isabel Muñoz Ojeda
- Isabel Muñoz Ojeda is a pharmacist, Pharmacy Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Marina Sánchez-Cuervo
- Marina Sánchez-Cuervo is a pharmacist, Pharmacy Department, Hospital Universitario Ramón y Cajal
| | - Ángel Candela-Toha
- Ángel Candela-Toha is a physician, Anesthesia and Resuscitation Department, Hospital Universitario Ramón y Cajal
| | - Dolores R Serrano-López
- Dolores R. Serrano-López is a pharmacist, Pharmacology Department, School of Pharmacy, Universidad Complutense de Madrid, Madrid
| | - Teresa Bermejo-Vicedo
- Teresa Bermejo-Vicedo is a pharmacist, Pharmacy Department, Hospital Universitario Ramón y Cajal
| | - Juan Miguel Alcaide-López-de-Lerma
- Juan Miguel Alcaide-López-de-Lerma is a postanethesia care unit nurse manager, intensive care unit, Hospital Universitario Ramón y Cajal
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6
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Eijsink JFH, Weiss M, Taneja A, Edwards T, Girgis H, Lahue BJ, Cribbs KA, Postma M. Creating an evidence-based economic model for prefilled parenteral medication delivery in the hospital setting. Eur J Hosp Pharm 2023:ejhpharm-2022-003620. [PMID: 37369597 DOI: 10.1136/ejhpharm-2022-003620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/18/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVES Prefilled syringes (PFS) may offer clinical and economic advantages over conventional parenteral medication delivery methods (vials and ampoules). The benefits of converting from vials and ampoules to PFS have been explained in previous drug-specific economic models; however, these models have limited generalisability to different drugs, healthcare settings and other countries. Our study aims to (1) present a comprehensive economic model to assess the impact of switching from vials to PFS delivery; and (2) illustrate through two case studies the model's utility by highlighting important features of shifting from vials to PFS. METHODS The economic model estimates the potential benefit of switching to PFS associated with four key outcomes: preventable adverse drug events (pADE), preparation time, unused drugs, and cost of supplies. Model reference values were derived from existing peer-reviewed literature sources. The user inputs specific information related to the department, drug, and dose of interest and can change reference values. Two hypothetical case studies are presented to showcase model utility. The first concerns a cardiac intensive care unit in the United Kingdom administering 30 doses of 1 mg/10 mL atropine/day. The second concerns a coronavirus (COVID-19) intensive care unit in France that administers 30 doses of 10 mg/25 mL ephedrine/day. RESULTS Total cost savings per hospital per year, associated with reductions in pADEs, unused drugs, drug cost and cost of supplies were £34 829 for the atropine example and €104 570 for the ephedrine example. Annual preparation time decreased by 371 and 234 hours in the atropine and ephedrine examples, respectively. CONCLUSIONS The model provides a generalisable framework with customisable inputs, giving hospitals a comprehensive view of the clinical and economic value of adopting PFS. Despite increased costs per dose with PFS, the hypothetical case studies showed notable reductions in medication preparation time and a net budget savings owing to fewer pADEs and reduced drug wastage.
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Affiliation(s)
- Job F H Eijsink
- Isala klinieken and Department of Health Sciences, University of Groningen, Zwolle, The Netherlands
| | - Mia Weiss
- Becton Dickinson and Company, Franklin Lakes, New Jersey, USA
| | - Ashley Taneja
- Becton Dickinson and Company, Franklin Lakes, New Jersey, USA
- Fairleigh Dickinson University - Florham Campus, Madison, New Jersey, USA
| | - Tyler Edwards
- Becton Dickinson and Company, Franklin Lakes, New Jersey, USA
| | - Haymen Girgis
- Becton Dickinson and Company, Le Pont-de-Claix, France
| | | | | | - Maarten Postma
- Department of Health Sciences, University Medical Centre Groningen, Groningen, The Netherlands
- Department of Economics, Econometrics & Finance, University of Groningen Faculty of Economics and Business, Groningen, The Netherlands
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7
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Hunter S, Considine J, Manias E. Nurse decision-making when managing noradrenaline in the intensive care unit: A naturalistic observational study. Intensive Crit Care Nurs 2023; 77:103429. [PMID: 37086603 DOI: 10.1016/j.iccn.2023.103429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 02/26/2023] [Accepted: 03/13/2023] [Indexed: 04/24/2023]
Abstract
OBJECTIVE Intensive care nurses care for critically ill patients in a complex, fast paced environment. Management of noradrenaline (norepinephrine) is core business for intensive care nurses and nurse decision-making on noradrenaline is poorly understood. The study objective was to investigate decision-making processes nurses use when caring for intensive care unit patients receiving noradrenaline. RESEARCH METHODOLOGY A qualitative exploratory design used the Cognitive Continuum Theory as a framework for naturalistic observations and interviews in two medical/surgical intensive care units in Melbourne, Australia. MAIN OUTCOME MEASURES Observational and interview data from field notes and audiovisual recordings were transcribed and coded to develop themes using reflexive thematic analysis. FINDINGS Fourteen nurse and patient dyads were recruited to observational sessions from December 2019 to June 2021. Three major themes developed were Learning through doing; Individualised patient care; and Clinical expertise, with six supporting sub-themes. Nurses learned to manage noradrenaline experientially and developed titration and weaning strategies to support decision-making. Blood pressure targets and monitor alarms were used consistently to aid decision-making processes. Nurses were observed practicing across the cognitive continuum depending on knowledge structure, complexity of interventions, response time, and patient acuity. CONCLUSION Experiential learning of complex and high-risk interventions in the absence of guidelines or algorithms meant nurses developed their own titration and weaning strategies based on constant evaluation and re-evaluation of patient cues. Patient heterogeneity, cue ambiguity and a dynamic practice environment contributed to decision-making complexity that would benefit from development of evidence-based practice resources. IMPLICATIONS FOR CLINICAL PRACTICE Nurses learn to manage noradrenaline through experiential learning, using blood pressure targets and monitor alarms to support decision-making when titrating and weaning noradrenaline. Nurses develop noradrenaline titration and weaning strategies to support decision-making in the absence of guidelines or algorithms. Supporting nurse decision-making and streamlining practice would reduce practice variation and cognitive workload.
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Affiliation(s)
- Stephanie Hunter
- Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, 1 Gheringhap Street, Geelong 3220, Australia; Eastern Health Centre for Quality and Patient Safety Research - Eastern Health Partnership, 5 Arnold Street, Box Hill 3128, Victoria, Australia.
| | - Julie Considine
- Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, 1 Gheringhap Street, Geelong 3220, Australia; Eastern Health Centre for Quality and Patient Safety Research - Eastern Health Partnership, 5 Arnold Street, Box Hill 3128, Victoria, Australia
| | - Elizabeth Manias
- Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, 1 Gheringhap Street, Geelong 3220, Australia
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Hambly P. Human factors and medication safety. Anaesthesia 2023. [DOI: 10.1111/anae.16014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
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Stipp MM, Deng H, Kong K, Moore S, Hickman RL, Nanji KC. Medication safety in the perioperative setting: A comparison of methods for detecting medication errors and adverse medication events. Medicine (Baltimore) 2022; 101:e31432. [PMID: 36343025 PMCID: PMC9646678 DOI: 10.1097/md.0000000000031432] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 09/30/2022] [Indexed: 11/09/2022] Open
Abstract
The purpose of this study was to evaluate perioperative medication-related incidents (medication errors (MEs) and/or adverse medication events (AMEs)) identified by 2 different reporting methods (self-report and direct observation), and to compare the types and severity of incidents identified by each method. We compared perioperative medication-related incidents identified by direct observation in Nanji et al's 2016 study[1] to those identified by self-report via a facilitated incident reporting system at the same 1046-bed tertiary care academic medical center during the same 8-month period. Incidents, including MEs and AMEs were classified by type and severity. In 277 operations involving 3671 medication administrations, 193 MEs and/or AMEs were observed (5.3% incident rate). While none of the observed incidents were self-reported, 10 separate medication-related incidents were self-reported from different (unobserved) operations that occurred during the same time period, which involved a total of 21,576 operations and approximately 280,488 medication administrations (0.004% self-reported incident rate). The distribution of incidents (ME, AME, or both) did not differ by direct observation versus self-report methodology. The types of MEs identified by direct observation differed from those identified by self-report (P = .005). Specifically, the most frequent types of MEs identified by direct observation were labeling errors (N = 37; 24.2%), wrong dose errors (N = 35; 22.9%) and errors of omission (N = 27; 17.6%). The most frequent types of MEs identified by self-report were wrong dose (N = 5; 50%) and wrong medication (N = 4; 40%). The severity of incidents identified by direct observation and self-report differed, with self-reported incidents having a higher average severity (P < .001). The procedure types associated with medication-related incidents did not differ by direct observation versus self-report methodology. Direct observation captured many more perioperative medication-related incidents than self-report. The ME types identified and their severity differed between the 2 methods, with a higher average incident severity in the self-reported data.
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Affiliation(s)
- Melanie M. Stipp
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Mass General Brigham, Wellesley, MA, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Hao Deng
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Mass General Brigham, Wellesley, MA, USA
| | - Kathy Kong
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Mass General Brigham, Wellesley, MA, USA
| | - Sonya Moore
- Case Western Reserve University, Cleveland, OH, USA
| | | | - Karen C. Nanji
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Mass General Brigham, Wellesley, MA, USA
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10
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Expert consensus on the glycemic management of critically ill patients. JOURNAL OF INTENSIVE MEDICINE 2022; 2:131-145. [PMID: 36789019 PMCID: PMC9923981 DOI: 10.1016/j.jointm.2022.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 11/21/2022]
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Nimmo AF, Shinde S, Absalom AR. Remifentanil: achieving a 'standard concentration': a reply. Anaesthesia 2022; 77:944. [PMID: 35514203 DOI: 10.1111/anae.15749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - A R Absalom
- University of Groningen, Groningen, The Netherlands
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12
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Malik P, Rangel M, VonBriesen T. Why the Utilization of Ready-to-Administer Syringes During High-Stress Situations Is More Important Than Ever. JOURNAL OF INFUSION NURSING 2022; 45:27-36. [PMID: 34839309 PMCID: PMC8700297 DOI: 10.1097/nan.0000000000000451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The COVID-19 pandemic has led to a high-stress environment causing a significant impact on frontline workers, including pharmacists and nurses. In addition to the increased workload, scarcity of resources, and emotional challenges, the frontline health care workers are required to wear additional personal protective equipment that can further limit their range of movement and decrease efficiency. The potential for errors can increase in these types of high-stress situations. One way to reduce the risk of errors is to use manufacturer-prepared, ready-to-administer (RTA) prefilled syringes, when appropriate. The use of RTA prefilled syringes is supported by literature evidence, recommendations, and guidelines from various professional organizations and societies.
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Affiliation(s)
- Pashmina Malik
- Fresenius Kabi, Lake Zurich, Illinois
- Pashmina Malik, PharmD, MPH, is the director of medical affairs at Fresenius Kabi and is responsible for leading the Simplist ready-to-administer products portfolio and generic pharmaceutical infusion products. Dr Malik is an accomplished clinical leader who has worked in large global pharmaceutical companies and has experience working with pharmaceutical products in multiple therapeutic areas, including critical care, anesthesia and analgesia, pain management, oncology, parenteral nutrition, and infectious disease. She has also worked as a home infusion clinical pharmacist before she moved to the pharmaceutical industry. Dr Malik earned her doctor of pharmacy from Midwestern University Chicago College of Pharmacy, her master of public health from University of Illinois Chicago, and Executive Leadership Scholar Program from Kellogg School of Management at Northwestern University
- Melissa Rangel, PharmD, RPh, is a senior medical affairs associate with Fresenius Kabi serving as an operational lead for creating and managing the dissemination of medical information. Prior to joining Fresenius Kabi, Dr Rangel worked as a clinical pharmacist in hospital and retail settings. Dr Rangel earned her doctor of pharmacy from Drake University College of Pharmacy and Health Sciences
- Tracy VonBriesen, MS, RN, is the director of human factors at Fresenius Kabi, focusing on new product development of combination drug-device products. Ms VonBriesen has led teams that provide clinical and human factors support during development activities required for product life cycle management of serialized and nonserialized infusion devices and combination products. Ms VonBriesen is a registered nurse with 20 years of experience and holds a master's degree in patient safety leadership from the University of Illinois School of Medicine. Prior to her corporate nursing career, Ms VonBriesen's clinical background encompassed a variety of hospital-based assignments including neonatal intensive care and liver transplants
| | - Melissa Rangel
- Fresenius Kabi, Lake Zurich, Illinois
- Pashmina Malik, PharmD, MPH, is the director of medical affairs at Fresenius Kabi and is responsible for leading the Simplist ready-to-administer products portfolio and generic pharmaceutical infusion products. Dr Malik is an accomplished clinical leader who has worked in large global pharmaceutical companies and has experience working with pharmaceutical products in multiple therapeutic areas, including critical care, anesthesia and analgesia, pain management, oncology, parenteral nutrition, and infectious disease. She has also worked as a home infusion clinical pharmacist before she moved to the pharmaceutical industry. Dr Malik earned her doctor of pharmacy from Midwestern University Chicago College of Pharmacy, her master of public health from University of Illinois Chicago, and Executive Leadership Scholar Program from Kellogg School of Management at Northwestern University
- Melissa Rangel, PharmD, RPh, is a senior medical affairs associate with Fresenius Kabi serving as an operational lead for creating and managing the dissemination of medical information. Prior to joining Fresenius Kabi, Dr Rangel worked as a clinical pharmacist in hospital and retail settings. Dr Rangel earned her doctor of pharmacy from Drake University College of Pharmacy and Health Sciences
- Tracy VonBriesen, MS, RN, is the director of human factors at Fresenius Kabi, focusing on new product development of combination drug-device products. Ms VonBriesen has led teams that provide clinical and human factors support during development activities required for product life cycle management of serialized and nonserialized infusion devices and combination products. Ms VonBriesen is a registered nurse with 20 years of experience and holds a master's degree in patient safety leadership from the University of Illinois School of Medicine. Prior to her corporate nursing career, Ms VonBriesen's clinical background encompassed a variety of hospital-based assignments including neonatal intensive care and liver transplants
| | - Tracy VonBriesen
- Fresenius Kabi, Lake Zurich, Illinois
- Pashmina Malik, PharmD, MPH, is the director of medical affairs at Fresenius Kabi and is responsible for leading the Simplist ready-to-administer products portfolio and generic pharmaceutical infusion products. Dr Malik is an accomplished clinical leader who has worked in large global pharmaceutical companies and has experience working with pharmaceutical products in multiple therapeutic areas, including critical care, anesthesia and analgesia, pain management, oncology, parenteral nutrition, and infectious disease. She has also worked as a home infusion clinical pharmacist before she moved to the pharmaceutical industry. Dr Malik earned her doctor of pharmacy from Midwestern University Chicago College of Pharmacy, her master of public health from University of Illinois Chicago, and Executive Leadership Scholar Program from Kellogg School of Management at Northwestern University
- Melissa Rangel, PharmD, RPh, is a senior medical affairs associate with Fresenius Kabi serving as an operational lead for creating and managing the dissemination of medical information. Prior to joining Fresenius Kabi, Dr Rangel worked as a clinical pharmacist in hospital and retail settings. Dr Rangel earned her doctor of pharmacy from Drake University College of Pharmacy and Health Sciences
- Tracy VonBriesen, MS, RN, is the director of human factors at Fresenius Kabi, focusing on new product development of combination drug-device products. Ms VonBriesen has led teams that provide clinical and human factors support during development activities required for product life cycle management of serialized and nonserialized infusion devices and combination products. Ms VonBriesen is a registered nurse with 20 years of experience and holds a master's degree in patient safety leadership from the University of Illinois School of Medicine. Prior to her corporate nursing career, Ms VonBriesen's clinical background encompassed a variety of hospital-based assignments including neonatal intensive care and liver transplants
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Lawson SA, Hornung LN, Lawrence M, Schuler CL, Courter JD, Miller C. An Initiative to Reduce Insulin-Related Adverse Drug Events in a Children's Hospital. Pediatrics 2022; 149:184053. [PMID: 35104886 DOI: 10.1542/peds.2020-004937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Adverse drug events (ADEs) during hospitalization are common. Insulin-related events, specifically, are frequent and preventable. At a tertiary children's hospital, we sought to reduce insulin-related ADEs by decreasing the median event rate of hyper- and hypoglycemia over a 12-month period. METHODS Using Lean 6 σ methodology, we instituted a house-wide process change from a single-order ordering process to a pro re nata (PRN) standing order process. The standardized process included parameters for administration and intervention, enabling physician and nursing providers to practice at top of licensure. Automated technology during dose calculation promoted patient safety during dual verification processes. Control charts tracked rates of insulin-related ADEs, defined as hyperglycemia (glucose level >250 mg/dL) or hypoglycemia (glucose level <65 mg/dL). Events were standardized according to use rates of insulin on each nursing unit. The rates of appropriately timed insulin doses (within 30 minutes of a blood sugar check) were assessed. RESULTS Baseline median house-wide frequencies of hyperglycemic and hypoglycemic episodes were 55 and 6.9 events (per 100 rapid-acting insulin days), respectively. The median time to insulin administration was 32 minutes. The implementation of the PRN process reduced the median frequencies of hyperglycemic and hypoglycemic episodes to 45 and 3.8 events, respectively. The median time to insulin administration decreased to 18 minutes. CONCLUSIONS A PRN ordering process and education decreased insulin-associated ADEs and the time to insulin dosing compared with single-entry processes. Engaging bedside providers was instrumental in reducing insulin-related ADEs. Strategies that decrease the time from patient assessment to drug administration should be studied for other high-risk drugs.
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Affiliation(s)
- Sarah A Lawson
- Divisions of Endocrinology.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | | | - Christine L Schuler
- Hospital Medicine.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Joshua D Courter
- Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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14
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Kuitunen SK, Niittynen I, Airaksinen M, Holmström AR. Systemic Defenses to Prevent Intravenous Medication Errors in Hospitals: A Systematic Review. J Patient Saf 2021; 17:e1669-e1680. [PMID: 32175962 PMCID: PMC8612901 DOI: 10.1097/pts.0000000000000688] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
OBJECTIVES Intravenous medication delivery is a complex process that poses systemic risks of errors. The objective of our study was to identify systemic defenses that can prevent in-hospital intravenous (IV) medication errors. METHODS A systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. We searched MEDLINE (Ovid), Scopus, CINAHL, and EMB reviews for articles published between January 2005 and June 2016. Peer-reviewed journal articles published in English were included. Two reviewers independently selected articles according to a predetermined PICO tool. The quality of studies was assessed using the Grading of Recommendations Assessment, Development and Evaluation system, and the evidence was analyzed using qualitative content analysis. RESULTS Forty-six studies from 11 countries were included in the analysis. We identified systemic defenses related to administration (n = 24 studies), prescribing (n = 8), preparation (n = 6), treatment monitoring (n = 2), and dispensing (n = 1). In addition, 5 studies explored defenses related to multiple stages of the drug delivery process. Systemic defenses including features of closed-loop medication management systems appeared in 61% of the studies, with smart pumps being the defense most widely studied (24%). The evidence quality of the included articles was limited, as 83% were graded as low quality, 13% were of moderate quality, and only 4% were of high quality. CONCLUSIONS In-hospital IV medication processes are developing toward closed-loop medication management systems. Our study provides health care organizations with preliminary knowledge about systemic defenses that can prevent IV medication errors, but more rigorous evidence is needed. There is a need for further studies to explore combinations of different systemic defenses and their effectiveness in error prevention throughout the drug delivery process.
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Affiliation(s)
- Sini Karoliina Kuitunen
- From the HUS Pharmacy, Hospital Pharmacy of Helsinki University Hospital (HUS)
- Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki; Helsinki, Finland
| | - Ilona Niittynen
- Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki; Helsinki, Finland
| | - Marja Airaksinen
- Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki; Helsinki, Finland
| | - Anna-Riia Holmström
- From the HUS Pharmacy, Hospital Pharmacy of Helsinki University Hospital (HUS)
- Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki; Helsinki, Finland
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15
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Massoomi F, Burger M, de Vries C. Advances in safe insulin infusions. Drugs Context 2021; 10:2021-1-6. [PMID: 34349818 PMCID: PMC8289406 DOI: 10.7573/dic.2021-1-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/09/2021] [Indexed: 11/21/2022] Open
Abstract
Hyperglycaemia is recognized as a marker of adverse clinical outcomes for hospitalized patients with and without diabetes, including mortality, morbidity, increased length of stay, infections and overall complications. In some cases, intravenous (IV) insulin infusions are the optimal intervention and, to date, these have been compounded in hospital pharmacy departments or, alternatively, at the point of care, when timeliness is a concern or the pharmacy is closed. However, in-house compounding of high-risk medications such as IV insulin poses risks both for patients and institutions. The critical nature of certain high-risk therapies has led to the development of ready-to-administer products to improve the safety, timeliness, efficacy and efficiency of critical infusions. Recently, IV insulin, a high-alert therapy, has been added to the ready-to-use armamentarium. This narrative review explores the expanding indications, risks and opportunities associated with insulin infusions and potential options for improved safety.
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16
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Madson ZC, Vangala S, Sund GT, Lin JA. Does carrier fluid reduce low flow drug infusion error from syringe size? World J Clin Pediatr 2020; 9:17-28. [PMID: 33014719 PMCID: PMC7515749 DOI: 10.5409/wjcp.v9.i2.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/07/2020] [Accepted: 08/31/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Critically ill neonates and pediatric patients commonly require multiple low flow infusions. Volume limitations are imposed by small body habitus and co-morbidities like cardiopulmonary disease, renal failure, or fluid overload. Vascular access is limited by diminutive veins. Maintenance fluids or parenteral nutrition in conjunction with actively titrated infusions such as insulin, fentanyl, prostaglandins, inotropes and vasopressors may necessitate simultaneous infusions using a single lumen to maintain vascular catheter patency. This requirement for multiple titratable infusions requires concentrated medications at low flows, rather than more dilute drugs at higher flows that in combination may volume overload small infants.
AIM To determine whether carrier fluid reduces variability that variability of low flow drug infusions is proportional to syringe size in pediatric critical care.
METHODS We assessed concentrations of orange “drug” in a 0.2 mL/h low flow clinical model with blue dyed carrier fluid at 5 mL/h, using 3-, 10-, or 60-mL syringes. A graduated volumetric pipette was used to measure total flow. Mean time to target concentration was 30, 21, and 46 min in 3-, 10-, and 60-mL syringes, respectively (P = 0.42). After achieving target concentration, more dilute drug was delivered by 60-mL (P < 0.001) and 10-mL syringes (P = 0.04) compared to 3-mL syringes. Drug overdoses were observed during the initial 45 min of infusion in 10-and 60-mL syringes. Total volumes infused after target concentration were less in the 60-mL condition compared to 3-mL (P < 0.01) and 10-mL (P < 0.001) syringes.
RESULTS Linear mixed effects models demonstrated lesser delivered drug concentrations in the initial 30 min by 3-mL compared to 10-and 60-mL syringes (P = 0.005 and P < 0.001, respectively) but greater drug concentrations and total infused drug in the subsequent 30-60 and 60-90 min intervals with the 3- and 10-mL compared to 60-mL syringes.
CONCLUSION With carrier fluid, larger syringes were associated with significantly less drug delivery, less total volume delivered, and other flow problems in our low flow drug model. Carrier fluid should not be used to compensate for inappropriately large syringes in critical low flow drug infusions.
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Affiliation(s)
- Zachary C Madson
- Pediatric Hospitalist Medicine, Lutheran Children's Hospital, Fort Wayne, IN 46804, United States
| | - Sitaram Vangala
- Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
| | - Grace T Sund
- Department of Nursing, UCLA Mattel Children's Hospital, Los Angeles, CA 90095, United States
| | - James A Lin
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
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17
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Hunter S, Considine J, Manias E. Nurse management of vasoactive medications in intensive care: A systematic review. J Clin Nurs 2019; 29:381-392. [PMID: 31715043 DOI: 10.1111/jocn.15093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/24/2019] [Accepted: 10/20/2019] [Indexed: 11/27/2022]
Abstract
AIM AND OBJECTIVE To investigate how intensive care nurses prepare, initiate, administer, titrate, and wean vasoactive medications. BACKGROUND The management of vasoactive medications is core business for intensive care nurses, but little is known on how nurses manage these ubiquitous and potentially harmful medications. DESIGN A systematic review of the literature with narrative synthesis of data. METHODS The databases CINAHL Complete, Medline Complete and EMBASE were searched from 1965 to January 2019 with keywords under five concept headings and in a variety of configurations. This systematic review was conducted according to the PRISMA guidelines. Studies were assessed for quality and bias, and a modified narrative synthesis was used to analyse data, investigate findings and explore relationships within and between studies. RESULTS The review identified 13 studies: two observational studies, two pre and post intervention studies, four survey studies, two quasi-experimental studies, one longitudinal time series, one prospective controlled trial, and one interview incorporating content analysis. Four studies on preparing and initiating vasoactive medications described a lack of standardisation in infusion preparation and inconsistencies in dosing units and patient weights. Five of six studies on vasoactive medication administration examined nurses' use of syringe changeovers to reduce patient haemodynamic compromise and there were three studies on titration and weaning. CONCLUSION Further research on nurse management of vasoactive medications is needed to develop an evidence base for specialist education and standardised practices aimed at reducing risk for patient harm. RELEVANCE TO CLINICAL PRACTICE Nurses working in intensive care units in many parts of the world are responsible for the management of vasoactive medications. There is great variation in practices that include preparation, initiation, administration, titration and weaning of vasoactive medications, which increases the risk for medication errors and adverse events in a vulnerable population of critically ill patients.
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Affiliation(s)
- Stephanie Hunter
- School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Geelong, Vic., Australia.,Intensive Care Services, Eastern Health, Box Hill, Vic., Australia
| | - Julie Considine
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Vic., Australia.,Centre for Quality and Patient Safety Research - Eastern Health Partnership, Eastern Health, Box Hill, Vic., Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Vic., Australia
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18
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Black S, Lerman J, Banks SE, Noghrehkar D, Curia L, Mai CL, Schwengel D, Nelson CK, Foster JMT, Breneman S, Arheart KL. Drug Calculation Errors in Anesthesiology Residents and Faculty: An Analysis of Contributing Factors. Anesth Analg 2019; 128:1292-1299. [PMID: 31094802 DOI: 10.1213/ane.0000000000004013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Limited data exist regarding computational drug error rates in anesthesia residents and faculty. We investigated the frequency and magnitude of computational errors in a sample of anesthesia residents and faculty. METHODS With institutional review board approval from 7 academic institutions in the United States, a 15-question computational test was distributed during rounds. Error rates and the magnitude of the errors were analyzed according to resident versus faculty, years of practice (or residency training), duration of sleep, type of question, and institution. RESULTS A total of 371 completed the test: 209 residents and 162 faculty. Both groups committed 2 errors (median value) per test, for a mean error rate of 17.0%. Twenty percent of residents and 25% of faculty scored 100% correct answers. The error rate for postgraduate year 2 residents was less than for postgraduate year 1 (P = .012). The error rate for faculty increased with years of experience, with a weak correlation (R = 0.22; P = .007). The error rates were independent of the number of hours of sleep. The error rate for percentage-type questions was greater than for rate, dose, and ratio questions (P = .001). The error rates varied with the number of operations needed to calculate the answer (P < .001). The frequency of large errors (100-fold greater or less than the correct answer) by residents was twice that of faculty. Error rates varied among institutions ranged from 12% to 22% (P = .021). CONCLUSIONS Anesthesiology residents and faculty erred frequently on a computational test, with junior residents and faculty with more experience committing errors more frequently. Residents committed more serious errors twice as frequently as faculty.
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Affiliation(s)
- Shira Black
- From the Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York
| | - Jerrold Lerman
- From the Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York
- Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
- Department of Anesthesiology, John R. Oishei Children's Hospital, Buffalo, New York
| | - Shawn E Banks
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami-Miller School of Medicine, Miami, Florida
| | - Dena Noghrehkar
- Department of Anesthesiology, John R. Oishei Children's Hospital, Buffalo, New York
| | - Luciana Curia
- From the Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York
| | - Christine L Mai
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Deborah Schwengel
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Corey K Nelson
- Department of Anesthesiology and Perioperative Care, University of California, Irvine, California
| | - James M T Foster
- Department of Anesthesiology, State University of New York Upstate, Syracuse, New York
| | - Stephen Breneman
- From the Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York
| | - Kris L Arheart
- Department of Public Health Sciences, Division of Biostatistics, University of Miami School of Medicine, Miami, Florida
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19
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Hermanspann T, van der Linden E, Schoberer M, Fitzner C, Orlikowsky T, Marx G, Eisert A. Evaluation to improve the quality of medication preparation and administration in pediatric and adult intensive care units. DRUG HEALTHCARE AND PATIENT SAFETY 2019; 11:11-18. [PMID: 30936751 PMCID: PMC6429998 DOI: 10.2147/dhps.s184479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose To determine the type, frequency, and factors associated with medication preparation and administration errors in adult intensive care units (ICUs) and neonatal ICUs (NICUs)/pediatric ICUs (PICUs). Patients and methods We conducted a prospective direct observation study in an adult ICU and NICU/PICU in a tertiary university hospital. Between June 2012 and June 2013, a clinical pharmacist and medical student observed the nursing care staff on weekdays during the preparation and administration of intravenous drugs. We analyzed the frequency and type of preparation and administration errors and factors associated with errors. Results Six hundred and three preparations in the adult ICU and 281 in the NICU/PICU were observed. Three hundred and eighty-five errors occurred in the adult ICU and 38 in the NICU/PICU. There were 5,040 and 2,514 error opportunities, with overall error rates of 7.6% and 1.5%, respectively. The total opportunities for error meant each single step of preparation and administration that was relevant for the drug. Most errors applied to the category “uniform mixing” (adult ICU: n=227, 59%; NICU/PICU: n=14, 37%). The multivariate logistic regression results showed a significantly different influence of the “preparation type” for the adult ICU compared with the NICU/PICU with regard to the occurrence of an error. Preparations for adult patients of the LCD type (liquid concentrate with diluent into syringe or infusion bag) were more often associated with errors than the P (powder in a glass vial that must be reconstituted and diluted if necessary), P=0.012, and LC (liquid concentrate into syringe), P=0.002 type. Conclusion “Uniform mixing” was the most erroneous preparation step in intravenous drug preparations in two ICUs. Improvement of nurse training and the preparation of prefilled syringes in the pharmacy might reduce errors and improve the quality and safety of drug therapy.
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Affiliation(s)
- Theresa Hermanspann
- Hospital Pharmacy, RWTH Aachen University Hospital, Aachen, Germany, .,Department of Pediatric and Adolescent Medicine, Section of Neonatology, RWTH Aachen University Hospital, Aachen, Germany,
| | - Eva van der Linden
- Department of Pediatric and Adolescent Medicine, Section of Neonatology, RWTH Aachen University Hospital, Aachen, Germany,
| | - Mark Schoberer
- Department of Pediatric and Adolescent Medicine, Section of Neonatology, RWTH Aachen University Hospital, Aachen, Germany,
| | - Christina Fitzner
- Department of Medical Statistics, Medical Faculty RWTH Aachen University, Aachen, Germany.,Department of Anaesthesiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Thorsten Orlikowsky
- Department of Pediatric and Adolescent Medicine, Section of Neonatology, RWTH Aachen University Hospital, Aachen, Germany,
| | - Gernot Marx
- Department of Intensive Care Medicine, RWTH Aachen University Hospital, Aachen, Germany
| | - Albrecht Eisert
- Hospital Pharmacy, RWTH Aachen University Hospital, Aachen, Germany, .,Institute of Pharmacology and Toxicology, Medical Faculty RWTH Aachen University, Aachen, Germany
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20
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Siebert JN, Ehrler F, Combescure C, Lovis C, Haddad K, Hugon F, Luterbacher F, Lacroix L, Gervaix A, Manzano S. A mobile device application to reduce medication errors and time to drug delivery during simulated paediatric cardiopulmonary resuscitation: a multicentre, randomised, controlled, crossover trial. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:303-311. [PMID: 30797722 DOI: 10.1016/s2352-4642(19)30003-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/11/2018] [Accepted: 12/20/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Vasoactive drug preparation for continuous infusion in children is both complex and time consuming and places the paediatric population at higher risk than adults for medication errors. We developed a mobile device application (app) as a step-by-step guide for the preparation to delivery of drugs requiring continuous infusion. The app has been previously tested during simulation-based resuscitations in a previous single-centre trial. In this trial, our aim was to assess this app in various hospital settings. METHODS We did a prospective, multicentre, randomised, controlled, crossover trial to compare this app with an internationally used drug-infusion-rates table for the preparation of continuous drug infusion during standardised, simulation-based, paediatric post-cardiac arrest scenarios using a high-fidelity manikin. The scenarios were split into two study periods to assess the two preparation methods consecutively, separated by a washout distraction manoeuvre. Nurses in six paediatric emergency centres in Switzerland were randomly assigned (1:1) to start the scenario with either the app or the infusion-rates table and then complete the scenario using the other preparation method. The primary endpoint was the proportion of participants committing a medication error, which was defined as a deviation from the correct weight dose of more than 10%, miscalculation of the infusion rate, misprogramming of the infusion pump, or the inability to calculate drug dosage without calculation and guidance help from the study team. The medication error proportions observed with both preparation methods were compared by pooling both study periods, with paired data analysed using the unconditional exact McNemar test for dependent groups with a two-sided α level of 0·05. We did sensitivity analyses to investigate the carryover effect. This trial is registered with ClinicalTrials.gov, number NCT03021122. FINDINGS From March 1 to Dec 31, 2017, we randomly assigned 128 nurses to start the scenario using the app (n=64) or the infusion-rates table (n=64). Among the 128 drug preparations associated with each of the two methods, 96 (75%, 95% CI 67-82) delivered using the infusion-rates table were associated with medication errors compared with nine (7%, 3-13) delivered using the mobile app. Medication errors were reduced by 68% (95% CI 59-76%; p<0·0001) with the app compared with the table, as was the mean time to drug preparation (difference 148·2 s [95% CI 124·2-172·1], a 45% reduction; p<0·0001) and mean time to drug delivery (168·5 s [146·1-190·8], a 40% reduction; p<0·0001). Hospital size and nurses' experience did not modify the intervention effect. We detected no carryover effect. INTERPRETATION Critically ill children are particularly vulnerable to medication errors. A mobile app designed to help paediatric drug preparation during resuscitation with the aim to significantly reduce the occurrence of medication errors, drug preparation time, and delivery time could have the potential to change paediatric clinical practice in the area of emergency medicine. FUNDING Swiss National Science Foundation.
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Affiliation(s)
- Johan N Siebert
- Geneva Children's Hospital, Department of Paediatric Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.
| | - Frédéric Ehrler
- Division of Medical Information Sciences, Department of Radiology and Medical Informatics, Geneva University Hospitals, Geneva, Switzerland
| | - Christophe Combescure
- Division of Clinical Epidemiology, Department of Health and Community Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
| | - Christian Lovis
- Division of Medical Information Sciences, Department of Radiology and Medical Informatics, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Kevin Haddad
- Geneva Children's Hospital, Department of Paediatric Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Florence Hugon
- Geneva Children's Hospital, Department of Paediatric Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Fanny Luterbacher
- Geneva Children's Hospital, Department of Paediatric Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Laurence Lacroix
- Geneva Children's Hospital, Department of Paediatric Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Alain Gervaix
- Geneva Children's Hospital, Department of Paediatric Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sergio Manzano
- Geneva Children's Hospital, Department of Paediatric Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
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21
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Sarfati L, Ranchon F, Vantard N, Schwiertz V, Larbre V, Parat S, Faudel A, Rioufol C. Human-simulation-based learning to prevent medication error: A systematic review. J Eval Clin Pract 2019; 25:11-20. [PMID: 29383867 DOI: 10.1111/jep.12883] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 12/29/2017] [Accepted: 01/02/2018] [Indexed: 01/27/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES In the past 2 decades, there has been an increasing interest in simulation-based learning programs to prevent medication error (ME). To improve knowledge, skills, and attitudes in prescribers, nurses, and pharmaceutical staff, these methods enable training without directly involving patients. However, best practices for simulation for healthcare providers are as yet undefined. By analysing the current state of experience in the field, the present review aims to assess whether human simulation in healthcare helps to reduce ME. METHODS A systematic review was conducted on Medline from 2000 to June 2015, associating the terms "Patient Simulation," "Medication Errors," and "Simulation Healthcare." Reports of technology-based simulation were excluded, to focus exclusively on human simulation in nontechnical skills learning. RESULTS Twenty-one studies assessing simulation-based learning programs were selected, focusing on pharmacy, medicine or nursing students, or concerning programs aimed at reducing administration or preparation errors, managing crises, or learning communication skills for healthcare professionals. The studies varied in design, methodology, and assessment criteria. Few demonstrated that simulation was more effective than didactic learning in reducing ME. This review highlights a lack of long-term assessment and real-life extrapolation, with limited scenarios and participant samples. These various experiences, however, help in identifying the key elements required for an effective human simulation-based learning program for ME prevention: ie, scenario design, debriefing, and perception assessment. The performance of these programs depends on their ability to reflect reality and on professional guidance. CONCLUSION Properly regulated simulation is a good way to train staff in events that happen only exceptionally, as well as in standard daily activities. By integrating human factors, simulation seems to be effective in preventing iatrogenic risk related to ME, if the program is well designed.
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Affiliation(s)
- Laura Sarfati
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie, Unité de Pharmacie Clinique Oncologique, Pierre Bénite, France
| | - Florence Ranchon
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie, Unité de Pharmacie Clinique Oncologique, Pierre Bénite, France.,Université Lyon 1, EMR, 3738, Lyon, France
| | - Nicolas Vantard
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie, Unité de Pharmacie Clinique Oncologique, Pierre Bénite, France
| | - Vérane Schwiertz
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie, Unité de Pharmacie Clinique Oncologique, Pierre Bénite, France
| | - Virginie Larbre
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie, Unité de Pharmacie Clinique Oncologique, Pierre Bénite, France
| | - Stéphanie Parat
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie, Unité de Pharmacie Clinique Oncologique, Pierre Bénite, France
| | - Amélie Faudel
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie, Unité de Pharmacie Clinique Oncologique, Pierre Bénite, France
| | - Catherine Rioufol
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie, Unité de Pharmacie Clinique Oncologique, Pierre Bénite, France.,Université Lyon 1, EMR, 3738, Lyon, France
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22
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Kafal AR, Vinh DC, Langelier MJ. Prefilled syringes for immunoglobulin G (IgG) replacement therapy: clinical experience from other disease settings. Expert Opin Drug Deliv 2018; 15:1199-1209. [DOI: 10.1080/17425247.2018.1546692] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Ayman R. Kafal
- Medical Affairs, CSL Behring LLC, King of Prussia, PA, USA
| | - Donald C. Vinh
- Infectious Disease Susceptibility Program, Research Institute – McGill University Health Centre, Montreal, Quebec, Canada
| | - Mélanie J. Langelier
- Infectious Disease Susceptibility Program, Research Institute – McGill University Health Centre, Montreal, Quebec, Canada
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23
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Casamayor M, DiDonato K, Hennebert M, Brazzi L, Prosen G. Administration of intravenous morphine for acute pain in the emergency department inflicts an economic burden in Europe. Drugs Context 2018; 7:212524. [PMID: 29675049 PMCID: PMC5898605 DOI: 10.7573/dic.212524] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/13/2018] [Accepted: 03/15/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Acute pain is among the leading causes of referral to the emergency department (ED) in industrialized countries. Its management mainly depends on intensity. Moderate-to-severe pain is treated with intravenous (IV) administered opioids, of which morphine is the most commonly used in the ED. We have estimated the burden of IV administration of morphine in the five key European countries (EU5) using a micro-costing approach. SCOPE A structured literature review was conducted to identify clinical guidelines for acute pain management in EU5 and clinical studies conducted in the ED setting. The data identified in this literature review constituted the source for all model input parameters, which were clustered as analgesic (morphine), material used for IV morphine administration, nurse workforce time and management of morphine-related adverse events and IV-related complications. FINDINGS The cost per patient of IV morphine administration in the ED ranges between €18.31 in Spain and €28.38 in Germany. If costs associated with the management of morphine-related adverse events and IV-related complications are also considered, the total costs amount to €121.13-€132.43. The main driver of those total costs is the management of IV-related complications (phlebitis, extravasation and IV prescription errors; 73% of all costs) followed by workforce time (14%). CONCLUSIONS IV morphine provides effective pain relief in the ED, but the costs associated with the IV administration inflict an economic burden on the respective national health services in EU5. An equally rapid-onset and efficacious analgesic that does not require IV administration could reduce this burden.
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Affiliation(s)
| | - Karen DiDonato
- AcelRx, 351 Galveston Drive, Redwood City, CA 94063, USA
| | | | - Luca Brazzi
- Department of Surgical Science, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy
| | - Gregor Prosen
- Centre for Emergency Medicine, Community Health Center, Maribor, Slovenia
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24
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Ainscough LP, Ford JL, Morecroft CW, Peak M, Turner MA, Nunn AJ, Roberts M. Accuracy of intravenous and enteral preparations involving small volumes for paediatric use: a review. Eur J Hosp Pharm 2018; 25:66-71. [PMID: 31156991 PMCID: PMC6452381 DOI: 10.1136/ejhpharm-2016-001117] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/28/2016] [Accepted: 12/12/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Children often need to be administered very small volumes of medicines that are authorised for use in adults. Neonatal drug delivery is particularly challenging, and doses are often immeasurable with the equipment currently available. AIM To summarise research to date on the accuracy of intravenous and enteral medicine preparation requiring small volumes (<0.1 mL), with a focus on paediatric use and to identify areas for further work. METHOD Twenty-three publications were identified for the narrative review via: Web of Science (1950-2016), Cumulative Index to Nursing and Allied Health Literature (1976-2016), Excerpta Medica Database (1974-2016) and International Pharmaceutical Abstracts (1970-2016) searches. Nine additional papers were identified through backward citation tracking and a further 17 were included from the personal knowledge of the review team. RESULTS Measurement of volumes (<0.1 mL), for enteral and intravenous dosing, accounts for 25% of medicine manipulations within paediatric hospitals. Inaccuracies are described throughout the literature with dose administration errors attributed to technique, calculation, dilution and problems associated with equipment. While standardised concentrations for intravenous infusion and drug concentrations that avoid measurement of small volumes would ameliorate problems, further work is needed to establish accurate methods for handling small volumes during the administration of medicines to children and risk minimisation strategies to support staff involved are also necessary. CONCLUSIONS This review has revealed a paucity of information on the clinical outcomes from problems in measuring small volumes for children and highlighted the need for further work to eliminate this source of inaccurate dosing and potential for medication error.
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Affiliation(s)
- L P Ainscough
- School of Pharmacy & Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - J L Ford
- School of Pharmacy & Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - C W Morecroft
- School of Pharmacy & Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - M Peak
- Paediatric Medicines Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - M A Turner
- Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - A J Nunn
- School of Pharmacy & Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
- Paediatric Medicines Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - M Roberts
- School of Pharmacy & Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
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Garrigue B, Dehu Y, Girault F, Figadère B, Leblanc K, Briole N, Capitani GA, Lagadec S, Laborne FX. Preparing Drugs for Infusion Via Syringe Pump: A Key Step to Ensure Homogeneous Concentration. Crit Care Nurse 2018; 36:36-44. [PMID: 27481800 DOI: 10.4037/ccn2016756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Preparation of drug solutions used with electronic syringe infusion pumps plays a crucial role in the delivery of an accurate drug concentration. Is there a correlation between drug concentrations during syringe pump infusion and preparation protocols? METHOD Norepinephrine, insulin, and sufentanil were prepared in 3 different ways: (1) the drug was taken from the vial, then the solvent was added followed by an air bubble, and mixing was performed by turning the syringe top-to-bottom in a 180° shaking movement 5 consecutive times; (2) the drug was taken from the vial, then the solvent was added and not mixed; and (3) the solvent was taken from a stock solution, then the drug was added and not mixed. Concentrations of drugs were determined at different times during administration by reverse-phase high-performance liquid chromatography with ultraviolet detection. All analyses were performed in triplicate and were based on measurement of peak areas. RESULTS With no shaking of the syringe, the concentration of the injected drugs varies widely. In any case, mixing of the syringe contents by turning the syringe in a top-to-bottom 180° shaking movement 5 times with an air bubble would ensure administration of the drug at a constant concentration. CONCLUSIONS Without mixing, the concentrations of all drug solutions varied widely when administered via an electronic syringe infusion pump. Mixing syringe contents should be made part of the compulsory curriculum for administering medications at all levels of medical education. (Critical Care Nurse. 2016;36[4]:36-45).
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Affiliation(s)
- Bruno Garrigue
- Bruno Garrigue is an anesthesia nurse and head of the prehospital emergency medicine service at Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France.Yann Dehu is an anesthesia nurse working in a surgical unit and a clinical research associate at Centre Hospitalier Sud-Francilien.Fabrice Girault is a registered nurse working in a prehospital emergency medicine service, Centre Hospitalier Sud-Francilien.Bruno Figadère is a medicinal chemist at Centre Nationale de Recherches Scientifiques (CNRS)/Universite Paris Sud-Faculte de Pharmacie Joint Laboratory, Chatenay-Malabry, France.Karine Leblanc is a chemical engineer at CNRS/Univ Paris Sud-Faculte de Pharmacie Joint Laboratory.Nicolas Briole is an emergency medicine physician at Centre Hospitalier Sud-Francilien.Georges Antoine Capitani is head of the acute care department at Centre Hospitalier Sud-Francilien.Steven Lagadec is a nurse in the prehospital emergency service and a clinical research associate at Centre Hospitalier Sud-Francilien.François-Xavier Laborne is a prehospital emergency practitioner and a methodologist and biostatistician in the clinical research unit of the Centre Hospitalier Sud-Francilien.
| | - Yann Dehu
- Bruno Garrigue is an anesthesia nurse and head of the prehospital emergency medicine service at Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France.Yann Dehu is an anesthesia nurse working in a surgical unit and a clinical research associate at Centre Hospitalier Sud-Francilien.Fabrice Girault is a registered nurse working in a prehospital emergency medicine service, Centre Hospitalier Sud-Francilien.Bruno Figadère is a medicinal chemist at Centre Nationale de Recherches Scientifiques (CNRS)/Universite Paris Sud-Faculte de Pharmacie Joint Laboratory, Chatenay-Malabry, France.Karine Leblanc is a chemical engineer at CNRS/Univ Paris Sud-Faculte de Pharmacie Joint Laboratory.Nicolas Briole is an emergency medicine physician at Centre Hospitalier Sud-Francilien.Georges Antoine Capitani is head of the acute care department at Centre Hospitalier Sud-Francilien.Steven Lagadec is a nurse in the prehospital emergency service and a clinical research associate at Centre Hospitalier Sud-Francilien.François-Xavier Laborne is a prehospital emergency practitioner and a methodologist and biostatistician in the clinical research unit of the Centre Hospitalier Sud-Francilien
| | - Fabrice Girault
- Bruno Garrigue is an anesthesia nurse and head of the prehospital emergency medicine service at Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France.Yann Dehu is an anesthesia nurse working in a surgical unit and a clinical research associate at Centre Hospitalier Sud-Francilien.Fabrice Girault is a registered nurse working in a prehospital emergency medicine service, Centre Hospitalier Sud-Francilien.Bruno Figadère is a medicinal chemist at Centre Nationale de Recherches Scientifiques (CNRS)/Universite Paris Sud-Faculte de Pharmacie Joint Laboratory, Chatenay-Malabry, France.Karine Leblanc is a chemical engineer at CNRS/Univ Paris Sud-Faculte de Pharmacie Joint Laboratory.Nicolas Briole is an emergency medicine physician at Centre Hospitalier Sud-Francilien.Georges Antoine Capitani is head of the acute care department at Centre Hospitalier Sud-Francilien.Steven Lagadec is a nurse in the prehospital emergency service and a clinical research associate at Centre Hospitalier Sud-Francilien.François-Xavier Laborne is a prehospital emergency practitioner and a methodologist and biostatistician in the clinical research unit of the Centre Hospitalier Sud-Francilien
| | - Bruno Figadère
- Bruno Garrigue is an anesthesia nurse and head of the prehospital emergency medicine service at Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France.Yann Dehu is an anesthesia nurse working in a surgical unit and a clinical research associate at Centre Hospitalier Sud-Francilien.Fabrice Girault is a registered nurse working in a prehospital emergency medicine service, Centre Hospitalier Sud-Francilien.Bruno Figadère is a medicinal chemist at Centre Nationale de Recherches Scientifiques (CNRS)/Universite Paris Sud-Faculte de Pharmacie Joint Laboratory, Chatenay-Malabry, France.Karine Leblanc is a chemical engineer at CNRS/Univ Paris Sud-Faculte de Pharmacie Joint Laboratory.Nicolas Briole is an emergency medicine physician at Centre Hospitalier Sud-Francilien.Georges Antoine Capitani is head of the acute care department at Centre Hospitalier Sud-Francilien.Steven Lagadec is a nurse in the prehospital emergency service and a clinical research associate at Centre Hospitalier Sud-Francilien.François-Xavier Laborne is a prehospital emergency practitioner and a methodologist and biostatistician in the clinical research unit of the Centre Hospitalier Sud-Francilien
| | - Karine Leblanc
- Bruno Garrigue is an anesthesia nurse and head of the prehospital emergency medicine service at Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France.Yann Dehu is an anesthesia nurse working in a surgical unit and a clinical research associate at Centre Hospitalier Sud-Francilien.Fabrice Girault is a registered nurse working in a prehospital emergency medicine service, Centre Hospitalier Sud-Francilien.Bruno Figadère is a medicinal chemist at Centre Nationale de Recherches Scientifiques (CNRS)/Universite Paris Sud-Faculte de Pharmacie Joint Laboratory, Chatenay-Malabry, France.Karine Leblanc is a chemical engineer at CNRS/Univ Paris Sud-Faculte de Pharmacie Joint Laboratory.Nicolas Briole is an emergency medicine physician at Centre Hospitalier Sud-Francilien.Georges Antoine Capitani is head of the acute care department at Centre Hospitalier Sud-Francilien.Steven Lagadec is a nurse in the prehospital emergency service and a clinical research associate at Centre Hospitalier Sud-Francilien.François-Xavier Laborne is a prehospital emergency practitioner and a methodologist and biostatistician in the clinical research unit of the Centre Hospitalier Sud-Francilien
| | - Nicolas Briole
- Bruno Garrigue is an anesthesia nurse and head of the prehospital emergency medicine service at Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France.Yann Dehu is an anesthesia nurse working in a surgical unit and a clinical research associate at Centre Hospitalier Sud-Francilien.Fabrice Girault is a registered nurse working in a prehospital emergency medicine service, Centre Hospitalier Sud-Francilien.Bruno Figadère is a medicinal chemist at Centre Nationale de Recherches Scientifiques (CNRS)/Universite Paris Sud-Faculte de Pharmacie Joint Laboratory, Chatenay-Malabry, France.Karine Leblanc is a chemical engineer at CNRS/Univ Paris Sud-Faculte de Pharmacie Joint Laboratory.Nicolas Briole is an emergency medicine physician at Centre Hospitalier Sud-Francilien.Georges Antoine Capitani is head of the acute care department at Centre Hospitalier Sud-Francilien.Steven Lagadec is a nurse in the prehospital emergency service and a clinical research associate at Centre Hospitalier Sud-Francilien.François-Xavier Laborne is a prehospital emergency practitioner and a methodologist and biostatistician in the clinical research unit of the Centre Hospitalier Sud-Francilien
| | - Georges Antoine Capitani
- Bruno Garrigue is an anesthesia nurse and head of the prehospital emergency medicine service at Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France.Yann Dehu is an anesthesia nurse working in a surgical unit and a clinical research associate at Centre Hospitalier Sud-Francilien.Fabrice Girault is a registered nurse working in a prehospital emergency medicine service, Centre Hospitalier Sud-Francilien.Bruno Figadère is a medicinal chemist at Centre Nationale de Recherches Scientifiques (CNRS)/Universite Paris Sud-Faculte de Pharmacie Joint Laboratory, Chatenay-Malabry, France.Karine Leblanc is a chemical engineer at CNRS/Univ Paris Sud-Faculte de Pharmacie Joint Laboratory.Nicolas Briole is an emergency medicine physician at Centre Hospitalier Sud-Francilien.Georges Antoine Capitani is head of the acute care department at Centre Hospitalier Sud-Francilien.Steven Lagadec is a nurse in the prehospital emergency service and a clinical research associate at Centre Hospitalier Sud-Francilien.François-Xavier Laborne is a prehospital emergency practitioner and a methodologist and biostatistician in the clinical research unit of the Centre Hospitalier Sud-Francilien
| | - Steven Lagadec
- Bruno Garrigue is an anesthesia nurse and head of the prehospital emergency medicine service at Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France.Yann Dehu is an anesthesia nurse working in a surgical unit and a clinical research associate at Centre Hospitalier Sud-Francilien.Fabrice Girault is a registered nurse working in a prehospital emergency medicine service, Centre Hospitalier Sud-Francilien.Bruno Figadère is a medicinal chemist at Centre Nationale de Recherches Scientifiques (CNRS)/Universite Paris Sud-Faculte de Pharmacie Joint Laboratory, Chatenay-Malabry, France.Karine Leblanc is a chemical engineer at CNRS/Univ Paris Sud-Faculte de Pharmacie Joint Laboratory.Nicolas Briole is an emergency medicine physician at Centre Hospitalier Sud-Francilien.Georges Antoine Capitani is head of the acute care department at Centre Hospitalier Sud-Francilien.Steven Lagadec is a nurse in the prehospital emergency service and a clinical research associate at Centre Hospitalier Sud-Francilien.François-Xavier Laborne is a prehospital emergency practitioner and a methodologist and biostatistician in the clinical research unit of the Centre Hospitalier Sud-Francilien
| | - François-Xavier Laborne
- Bruno Garrigue is an anesthesia nurse and head of the prehospital emergency medicine service at Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France.Yann Dehu is an anesthesia nurse working in a surgical unit and a clinical research associate at Centre Hospitalier Sud-Francilien.Fabrice Girault is a registered nurse working in a prehospital emergency medicine service, Centre Hospitalier Sud-Francilien.Bruno Figadère is a medicinal chemist at Centre Nationale de Recherches Scientifiques (CNRS)/Universite Paris Sud-Faculte de Pharmacie Joint Laboratory, Chatenay-Malabry, France.Karine Leblanc is a chemical engineer at CNRS/Univ Paris Sud-Faculte de Pharmacie Joint Laboratory.Nicolas Briole is an emergency medicine physician at Centre Hospitalier Sud-Francilien.Georges Antoine Capitani is head of the acute care department at Centre Hospitalier Sud-Francilien.Steven Lagadec is a nurse in the prehospital emergency service and a clinical research associate at Centre Hospitalier Sud-Francilien.François-Xavier Laborne is a prehospital emergency practitioner and a methodologist and biostatistician in the clinical research unit of the Centre Hospitalier Sud-Francilien
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Siebert JN, Ehrler F, Lovis C, Combescure C, Haddad K, Gervaix A, Manzano S. A Mobile Device App to Reduce Medication Errors and Time to Drug Delivery During Pediatric Cardiopulmonary Resuscitation: Study Protocol of a Multicenter Randomized Controlled Crossover Trial. JMIR Res Protoc 2017; 6:e167. [PMID: 28830854 PMCID: PMC5585594 DOI: 10.2196/resprot.7901] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/05/2017] [Accepted: 08/09/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND During pediatric cardiopulmonary resuscitation (CPR), vasoactive drug preparation for continuous infusions is complex and time-consuming. The need for individual specific weight-based drug dose calculation and preparation places children at higher risk than adults for medication errors. Following an evidence-based and ergonomic driven approach, we developed a mobile device app called Pediatric Accurate Medication in Emergency Situations (PedAMINES), intended to guide caregivers step-by-step from preparation to delivery of drugs requiring continuous infusion. In a prior single center randomized controlled trial, medication errors were reduced from 70% to 0% by using PedAMINES when compared with conventional preparation methods. OBJECTIVE The purpose of this study is to determine whether the use of PedAMINES in both university and smaller hospitals reduces medication dosage errors (primary outcome), time to drug preparation (TDP), and time to drug delivery (TDD) (secondary outcomes) during pediatric CPR when compared with conventional preparation methods. METHODS This is a multicenter, prospective, randomized controlled crossover trial with 2 parallel groups comparing PedAMINES with a conventional and internationally used drug infusion rate table in the preparation of continuous drug infusion. The evaluation setting uses a simulation-based pediatric CPR cardiac arrest scenario with a high-fidelity manikin. The study involving 120 certified nurses (sample size) will take place in the resuscitation rooms of 3 tertiary pediatric emergency departments and 3 smaller hospitals. After epinephrine-induced return of spontaneous circulation, nurses will be asked to prepare a continuous infusion of dopamine using either PedAMINES (intervention group) or the infusion table (control group) and then prepare a continuous infusion of norepinephrine by crossing the procedure. The primary outcome is the medication dosage error rate. The secondary outcome is the time in seconds elapsed since the oral prescription by the physician to drug delivery by the nurse in each allocation group. TDD includes TDP. Stress level during the resuscitation scenario will be assessed for each participant by questionnaire and recorded by the heart rate monitor of a fitness watch. The study is formatted according to the Consolidated Standards of Reporting Trials Statement for Randomized Controlled Trials of Electronic and Mobile Health Applications and Online TeleHealth (CONSORT-EHEALTH) and the Reporting Guidelines for Health Care Simulation Research. RESULTS Enrollment and data analysis started in March 2017. We anticipate the intervention will be completed in late 2017, and study results will be submitted in early 2018 for publication expected in mid-2018. Results will be reported in line with recommendations from CONSORT-EHEALTH and the Reporting Guidelines for Health Care Simulation Research . CONCLUSIONS This paper describes the protocol used for a clinical trial assessing the impact of a mobile device app to reduce the rate of medication errors, time to drug preparation, and time to drug delivery during pediatric resuscitation. As research in this area is scarce, results generated from this study will be of great importance and might be sufficient to change and improve the pediatric emergency care practice. TRIAL REGISTRATION ClinicalTrials.gov NCT03021122; https://clinicaltrials.gov/ct2/show/NCT03021122 (Archived by WebCite at http://www.webcitation.org/6nfVJ5b4R).
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Affiliation(s)
- Johan N Siebert
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Frederic Ehrler
- Division of Medical Information Sciences, Department of Radiology and Medical Informatics, University Hospitals of Geneva, Geneva, Switzerland
| | - Christian Lovis
- Division of Medical Information Sciences, Department of Radiology and Medical Informatics, University Hospitals of Geneva, Geneva, Switzerland
| | - Christophe Combescure
- Division of Clinical Epidemiology, Department of Health and Community Medicine, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland
| | - Kevin Haddad
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Alain Gervaix
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Sergio Manzano
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
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Kaufmann J, Wolf A, Becke K, Laschat M, Wappler F, Engelhardt T. Drug safety in paediatric anaesthesia. Br J Anaesth 2017; 118:670-679. [DOI: 10.1093/bja/aex072] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Siebert JN, Ehrler F, Combescure C, Lacroix L, Haddad K, Sanchez O, Gervaix A, Lovis C, Manzano S. A Mobile Device App to Reduce Time to Drug Delivery and Medication Errors During Simulated Pediatric Cardiopulmonary Resuscitation: A Randomized Controlled Trial. J Med Internet Res 2017; 19:e31. [PMID: 28148473 PMCID: PMC5311423 DOI: 10.2196/jmir.7005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 01/11/2017] [Indexed: 11/18/2022] Open
Abstract
Background During pediatric cardiopulmonary resuscitation (CPR), vasoactive drug preparation for continuous infusion is both complex and time-consuming, placing children at higher risk than adults for medication errors. Following an evidence-based ergonomic-driven approach, we developed a mobile device app called Pediatric Accurate Medication in Emergency Situations (PedAMINES), intended to guide caregivers step-by-step from preparation to delivery of drugs requiring continuous infusion. Objective The aim of our study was to determine whether the use of PedAMINES reduces drug preparation time (TDP) and time to delivery (TDD; primary outcome), as well as medication errors (secondary outcomes) when compared with conventional preparation methods. Methods The study was a randomized controlled crossover trial with 2 parallel groups comparing PedAMINES with a conventional and internationally used drugs infusion rate table in the preparation of continuous drug infusion. We used a simulation-based pediatric CPR cardiac arrest scenario with a high-fidelity manikin in the shock room of a tertiary care pediatric emergency department. After epinephrine-induced return of spontaneous circulation, pediatric emergency nurses were first asked to prepare a continuous infusion of dopamine, using either PedAMINES (intervention group) or the infusion table (control group), and second, a continuous infusion of norepinephrine by crossing the procedure. The primary outcome was the elapsed time in seconds, in each allocation group, from the oral prescription by the physician to TDD by the nurse. TDD included TDP. The secondary outcome was the medication dosage error rate during the sequence from drug preparation to drug injection. Results A total of 20 nurses were randomized into 2 groups. During the first study period, mean TDP while using PedAMINES and conventional preparation methods was 128.1 s (95% CI 102-154) and 308.1 s (95% CI 216-400), respectively (180 s reduction, P=.002). Mean TDD was 214 s (95% CI 171-256) and 391 s (95% CI 298-483), respectively (177.3 s reduction, P=.002). Medication errors were reduced from 70% to 0% (P<.001) by using PedAMINES when compared with conventional methods. Conclusions In this simulation-based study, PedAMINES dramatically reduced TDP, to delivery and the rate of medication errors.
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Affiliation(s)
- Johan N Siebert
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Frederic Ehrler
- Department of Radiology and Medical Informatics, Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Christophe Combescure
- Department of Health and Community Medicine, Division of Clinical Epidemiology, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland
| | - Laurence Lacroix
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Kevin Haddad
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Oliver Sanchez
- Department of Pediatric Surgery, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Alain Gervaix
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Christian Lovis
- Department of Radiology and Medical Informatics, Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Sergio Manzano
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
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Cuesta López I, Sánchez Cuervo M, Candela Toha Á, Benedí González J, Bermejo Vicedo T. Impact of the implementation of vasoactive drug protocols on safety and efficacy in the treatment of critically ill patients. J Clin Pharm Ther 2016; 41:703-710. [PMID: 27699815 DOI: 10.1111/jcpt.12459] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 09/04/2016] [Indexed: 01/25/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE The correct management of high-alert medications is a priority issue in expert recommendations for improving the clinical safety of patients. Objectives were to assess the impact of the implementation of vasoactive drug (VAD) protocols on safety and efficacy in the treatment of critically ill patients. METHODS A prospective before-and-after study on the implementation of different VAD protocols, comparing medication errors (MEs) rates, mean intensive care unit (ICU) stay, mean blood pressure (MAP), heart rate (HR) and oxygen saturation. RESULTS AND DISCUSSION The study included 432 patients. There was a statistically significant decrease in prescribing errors (55·9%), validation errors (68·1%) and medication administration records (MAR) errors (78·8%). No differences were found between the two phases in ICU stay, MAP, HR and oxygen saturation. WHAT IS NEW AND CONCLUSION Implementation of protocols decreases variability in clinical practice, reduces the incidence of MEs and maintains the effectiveness of VAD therapy in critically ill patients.
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Affiliation(s)
- I Cuesta López
- Pharmacy Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - M Sánchez Cuervo
- Pharmacy Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Á Candela Toha
- Anaesthesia and Resuscitation Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J Benedí González
- Pharmacology Department, School of Pharmacy, Universidad Complutense de Madrid, Madrid, Spain
| | - T Bermejo Vicedo
- Pharmacy Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Armoiry X, Carry PY, Lehot JJ, Michel C, Aulagner G, Piriou V. Estimated economic impact of pre-filled ephedrine syringes in the operating room. Acta Anaesthesiol Scand 2016; 60:917-24. [PMID: 26935817 DOI: 10.1111/aas.12718] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 01/15/2016] [Accepted: 01/25/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Syringes of ephedrine are usually prepared ahead of time in order to reduce the time to injection. Commercial pre-filled syringes of ephedrine have been introduced to minimize the amount of waste. Our primary objective was to determine the economic impact of commercial syringes. We hypothesized that costs could be reduced compared to standard syringes. METHODS Using data extracted from our medical records system, we retrospectively measured the total dose of ephedrine received per patient in 2013 to estimate the number of administered standard syringes. The proportion of administered standard syringes was calculated as the total number of administered standard syringes divided by the number of delivered ampoules in 2013. Thereafter, we calculated the annual cost difference as the difference between the cost for commercial syringes and the cost for standard syringes. Endpoints were calculated overall and for each operating room. RESULTS At least one dose of ephedrine was given in 19,422 patients (44,943 administrations). The overall proportion of administered standard syringes was estimated to 52.8%. The threshold proportion of administered standard syringes for which commercial syringes would add no extra cost was 20.4%. In 30/32 operating rooms, the proportion of administered standard syringes was higher than 20.4%. The overall cost increase with commercial syringes was estimated to 51,567 €. Among operating rooms, incremental costs varied between -703 and 5086 €. CONCLUSION Based on our findings, pre-filled ephedrine commercial syringes do not appear to reduce costs.
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Affiliation(s)
- X. Armoiry
- Délégation à la Recherche Clinique et à l'Innovation; Cellule Innovation/UMR-CNRS 5510/MATEIS; Hospices Civils De Lyon; Bron France
| | - P.-Y. Carry
- Groupement Hospitalier Sud; Service d'Anesthésie-réanimation; Claude Bernard University Lyon 1; Hospices Civils De Lyon; Pierre-Bénite France
| | - J.-J. Lehot
- Hospices Civils De Lyon; Groupement Hospitalier Est; Service d'Anesthésie-réanimation/Claude Bernard University Lyon 1; Bron France
| | - C. Michel
- Hospices Civils De Lyon; Direction des Systèmes d'Information; Lyon France
| | - G. Aulagner
- Hospices Civils De Lyon; Groupement Hospitalier Est; Service Pharmaceutique/UMR-CNRS 5510/MATEIS; Bron France
| | - V. Piriou
- Groupement Hospitalier Sud; Service d'Anesthésie-réanimation; Claude Bernard University Lyon 1; Hospices Civils De Lyon; Pierre-Bénite France
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Flannery AH, Parli SE. Medication Errors in Cardiopulmonary Arrest and Code-Related Situations. Am J Crit Care 2016; 25:12-20. [PMID: 26724288 DOI: 10.4037/ajcc2016190] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
PubMed/MEDLINE (1966-November 2014) was searched to identify relevant published studies on the overall frequency, types, and examples of medication errors during medical emergencies involving cardiopulmonary resuscitation and related situations, and the breakdown by type of error. The overall frequency of medication errors during medical emergencies, specifically situations related to resuscitation, is highly variable. Medication errors during such emergencies, particularly cardiopulmonary resuscitation and surrounding events, are not well characterized in the literature but may be more frequent than previously thought. Depending on whether research methods included database mining, simulation, or prospective observation of clinical practice, reported occurrence of medication errors during cardiopulmonary resuscitation and surrounding events has ranged from less than 1% to 50%. Because of the chaos of the resuscitation environment, errors in prescribing, dosing, preparing, labeling, and administering drugs are prone to occur. System-based strategies, such as infusion pump policies and code cart management, as well as personal strategies exist to minimize medication errors during emergency situations.
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Affiliation(s)
- Alexander H. Flannery
- Alexander H. Flannery is a critical care pharmacist, medical intensive care unit/pulmonary, University of Kentucky HealthCare, and an adjunct assistant professor, Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky. Sara E. Parli is a critical care pharmacist, trauma/acute care surgery, University of Kentucky HealthCare, and an adjunct assistant professor, Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy
| | - Sara E. Parli
- Alexander H. Flannery is a critical care pharmacist, medical intensive care unit/pulmonary, University of Kentucky HealthCare, and an adjunct assistant professor, Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky. Sara E. Parli is a critical care pharmacist, trauma/acute care surgery, University of Kentucky HealthCare, and an adjunct assistant professor, Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy
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Pignard J, Cosserant S, Traore O, Souweine B, Sautou V. [Security of hospital infusion practices: From an a priori risk analysis to an improvement action plan]. ANNALES PHARMACEUTIQUES FRANÇAISES 2015; 74:154-64. [PMID: 26294272 DOI: 10.1016/j.pharma.2015.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 07/01/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Infusion in care units, and all the more in intensive care units, is a complex process which can be the source of many risks for the patient. Under cover of an institutional approach for the improvement of the quality and safety of patient healthcare, a risk mapping infusion practices was performed. METHODS The analysis was focused on intravenous infusion situations in adults, the a priori risk assessment methodology was applied and a multidisciplinary work group established. RESULTS Forty-three risks were identified for the infusion process (prescription, preparation and administration). The risks' assessment and the existing means of control showed that 48% of them would have a highly critical patient security impact. Recommendations were developed for 20 risks considered to be most critical, to limit their occurrence and severity, and improve their control level. An institutional action plan was developed and validated in the Drug and Sterile Medical Devices Commission. CONCLUSION This mapping allowed the realization of an exhaustive inventory of potential risks associated with the infusion. At the end of this work, multidisciplinary groups were set up to work on different themes and regular quarterly meetings were established to follow the progress of various projects. Risk mapping will be performed in pediatric and oncology unit where the risks associated with the handling of toxic products is omnipresent.
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Affiliation(s)
- J Pignard
- Pôle pharmacie, CHU de Clermont-Ferrand, rue Montalembert, 63003 Clermont-Ferrand, France.
| | - S Cosserant
- Service de réanimation médicale polyvalente, CHU de Clermont-Ferrand, rue Montalembert, 63003 Clermont-Ferrand, France
| | - O Traore
- Service d'hygiène, CHU de Clermont-Ferrand, rue Montalembert, 63003 Clermont-Ferrand, France; Direction qualité, gestion des risques et droits des usagers, CHU de Clermont-Ferrand, rue Montalembert, 63003 Clermont-Ferrand, France
| | - B Souweine
- Service de réanimation médicale polyvalente, CHU de Clermont-Ferrand, rue Montalembert, 63003 Clermont-Ferrand, France
| | - V Sautou
- Pôle pharmacie, CHU de Clermont-Ferrand, rue Montalembert, 63003 Clermont-Ferrand, France; EA 4676 C-BIOSENSS, Clermont université, université d'Auvergne, BP 10448, 63000 Clermont-Ferrand, France
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Stevens AD, Hernandez C, Jones S, Moreira ME, Blumen JR, Hopkins E, Sande M, Bakes K, Haukoos JS. Color-coded prefilled medication syringes decrease time to delivery and dosing errors in simulated prehospital pediatric resuscitations: A randomized crossover trial. Resuscitation 2015; 96:85-91. [PMID: 26247145 DOI: 10.1016/j.resuscitation.2015.07.035] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 07/09/2015] [Accepted: 07/25/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Medication dosing errors remain commonplace and may result in potentially life-threatening outcomes, particularly for pediatric patients where dosing often requires weight-based calculations. Novel medication delivery systems that may reduce dosing errors resonate with national healthcare priorities. Our goal was to evaluate novel, prefilled medication syringes labeled with color-coded volumes corresponding to the weight-based dosing of the Broselow Tape, compared to conventional medication administration, in simulated prehospital pediatric resuscitation scenarios. METHODS We performed a prospective, block-randomized, cross-over study, where 10 full-time paramedics each managed two simulated pediatric arrests in situ using either prefilled, color-coded syringes (intervention) or their own medication kits stocked with conventional ampoules (control). Each paramedic was paired with two emergency medical technicians to provide ventilations and compressions as directed. The ambulance patient compartment and the intravenous medication port were video recorded. Data were extracted from video review by blinded, independent reviewers. RESULTS Median time to delivery of all doses for the intervention and control groups was 34 (95% CI: 28-39) seconds and 42 (95% CI: 36-51) seconds, respectively (difference=9 [95% CI: 4-14] seconds). Using the conventional method, 62 doses were administered with 24 (39%) critical dosing errors; using the prefilled, color-coded syringe method, 59 doses were administered with 0 (0%) critical dosing errors (difference=39%, 95% CI: 13-61%). CONCLUSIONS A novel color-coded, prefilled syringe decreased time to medication administration and significantly reduced critical dosing errors by paramedics during simulated prehospital pediatric resuscitations.
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Affiliation(s)
- Allen D Stevens
- Department of Medicine, National Jewish Health, Denver, CO, USA; Division of Emergency Medical Services, Platte Valley Medical Center, Brighton, CO, USA
| | - Caleb Hernandez
- Department of Emergency Medicine, University of Northern Colorado Medical Center, Greeley, CO, USA
| | - Seth Jones
- Paramedic Division, Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA
| | - Maria E Moreira
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jason R Blumen
- Paramedic Division, Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA
| | - Emily Hopkins
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Margaret Sande
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Katherine Bakes
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jason S Haukoos
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA; Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.
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Moreira ME, Hernandez C, Stevens AD, Jones S, Sande M, Blumen JR, Hopkins E, Bakes K, Haukoos JS. Color-Coded Prefilled Medication Syringes Decrease Time to Delivery and Dosing Error in Simulated Emergency Department Pediatric Resuscitations. Ann Emerg Med 2015; 66:97-106.e3. [PMID: 25701295 DOI: 10.1016/j.annemergmed.2014.12.035] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/17/2014] [Accepted: 12/29/2014] [Indexed: 12/23/2022]
Abstract
STUDY OBJECTIVE The Institute of Medicine has called on the US health care system to identify and reduce medical errors. Unfortunately, medication dosing errors remain commonplace and may result in potentially life-threatening outcomes, particularly for pediatric patients when dosing requires weight-based calculations. Novel medication delivery systems that may reduce dosing errors resonate with national health care priorities. Our goal was to evaluate novel, prefilled medication syringes labeled with color-coded volumes corresponding to the weight-based dosing of the Broselow Tape, compared with conventional medication administration, in simulated pediatric emergency department (ED) resuscitation scenarios. METHODS We performed a prospective, block-randomized, crossover study in which 10 emergency physician and nurse teams managed 2 simulated pediatric arrest scenarios in situ, using either prefilled, color-coded syringes (intervention) or conventional drug administration methods (control). The ED resuscitation room and the intravenous medication port were video recorded during the simulations. Data were extracted from video review by blinded, independent reviewers. RESULTS Median time to delivery of all doses for the conventional and color-coded delivery groups was 47 seconds (95% confidence interval [CI] 40 to 53 seconds) and 19 seconds (95% CI 18 to 20 seconds), respectively (difference=27 seconds; 95% CI 21 to 33 seconds). With the conventional method, 118 doses were administered, with 20 critical dosing errors (17%); with the color-coded method, 123 doses were administered, with 0 critical dosing errors (difference=17%; 95% CI 4% to 30%). CONCLUSION A novel color-coded, prefilled syringe decreased time to medication administration and significantly reduced critical dosing errors by emergency physician and nurse teams during simulated pediatric ED resuscitations.
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Affiliation(s)
- Maria E Moreira
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Caleb Hernandez
- Department of Emergency Medicine, University of Northern Colorado Medical Center, Greeley, CO
| | - Allen D Stevens
- Department of Medicine, National Jewish Health, Denver, CO; Division of Emergency Medical Services, Platte Valley Medical Center, Brighton, CO
| | - Seth Jones
- Paramedic Division, Department of Emergency Medicine, Denver Health Medical Center, Denver, CO
| | - Margaret Sande
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Jason R Blumen
- Paramedic Division, Department of Emergency Medicine, Denver Health Medical Center, Denver, CO
| | - Emily Hopkins
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Katherine Bakes
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Jason S Haukoos
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO; Department of Epidemiology, Colorado School of Public Health, Aurora, CO.
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Urbine TF, Schneider PJ. Estimated cost savings from reducing errors in the preparation of sterile doses of medications. Hosp Pharm 2014; 49:731-9. [PMID: 25477598 PMCID: PMC4252201 DOI: 10.1310/hpj4908-731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Preventing intravenous (IV) preparation errors will improve patient safety and reduce costs by an unknown amount. OBJECTIVE To estimate the financial benefit of robotic preparation of sterile medication doses compared to traditional manual preparation techniques. METHODS A probability pathway model based on published rates of errors in the preparation of sterile doses of medications was developed. Literature reports of adverse events were used to project the array of medical outcomes that might result from these errors. These parameters were used as inputs to a customized simulation model that generated a distribution of possible outcomes, their probability, and associated costs. RESULTS By varying the important parameters across ranges found in published studies, the simulation model produced a range of outcomes for all likely possibilities. Thus it provided a reliable projection of the errors avoided and the cost savings of an automated sterile preparation technology. The average of 1,000 simulations resulted in the prevention of 5,420 medication errors and associated savings of $288,350 per year. The simulation results can be narrowed to specific scenarios by fixing model parameters that are known and allowing the unknown parameters to range across values found in previously published studies. CONCLUSIONS The use of a robotic device can reduce health care costs by preventing errors that can cause adverse drug events.
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Affiliation(s)
- Terry F. Urbine
- Associate Research Scientist and Instructor, Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Phoenix, Arizona
| | - Philip J. Schneider
- Professor and Associate Dean, Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Phoenix, Arizona
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Abstracts of the Royal College of Anaesthetists Annual Congress 2014. Br J Anaesth 2014. [DOI: 10.1093/bja/aeu197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
PURPOSE OF REVIEW The very complex process of intensive care is accompanied by a not unexpected accumulation of risk for error and adverse events. The present review addresses strategies to decrease care errors in several domains of daily intensive care practice. RECENT FINDINGS Strategies to decrease care errors now focus on a systematic approach by identifying latent system failures and change the design of the care process in such a way that inevitable human errors are prevented or their consequences are mitigated. Recent examples refer to the standardization of processes, adaptation to cognitive limitations of human beings, optimization of working conditions, and the increasing use of supporting information technologies. The development of a safety climate constitutes a key element and apparently contributes to reduction of medical errors in ICUs. SUMMARY The present review discusses recent approaches aimed to decrease care errors in ICUs. A growing body of evidence demonstrates that a system based approach with the change of process characteristics and the development of a safety climate is most essential in the effort to increase patient safety.
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Gurman P, Chi A, Hood T, Reina M, Rosen Y, D’hers S, Elman N. Prefilled devices for parenteral applications. Expert Rev Med Devices 2014; 11:205-23. [DOI: 10.1586/17434440.2014.882227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Jothiraj H, Howland-Harris J, Evley R, Moppett I. Distractions and the anaesthetist: a qualitative study of context and direction of distraction. Br J Anaesth 2013; 111:477-482. [DOI: 10.1093/bja/aet108] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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