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Kuitunen S, Airaksinen M, Holmström AR. Evolution of Intravenous Medication Errors and Preventive Systemic Defenses in Hospital Settings-A Narrative Review of Recent Evidence. J Patient Saf 2024; 20:e29-e39. [PMID: 38536101 DOI: 10.1097/pts.0000000000001222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
OBJECTIVES Intravenous drug administration has been associated with severe medication errors in hospitals. The present narrative review is based on a systematic literature search, and aimed to describe the recent evolution in research on systemic causes and defenses in intravenous medication errors in hospitals. METHODS This narrative review was based on Reason's theory of systems-based risk management. A systematic literature search covering the period from June 2016 to October 2021 was conducted on Medline (Ovid). We used the search strategy and selection criteria developed for our previous systematic reviews. The included articles were analyzed and compared to our previous reviews. RESULTS The updated search found 435 articles. Of the 63 included articles, 16 focused on systemic causes of intravenous medication errors, and 47 on systemic defenses. A high proportion (n = 24, 38%) of the studies were conducted in the United States or Canada. Most of the studies focused on drug administration (n = 21/63, 33%) and preparation (n = 19/63, 30%). Compared to our previous review of error causes, more studies (n = 5/16, 31%) utilized research designs with a prospective risk management approach. Within articles related to systemic defenses, smart infusion pumps remained most widely studied (n = 10/47, 21%), while those related to preparation technologies (n = 7/47, 15%) had increased. CONCLUSIONS This narrative review demonstrates a growing interest in systems-based risk management for intravenous drug therapy and in introducing new technology, particularly smart infusion pumps and preparation systems, as systemic defenses. When introducing new technologies, prospective assessment and continuous monitoring of emerging safety risks should be conducted.
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Affiliation(s)
- Sini Kuitunen
- From the HUS Pharmacy, Hospital Pharmacy of Helsinki University Hospital (HUS)
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Anna-Riia Holmström
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
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2
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Howlett M, McCarthy S, Silvari V, Franklin BD, Laaksonen R. Development and prioritisation of policy recommendations for medication safety improvement for intensive care units: a European Association of Hospital Pharmacists Special Interest Group Delphi Study. Eur J Hosp Pharm 2024:ejhpharm-2023-004065. [PMID: 38604615 DOI: 10.1136/ejhpharm-2023-004065] [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: 12/14/2023] [Accepted: 03/12/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVES Medication errors (MEs) are a leading cause of morbidity and mortality in the healthcare system. Patients admitted to intensive care units (ICUs) are potentially more susceptible to MEs due to severity of illness, the complexity of treatments they receive and the challenging nature of the ICU setting. The European Association of Hospital Pharmacists established a Special Interest Group (SIG) to undertake a programme of work to develop and prioritise recommendations to support medication safety improvement in ICUs across Europe. METHODS Initial policy recommendations for medication safety within the ICU environment were developed following reviews of the literature and engagement with relevant stakeholders. A Delphi panel of 21 members of the SIG, that comprised healthcare professionals (HCPs) with expertise in ICU and/or medication safety, was convened in 2022. We conducted two rounds using a modified Delphi technique whereby participants anonymously ranked on a 9-point Likert Scale the policy recommendations according to their priority for implementation. RESULTS In total, 32 policy recommendations were developed. In Delphi Round 1, 19 HCPs participated; consensus was achieved on most recommendations and partial consensus on six. In Delphi Round 2, 18 HCPs participated. After two Delphi rounds, consensus was achieved on all 32 recommendations. All recommendations were considered 'high priority' except one that was considered 'medium priority'. CONCLUSIONS Through this study it was possible to develop and prioritise evidence-based policy recommendations to enhance medication safety, which may contribute to reducing MEs in ICUs across Europe. All recommendations were considered 'high priority' for implementation except one, indicating the perceived value of these recommendations in improving medication safety through preventing MEs in ICUs.
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Affiliation(s)
- Moninne Howlett
- Departments of Pharmacy and Digital Health, Children's Health Ireland, Dublin, Ireland
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Virginia Silvari
- School of Pharmacy, University College Cork, Cork, Ireland
- Pharmacy Department, Cork University Hospital, Cork, Ireland
| | - Bryony Dean Franklin
- School of Pharmacy, University College London, London, UK
- Centre for Medication Safety and Service Quality, Pharmacy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Raisa Laaksonen
- Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
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3
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Kopanz J, Lichtenegger K, Schwarz C, Wimmer M, Kamolz LP, Pieber T, Sendlhofer G, Mader J, Hoffmann M. Risks in the analogue and digitally-supported medication process and potential solutions to increase patient safety in the hospital: A mixed methods study. PLoS One 2024; 19:e0297491. [PMID: 38412194 PMCID: PMC10898776 DOI: 10.1371/journal.pone.0297491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 01/05/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND In hospital medication errors are common. Our aim was to investigate risks of the analogue and digitally-supported medication process and any potential solutions. METHODS A mixed methods study including a structured literature search and online questionnaires based on the Delphi method was conducted. First, all risks were structured into main and sub-risks and second, risks were grouped into risk clusters. Third, healthcare experts assessed risk clusters regarding their likelihood of occurrence their possible impact on patient safety. Experts were also asked to estimate the potential for digital solutions and solutions that strengthen the competence of healthcare professionals. RESULTS Overall, 160 main risks and 542 sub-risks were identified. Main risks were grouped into 43 risk clusters. 33 healthcare experts (56% female, 50% with >20 years professional-experience) ranked the likelihood of occurrence and the impact on patient safety in the top 15 risk clusters regarding the process steps: admission (n = 4), prescribing (n = 3), verifying (n = 1), preparing/dispensing (n = 3), administering (n = 1), discharge (n = 1), healthcare professional competence (n = 1), and patient adherence (n = 1). 28 healthcare experts (64% female, 43% with >20 years professional-experience) mostly suggested awareness building and training, strengthened networking, and involvement of pharmacists at point-of-care as likely solutions to strengthen healthcare professional competence. For digital solutions they primarily suggested a digital medication list, digital warning systems, barcode-technology, and digital support in integrated care. CONCLUSIONS The medication process holds a multitude of potential risks, in both the analogue and the digital medication process. Different solutions to strengthen healthcare professional competence and in the area of digitalization were identified that could help increase patient safety and minimize possible errors.
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Affiliation(s)
- Julia Kopanz
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Styria, Austria
| | - Katharina Lichtenegger
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Styria, Austria
| | - Christine Schwarz
- Department of Quality and Risk Management, University Hospital of Graz, Styria, Austria
- Department for Surgery, c/o Division for Plastic, Aesthetic and Reconstructive Surgery, Research Unit for Safety and Sustainability in Healthcare, Medical University of Graz, Styria, Austria
| | - Melanie Wimmer
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Styria, Austria
| | - Lars Peter Kamolz
- Department for Surgery, c/o Division for Plastic, Aesthetic and Reconstructive Surgery, Research Unit for Safety and Sustainability in Healthcare, Medical University of Graz, Styria, Austria
| | - Thomas Pieber
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Styria, Austria
| | - Gerald Sendlhofer
- Department of Quality and Risk Management, University Hospital of Graz, Styria, Austria
- Department for Surgery, c/o Division for Plastic, Aesthetic and Reconstructive Surgery, Research Unit for Safety and Sustainability in Healthcare, Medical University of Graz, Styria, Austria
| | - Julia Mader
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Styria, Austria
| | - Magdalena Hoffmann
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Styria, Austria
- Department of Quality and Risk Management, University Hospital of Graz, Styria, Austria
- Department for Surgery, c/o Division for Plastic, Aesthetic and Reconstructive Surgery, Research Unit for Safety and Sustainability in Healthcare, Medical University of Graz, Styria, Austria
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Gilliot S, Martin Mena A, Genay S, Masse M, Thibaut M, Carta N, Lannoy D, Négrier L, Barthélémy C, Décaudin B, Odou P. Factors influencing accuracy when preparing injectable drug concentrations in appliance with clinical practice: a norepinephrine case study. Eur J Hosp Pharm 2024; 31:168-170. [PMID: 35882533 PMCID: PMC10895172 DOI: 10.1136/ejhpharm-2022-003358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/12/2022] [Indexed: 11/04/2022] Open
Abstract
Errors in injectable preparations with high-risk drugs can be fatal. This study aimed to identify the factors influencing the accuracy of high-risk injectable drug concentrations in appliances used for intensive care unit preparation practices. Norepinephrine (NE) was chosen as an example of a high-risk medication drug. The concentration (0.2 and 0.5 mg/mL), the diluent (sodium chloride 0.9% and 5% dextrose), and the container type (prefilled- and empty-infusion bag and syringe) were tested as potential variability factors. An ultraviolet spectrophotometric method was used for NE dosage. 108 NE solutions were prepared by five individuals (pharmacists or laboratory technicians) with clinical experience as well as experience in the aseptic preparation of solutions. The container type was found to be the only factor influencing the accuracy of NE concentration. NE solutions in syringes proved to be the most accurate while preparations in prefilled bags tended to underdose NE.
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Affiliation(s)
- Sixtine Gilliot
- Institute of Pharmacy, CHRU Lille Pôle Spécialités Médicochirurgicales, Lille, Hauts-de-France, France
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
| | - Anthony Martin Mena
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
| | - Stéphanie Genay
- Institute of Pharmacy, CHRU Lille Pôle Spécialités Médicochirurgicales, Lille, Hauts-de-France, France
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
| | - Morgane Masse
- Institute of Pharmacy, CHRU Lille Pôle Spécialités Médicochirurgicales, Lille, Hauts-de-France, France
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
| | - Manon Thibaut
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
| | - Natacha Carta
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
| | - Damien Lannoy
- Institute of Pharmacy, CHRU Lille Pôle Spécialités Médicochirurgicales, Lille, Hauts-de-France, France
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
| | - Laura Négrier
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
| | - Christine Barthélémy
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
| | - Bertrand Décaudin
- Institute of Pharmacy, CHRU Lille Pôle Spécialités Médicochirurgicales, Lille, Hauts-de-France, France
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
| | - Pascal Odou
- Institute of Pharmacy, CHRU Lille Pôle Spécialités Médicochirurgicales, Lille, Hauts-de-France, France
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
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5
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Crul M, Polidori C, Paolucci D, Lowey A, Ølgaard McNulty H, Rieutord A, Salinas Silva P, Clopes A, Bredesen Hatlelid L, Leoni S. Centralization and automation of non-toxic drug reconstitution in the pharmacy: a strengths, weaknesses, opportunities, and threats analysis. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2024; 32:97-99. [PMID: 37897401 DOI: 10.1093/ijpp/riad070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 10/10/2023] [Indexed: 10/30/2023]
Affiliation(s)
- Mirjam Crul
- Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Center, location Vrije Universiteit, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Carlo Polidori
- Department of Experimental Medicine and Public Health, University of Camerino, Via Madonna delle Carceri 9, 62032 Camerino, Italy
| | - Demis Paolucci
- Loccioni, Via Fiume 16, 60030, Moie di Maiolati, Ancona, Italy
| | - Andrew Lowey
- Medicines Management & Pharmacy Services, Leeds Teaching Hospitals NHS Trust, Moor House, LS10 2JQ Leeds, United Kingdom
| | | | - André Rieutord
- Département Pharmacie Clinique, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94805 Villejuif, France
| | - Paola Salinas Silva
- Department of Pharmaceutical Services, Instituto Oncológico Fundación Arturo Lopez Perez (Falp), José Manuel Infante 805, 7500921 Santiago, Chile
| | - Ana Clopes
- Pharmacy Department, Catalan Institute of Oncology, Blanquerna Ramon Llull University Faculty of Health Sciences, Granvia de l'Hospitalet 199-203, 08908 Barcelona, Spain
| | - Liv Bredesen Hatlelid
- Department of Pharmacy, Hospital Pharmacy Enterprise, South Eastern, Biskop Gunerius Gate 14 A - 12, 0101 Oslo, Norway
| | - Simone Leoni
- Department of Pharmacy, University Hospital of Marche, 71 Via Conca 61012 Ancona, Italy
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Christel H, Aubry SC, Florence T, Nora EB, Lisa W, Tomislav P, Frédéric L. Optimization of intravenous administration of hydroxocobalamin in pediatric emergencies - HYDROX-OPTIMIS study. Int Emerg Nurs 2023; 71:101353. [PMID: 37871551 DOI: 10.1016/j.ienj.2023.101353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 08/28/2023] [Accepted: 09/10/2023] [Indexed: 10/25/2023]
Abstract
INTRODUCTION Procedures to prepare and infuse intravenous drugs are poorly documented. OBJECTIVE To determinate the optimal mode of hydroxocobalamin administration in children in emergency care. METHODS We identified three modes of administration: (1) connect infusion tubing to the vial, start the infusion and interrupt it when the desired dose has been delivered; (2) remove from the vial the volume corresponding to the excessive dose and connect infusion tubing and (3) extract from the vial the required volume to be delivered and infuse directly. EXPERIMENTAL STUDY 25 nurses performed each of these three procedures for children weighting 15 and 30 kg. Speed and precision were primary end-points; ease, safety and drug economy were secondary end-points. RESULTS Mode 3 was the fastest (42[37-61] sec) followed by modes 1 and 2 (p < 0.05). Mode 3 was the most precise (100[100-100]%) followed by modes 1 and 2 (p = 0.001). Mode 3 was the easiest (10.0[9.0-10.0]) followed by modes 2 and 3 (p = 0.001). Modes 1 and 3 allowed administration of a second dose whereas mode 2 did not. CONCLUSION Taking the required volume from the vial and infuse directly was the fastest, the most precise, the easiest and most economical mode of administration. It should be recommended.
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Affiliation(s)
- Hilaire Christel
- SAMU 93 - UF Research-Teaching-Quality University Paris 13, Sorbonne Paris Cité, Inserm U942 Avicenne Hospital, 125, rue de Stalingrad, 93009 Bobigny, France.
| | - Saint-Cast Aubry
- SAMU 93 - UF Research-Teaching-Quality University Paris 13, Sorbonne Paris Cité, Inserm U942 Avicenne Hospital, 125, rue de Stalingrad, 93009 Bobigny, France.
| | | | - El Barrak Nora
- SAMU 93 - UF Research-Teaching-Quality University Paris 13, Sorbonne Paris Cité, Inserm U942 Avicenne Hospital, 125, rue de Stalingrad, 93009 Bobigny, France.
| | - Weisslinger Lisa
- SAMU 93 - UF Research-Teaching-Quality University Paris 13, Sorbonne Paris Cité, Inserm U942 Avicenne Hospital, 125, rue de Stalingrad, 93009 Bobigny, France.
| | - Petrovic Tomislav
- SAMU 93 - UF Research-Teaching-Quality University Paris 13, Sorbonne Paris Cité, Inserm U942 Avicenne Hospital, 125, rue de Stalingrad, 93009 Bobigny, France.
| | - Lapostolle Frédéric
- SAMU 93 - UF Research-Teaching-Quality University Paris 13, Sorbonne Paris Cité, Inserm U942 Avicenne Hospital, 125, rue de Stalingrad, 93009 Bobigny, France.
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7
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Yin Y, Fu W, Liu W, Li F, Gong X, Liu D, Li J. Real-world study of the leakage of two types of infusion bags in multicenter pharmacy intravenous admixture service (PIVAS). Front Pharmacol 2023; 14:1273020. [PMID: 37869755 PMCID: PMC10587401 DOI: 10.3389/fphar.2023.1273020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 09/25/2023] [Indexed: 10/24/2023] Open
Abstract
Background: This study sought to analyze the leakage rate, economic loss caused by leakage, leakage reasons, and usage of upright polypropylene infusion bags and non-polyvinyl chloride (PVC) infusion bags, two types of closed intravenous infusion containers used in pharmacy intravenous admixture service (PIVAS), to improve the product quality of drug infusion packaging materials, reduce drug and clinical economic losses, and reduce the safety hazards of medication. Method: A real-world study was used to collect statistics for these infusion containers. The study was conducted in 21 hospitals in China from September to December 2022. Upright polypropylene infusion bags or non-PVC infusion bags in PIVAS of these 21 hospitals were chosen as the research material. Results: In total, 2,349,899 upright polypropylene infusion bags and 3,301,722 non-PVC infusion bags were collected. Eleven cases of upright polypropylene infusion bag leakage occurred (with a the leakage rate of 0.05‱), and 394 cases of non-PVC infusion bag leakage occurred (with a leakage rate of 1.19‱). The leakage rate of non-PVC infusion bags was significantly higher than that of upright polypropylene infusion bags (p < 0.01). The main reason for leakage in upright polypropylene infusion bags was sharp objects such as glass fragments or aluminum caps piercing the bag. The main reason for leakage in non-PVC infusion bags was squeezing, stacking, and uneven arrangement that causes folding of edges. For non-PVC bags, additional reasons for leakage included leakage at the nozzle joint, excessive manual or machine throwing force, and excessive dosage. The economic loss of upright polypropylene infusion bags was 1,116.56 CNY. The economic loss of non-PVC infusion bags was 32,210.86 CNY. Conclusion: Based on real-world study data on the leakage of upright polypropylene infusion bags and non-PVC infusion bags in multicenter PIVAS, it can be concluded that the leakage rates of upright polypropylene infusion bags are significantly lower than those of non-PVC infusion bags in PIVAS, and the economic losses due to upright polypropylene infusion bags are lower than those due to non-PVC infusion bags in PIVAS. Therefore, we can infer that upright polypropylene infusion bags are superior to non-PVC infusion bags.
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Affiliation(s)
- Yanchao Yin
- Department of Pharmacy, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Wei Fu
- Department of Pharmacy, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Wenhua Liu
- Clinical Research Center, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Feie Li
- Department of Pharmacy, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Xuepeng Gong
- Department of Pharmacy, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Dong Liu
- Department of Pharmacy, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Juan Li
- Department of Pharmacy, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
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8
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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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9
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Yang C, Ni X, Zhang L, Peng L. Intravenous compounding robots in pharmacy intravenous admixture services: A systematic review. Medicine (Baltimore) 2023; 102:e33476. [PMID: 37171327 PMCID: PMC10174346 DOI: 10.1097/md.0000000000033476] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND There is a lack of best evidence of intravenous compounding robots for hospital decision-makers. This study aimed to conduct a systematic review of intravenous compounding robots. METHODS A comprehensive search of relevant professional health technology assessment websites and electronic databases was conducted from inception to February 3, 2022. Current studies related to intravenous compounding robots were included in this systematic review. Two reviewers independently screened the literature, extracted data, and assessed quality. The results were reported by qualitative description because of heterogeneity in the characteristics of the data in the included studies. RESULTS Thirty-three studies were included. Effectiveness: The robots improved production efficiency compared with usual/manual preparation; however, the intravenous preparation process requires further optimization. Additionally, robots reduced the incidence of medicine residues, preparation errors, and preparation failures. The solution properties of intravenous admixture medicines were satisfactory, and the robots also contributed to error recognition. Safety: The robots reduced product pollution and environmental pollution, but vigilance is still required to ensure that pollution stays low. The robots also reduced the incidence of health damage to technicians. Economy: The robots reduced material costs in these studies; however, whether they can reduce labor costs remains unclear. Social suitability: Technicians had a high degree of satisfaction with the robots, but few relevant studies focused on this aspect. CONCLUSIONS Intravenous compounding robots have certain advantages in terms of effectiveness, safety, economy, and social adaptability.
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Affiliation(s)
- Chunsong Yang
- Department of Pharmacy, West China Second Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Xiaofeng Ni
- Department of Pharmacy, West China Second Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Lingli Zhang
- Department of Pharmacy, West China Second Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Lijuan Peng
- Department of Purchasing, West China Second Hospital, Sichuan University, Chengdu, China
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10
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Jessurun JG, Hunfeld NG, van Rosmalen J, van Dijk M, van den Bemt PM. Effect of a Pharmacy-based Centralized Intravenous Admixture Service on the Prevalence of Medication Errors: A Before-and-After Study. J Patient Saf 2022; 18:e1181-e1188. [PMID: 35786788 PMCID: PMC9698191 DOI: 10.1097/pts.0000000000001047] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Intravenous admixture preparation errors (IAPEs) may lead to patient harm. The primary aim of this study was to assess the effect of a pharmacy-based centralized intravenous admixture service (CIVAS) on IAPEs. METHODS We conducted a before-and-after study in 3 clinical wards before CIVAS implementation and in the CIVAS unit 18 months after implementation. Intravenous admixture preparation error data were collected by disguised observation. The primary outcome was the proportion of admixtures with 1 or more IAPEs. Secondary outcomes were the type and potential severity of IAPEs, noncompliance to hygiene procedures, and nursing staff satisfaction with the CIVAS. The primary outcome was analyzed using a multivariable mixed-effects logistic regression model. RESULTS One or more IAPEs were identified in 14 of 543 admixtures (2.6%) in the CIVAS unit and in 148 of 282 admixtures (52.5%) in the clinical wards (odds ratio, 0.02; 95% confidence interval, 0.004-0.05). The most common IAPE types were wrong solvent or diluent (n = 95) and wrong volume of infusion fluid (n = 45). No potentially harmful IAPEs occurred in the CIVAS unit as opposed to 22 (7.8%) in the clinical wards. Disinfection procedures were better adhered to in the CIVAS unit. Overall nurse satisfaction with the CIVAS increased from a median of 70 (n = 166) 5 months after intervention to 77 (n = 115) 18 months after intervention ( P < 0.001) on a 100-point scale. CONCLUSIONS Centralized intravenous admixture service performed notably better than the clinical wards with regard to IAPEs and noncompliance to hygiene procedures. Nurses were satisfied with the CIVAS. Hence, the implementation of CIVAS is an important strategy to improve medication safety in hospitals.
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Affiliation(s)
| | | | - Joost van Rosmalen
- Biostatistics
- Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam
| | - Monique van Dijk
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen
| | - Patricia M.L.A. van den Bemt
- From the Departments of Hospital Pharmacy
- Internal Medicine, Section of Nursing Science, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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11
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Wennberg-Capellades L, Fuster-Linares P, Rodríguez-Higueras E, Fernández-Puebla AG, Llaurado-Serra M. Where do nursing students make mistakes when calculating drug doses? A retrospective study. BMC Nurs 2022; 21:309. [PMID: 36357884 PMCID: PMC9648043 DOI: 10.1186/s12912-022-01085-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/27/2022] [Indexed: 11/11/2022] Open
Abstract
Background Research internationally shows that nursing students find dosage calculation difficult. Identifying the specific aspects of dose calculation procedures that are most commonly associated with errors would enable teaching to be targeted where it is most needed, thus improving students’ calculation skills. The aim of this study was to analyze where specifically nursing students make mistakes when calculating drug doses. Method Retrospective analysis of written examination papers including dosage calculation exercises from years 1, 2, and 3 of a nursing degree program. Exercises were analyzed for errors in relation to 23 agreed categories reflecting different kinds of calculation or steps in the calculation process. We conducted a descriptive and bivariate analysis of results, examining the relationship between the presence of errors and the proportion of correct and incorrect final answers. Results A total of 285 exam papers including 1034 calculation exercises were reviewed. After excluding those that had been left blank, a total of 863 exercises were analyzed in detail. A correct answer was given in 455 exercises (52.7%), although this varied enormously depending on the type of exercise: 89.2% of basic dose calculations were correct, compared with just 2.9% of those involving consideration of maximum concentration. The most common errors were related to unit conversion, more complex concepts such as maximum concentration and minimum dilution, or failure to contextualize the answer to the clinical case. Other frequent errors involved not extracting the key information from the question, not including the units when giving their answer, and not understanding the question. In general, fewer errors in basic dose calculations were made by students at later stages of the degree program. Conclusions Students struggle with more complex dose calculations. The main errors detected were related to understanding the task and the key concepts involved, as well as not following the correct steps when solving the problem. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-022-01085-9.
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Henry Basil J, Premakumar CM, Mhd Ali A, Mohd Tahir NA, Mohamed Shah N. Prevalence, Causes and Severity of Medication Administration Errors in the Neonatal Intensive Care Unit: A Systematic Review and Meta-Analysis. Drug Saf 2022; 45:1457-1476. [PMID: 36192535 DOI: 10.1007/s40264-022-01236-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Neonates are at greater risk of preventable adverse drug events as compared to children and adults. OBJECTIVE This study aimed to estimate and critically appraise the evidence on the prevalence, causes and severity of medication administration errors (MAEs) amongst neonates in Neonatal Intensive Care Units (NICUs). METHODS A systematic review and meta-analysis was conducted by searching nine electronic databases and the grey literature for studies, without language and publication date restrictions. The pooled prevalence of MAEs was estimated using a random-effects model. Data on error causation were synthesised using Reason's model of accident causation. RESULTS Twenty unique studies were included. Amongst direct observation studies reporting total opportunity for errors as the denominator for MAEs, the pooled prevalence was 59.3% (95% confidence interval [CI] 35.4-81.3, I2 = 99.5%). Whereas, the non-direct observation studies reporting medication error reports as the denominator yielded a pooled prevalence of 64.8% (95% CI 46.6-81.1, I2 = 98.2%). The common reported causes were error-provoking environments (five studies), while active failures were reported by three studies. Only three studies examined the severity of MAEs, and each utilised a different method of assessment. CONCLUSIONS This is the first comprehensive systematic review and meta-analysis estimating the prevalence, causes and severity of MAEs amongst neonates. There is a need to improve the quality and reporting of studies to produce a better estimate of the prevalence of MAEs amongst neonates. Important targets such as wrong administration-technique, wrong drug-preparation and wrong time errors have been identified to guide the implementation of remedial measures.
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Affiliation(s)
- Josephine Henry Basil
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Chandini Menon Premakumar
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Adliah Mhd Ali
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Nurul Ain Mohd Tahir
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Noraida Mohamed Shah
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia.
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An Economic Analysis of Critical Care Nurse Resourcing Following the Uptake of Ready-to-Administer Noradrenaline for Hypotensive Shock in Adults in England. Adv Ther 2022; 39:727-737. [PMID: 34874515 PMCID: PMC8649679 DOI: 10.1007/s12325-021-02003-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/17/2021] [Indexed: 12/03/2022]
Abstract
Introduction Ready-to-administer formulations for intravenous administration of noradrenaline are now broadly recommended and predicted to reduce pressure on critical care nursing. This analysis sought to quantify the nurse resource released from national level transition. Methods The annual number of noradrenaline support days for hypotensive shock was determined and the administration of noradrenaline was simulated over 24 h using a decision tree. A ‘best-practice’ ready-to-administer strategy (RtA) of volumetrically pumped noradrenaline was compared to a ‘nil uptake’ strategy (AfC) of bedside prepared solution delivered either volumetrically or using a double syringe pump. A mix of noradrenaline concentrations, flow rates, product sizes, and preferences for ampoule pooling, preparation volume, and sterility were included. The consumption of nurse days and product units was then projected over 1 year for a population of adults in critical care in England. Results Noradrenaline was administered over 231,011 days per year across 4123 critical care beds in England. Implementing a transition from AfC to RtA strategies on this scale released 35,791 nurse days or 176 whole-time nurse equivalents at 50/50 NHS band 5 and 6, a monetised release of £11.6 million. There was an increase in drug acquisition cost of £2.1 million using the licensed commercial product Sinora®. Annual net monetary benefit was + £9.5 million, or + £65,961 per critical care unit (CCU) of 29 beds, equivalent to one nurse released per unit for patient care. Conclusions This modelling of ready-to-administer noradrenaline with volumetric delivery quantifies and bears out the recommendations of the Lord Carter review, the Royal Pharmaceutical Society, and the NHS Specialist Pharmacy Service in their encouragement of ready-to-administer formulations for safe and resource-effective critical care.
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14
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Kuitunen S, Niittynen I, Airaksinen M, Holmström AR. Systemic Causes of In-Hospital Intravenous Medication Errors: A Systematic Review. J Patient Saf 2021; 17:e1660-e1668. [PMID: 32011427 PMCID: PMC8612891 DOI: 10.1097/pts.0000000000000632] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
OBJECTIVES Delivery of intravenous medications in hospitals is a complex process posing to systemic risks for errors. The aim of this study was to identify systemic causes of in-hospital intravenous medication errors. METHODS A systematic review adhering to PRISMA 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 GRADE system and the evidence analyzed using qualitative content analysis. RESULTS Eleven studies from six countries were included in the analysis. We identified systemic causes related to prescribing (n = 6 studies), preparation (n = 6), administration (n = 6), dispensing and storage (n = 5), and treatment monitoring (n = 2). Administration, prescribing, and preparation were the process phases most prone to systemic errors. Insufficient actions to secure safe use of high-alert medications, lack of knowledge of the drug, calculation tasks, failure in double-checking procedures, and confusion between look-alike, sound-alike medications were the leading causes of intravenous medication errors. The number of the included studies was limited, all of them being observational studies and graded as low quality. CONCLUSIONS Current intravenous medication systems remain vulnerable, which can result in patient harm. Our findings suggest further focus on medication safety activities related to administration, prescribing, and preparation of intravenous medications. This study provides healthcare organizations with preliminary knowledge about systemic causes of intravenous medication errors, but more rigorous evidence is needed.
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Affiliation(s)
- Sini Kuitunen
- From the HUS Pharmacy, Hospital Pharmacy of Helsinki University Hospital (HUS), Finland
- Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Finland
| | - Ilona Niittynen
- Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Finland
| | - Marja Airaksinen
- Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Finland
| | - Anna-Riia Holmström
- From the HUS Pharmacy, Hospital Pharmacy of Helsinki University Hospital (HUS), Finland
- Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Finland
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Analysis of IV Drugs in the Hospital Workflow by Raman Spectroscopy: The Case of Piperacillin and Tazobactam. Molecules 2021; 26:molecules26195879. [PMID: 34641421 PMCID: PMC8513103 DOI: 10.3390/molecules26195879] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022] Open
Abstract
Medical errors associated with IV preparation and administration procedures in a hospital workflow can even cost human lives due to the direct effect they have on patients. A large number of such incidents, which have been reported in bibliography up to date, indicate the urgent need for their prevention. This study aims at proposing an analytical methodology for identifying and quantifying IV drugs before their administration, which has the potential to be fully harmonized with clinical practices. More specifically, it reports on the analysis of a piperacillin (PIP) and tazobactam (TAZ) IV formulation, using Raman spectroscopy. The simultaneous analysis of the two APIs in the same formulation was performed in three stages: before reconstitution in the form of powder without removing the substance out of the commercial glass bottle (non-invasively), directly after reconstitution in the same way, and just before administration, either the liquid drug is placed in the infusion set (on-line analysis) or a minimal amount of it is transferred from the IV bag to a Raman optic cell (at-line analysis). Except for the successful identification of the APIs in all cases, their quantification was also achieved through calibration curves with correlation coefficients ranging from 0.953 to 0.999 for PIP and from 0.965 to 0.997 for TAZ. In any case, the whole procedure does not need more than 10 min to be completed. The current methodology, based on Raman spectroscopy, outweighs other spectroscopic (UV/Vis, FT-IR/ATR) or chromatographic (HPLC, UHPLC) protocols, already applied, which are invasive, costly, time-consuming, not environmentally friendly, and require specialized staff and more complex sample preparation procedures, thus exposing the staff to hazardous materials, especially in cases of cytotoxic drugs. Such an approach has the potential to bridge the gap between experimental setup and clinical implementation through exploitation of already developed handheld devices, along with the presence of digital spectral libraries.
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Prevalence and determinants of intravenous admixture preparation errors: A prospective observational study in a university hospital. Int J Clin Pharm 2021; 44:44-52. [PMID: 34363192 PMCID: PMC8866293 DOI: 10.1007/s11096-021-01310-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/22/2021] [Indexed: 11/22/2022]
Abstract
Background Intravenous admixture preparation errors (IAPEs) may lead to patient harm. Insight into the prevalence as well as the determinants associated with these IAPEs is needed to elicit preventive measures. Aim The primary aim of this study was to assess the prevalence of IAPEs. Secondary aims were to identify the type, severity, and determinants of IAPEs. Method A prospective observational study was performed in a Dutch university hospital. IAPE data were collected by disguised observation. The primary outcome was the proportion of admixtures with one or more IAPEs. Descriptive statistics were used for the prevalence, type, and severity of IAPEs. Mixed-effects logistic regression analyses were used to estimate the determinants of IAPEs. Results A total of 533 IAPEs occurred in 367 of 614 admixtures (59.8%) prepared by nursing staff. The most prevalent errors were wrong preparation technique (n = 257) and wrong volume of infusion fluid (n = 107). Fifty-nine IAPEs (11.1%) were potentially harmful. The following variables were associated with IAPEs: multistep versus single-step preparations (adjusted odds ratio [ORadj] 4.08, 95% confidence interval [CI] 2.27–7.35); interruption versus no interruption (ORadj 2.32, CI 1.13–4.74); weekend versus weekdays (ORadj 2.12, CI 1.14–3.95); time window 2 p.m.-6 p.m. versus 7 a.m.-10 a.m. (ORadj 3.38, CI 1.60–7.15); and paediatric versus adult wards (ORadj 0.14, CI 0.06–0.37). Conclusion IAPEs, including harmful IAPEs, occurred frequently. The determinants associated with IAPEs point to factors associated with preparation complexity and working conditions. Strategies to reduce the occurrence of IAPEs and therefore patient harm should target the identified determinants.
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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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Schenkel L, Vogel Kahmann I, Steuer C. Opioid-Free Anesthesia: Physico Chemical Stability Studies on Multi-Analyte Mixtures Intended for Use in Clinical Anesthesiology. Hosp Pharm 2021; 57:246-252. [PMID: 35601712 PMCID: PMC9117769 DOI: 10.1177/00185787211016336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objectives: Opioid-free anesthesia is used increasingly often in hospitals around the world. In this type of anesthesia, opioids are replaced by other analgesics, such as ketamine, lidocaine, dexmedetomidine, and magnesium sulfate. Many clinicians prepare these agents as dual, triple, or quadruple admixtures within a single syringe. However, data on the stability of the individual substances within these preparations over time and in different storage conditions is very limited. Here, we aim to investigate various admixture of dexmedetomidine, ketamine, lidocaine, and magnesium sulfate with respect to the stability of the individual agents over time at different storage conditions. Methods: An ultra-high performance liquid chromatography method coupled to mass spectrometric detection was developed and validated to determine the stability of lidocaine, ketamine, and dexmedetomidine. Quantification of magnesium was carried out in parallel by potentiometric titration. Results: Our results demonstrate the stability of dual, triple or quadruple mixtures of selected substances in 0.9% saline under different storage conditions. Under all conditions, analyzed admixtures remain stable for at least 8 weeks. The quadruple mixture of lidocaine, ketamine, dexmedetomidine, and magnesium sulfate was storable for as long as 148 days without a significant loss of analyte. Conclusion: A new chromatographic method was successfully developed to analyze the stability of various pharmacological agents commonly used by clinicians in opioid-free anesthesia. The data we obtained indicate that mixing these agents together in a single syringe is safe and reliable and suggest that hospital pharmacies may prepare these solutions in advance of planned surgeries.
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Chen H, Guo Y, Wei H, Chen X. The impact of pharmacist oriented mode on risk control in a Chinese centralized intravenous admixture service centre. Sci Rep 2021; 11:5445. [PMID: 33686207 PMCID: PMC7940617 DOI: 10.1038/s41598-021-85077-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/24/2021] [Indexed: 11/09/2022] Open
Abstract
Centralized intravenous admixture service (CIVAS) centres, which are pharmaceutical departments found in Chinese hospitals, provide high-quality intravenous fluids and pharmaceutical services for patients, and errors in their working procedures can lead to adverse consequences. Pharmacists, the primary CIVAS centre personnel, play a role in risk control; however, to date, the effect of pharmacists' participation in risk management has not been reported. The main aim of this study was to evaluate the pharmacist's role in risk control and evaluate its impact. A retrospective observational study was designed to assess the principal working process in the CIVAS centre of a provincial healthcare setting. Errors in the main working process were identified, and intervention measures were formulated. The pharmacist intervention effect was evaluated by assessing the identification rate of improper prescriptions; the incidence rate of drug preparation, compounding, packaging and delivery process errors; and expenditures on wasteful drugs. There was a higher identification rate for improper prescriptions after the intervention (P < 0.05), while the incidence of drug preparation (P < 0.05), admixture (P < 0.05), and packaging and delivery errors (P < 0.01) was significantly lower; the total wasteful medication expenditure was also dramatically reduced. The potential creativity of pharmacists in error control can provide dependable intravenous drugs for patients and reduce the running expenditures for CIVAS.
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Affiliation(s)
- Hongxia Chen
- Department of Clinical Pharmacy, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, Guangxi, China. .,Intravenous Admixture Services Centre, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, Guangxi, China.
| | - Yanrong Guo
- Intravenous Admixture Services Centre, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, Guangxi, China
| | - Hualing Wei
- Department of Pharmacy, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, Guangxi, China
| | - Xiaoyu Chen
- Department of Clinical Pharmacy, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, Guangxi, China.,Department of Pharmacy, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, Guangxi, China
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Bifftu BB, Mekonnen BY. The Magnitude of Medication Administration Errors among Nurses in Ethiopia: a Systematic Review and Meta-analysis. J Caring Sci 2020; 9:1-8. [PMID: 32296652 PMCID: PMC7146728 DOI: 10.34172/jcs.2020.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 07/28/2019] [Indexed: 12/18/2022] Open
Abstract
Introduction: Nurses are the final safety check in the process of medication administration process to prevent errors that adversely affect life; yet death of comprehensive evidences in Ethiopia. The present study aimed to assess the pooled magnitude of MAEs (Medication Administration Errors) in Ethiopia. Methods: Systematic literature search in the databases of Pub-Med, Cochrane, and Google Scholar for gray literature were performed until December 3, 2018. The quality of study was assessed using criteria adopted from similar studies. Heterogeneity test and evidence of publication bias were assessed. Moreover, sensitivity analysis was also performed. Pooled prevalence of MAE was calculated using the random effects model. Results: A total of 2142 medication administrations were from observational and 681from self-reported studies were included in this systematic review and meta-analysis. The most prevalent and frequently reported type of MAEs was documentation error (52% to 87.5%) and time error (25.5% to 58.5%) respectively. Overall, the pooled magnitude of MAE was found to be 39.3% (95% CI, 29.1%-49.5%).It has no evidence of significant heterogeneity (I2 = 0%, P = 0.57) and publication bias Egger's test (P = 0.40). Conclusion: Overall, more than one in four observed/perceived medication administrations had errors. Documentation error is the most prevalent type of error. Nurses are suggested to strengthen their focus on the rights of medication administration guide particularly, documentation of their activities need special attention.
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Affiliation(s)
- Berhanu Boru Bifftu
- Department of Community Health Nursing, School of Nursing, University of Gondar College of Medicine and Health Science, Gondar, Ethiopia
| | - Bezenaw Yimer Mekonnen
- Department of Community Health Nursing, School of Nursing, University of Gondar College of Medicine and Health Science, Gondar, Ethiopia
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Gilliot S, Masse M, Genay S, Lannoy D, Barthélémy C, Décaudin B, Odou P. Long-term stability of ready-to-use norepinephrine solution at 0.2 and 0.5 mg/mL. Eur J Hosp Pharm 2020; 27:e93-e98. [PMID: 32296514 DOI: 10.1136/ejhpharm-2019-002146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 12/29/2022] Open
Abstract
Objectives Norepinephrine is a vasopressor frequently administered after dilution to treat hypotension and shocks in intensive care units. The stability of norepinephrine is known to be highly sensitive to storage conditions. Moreover, medication errors linked to the dilution step are frequent and may be deleterious for critically-ill patients, especially in intensive care units. This study aimed to evaluate the stability of ready-to-use diluted norepinephrine solutions prepared at two target concentrations (0.2 and 0.5 mg/mL), according to the summary of product characteristics, and stored for 365 days in two containers: AT-closed cyclic olefin copolymer vials, and polypropylene syringes. Methods A fast reversed-phase liquid chromatography method coupled with an ultra-violet detector was developed to assess the chemical stability of norepinephrine solutions. Validation was conducted according to the linearity of the calibration ranges, selectivity, sensitivity, accuracy and precision. Dosage, sub-visible particle contamination, pH monitoring and sterility assays were performed. Chemical stability was maintained if the measured concentration respected the lower limit of 90% of the initial concentration. Containers were stored at -20±5°C, +5±3°C and +25±2°C with 60±5% relative humidity in a dark closed enclosure. Results Stability was successfully maintained for every concentration and container tested when stored at -20±5°C and +5±3°C. In these storage conditions, particle contamination, pH monitoring and sterility assay respected the required criteria. Chemical degradation and colouring of solutions appeared before the end of the 1 year study period for most norepinephrine solutions stored at room temperature. Conclusions Ready-to-use solutions containing 0.2 and 0.5 mg/mL norepinephrine in polypropylene syringes or cyclic olefin copolymer vials must be stored at refrigerated or frozen temperatures to obtain acceptable 1 year shelf-stability. Exposure to higher temperatures significantly decreases shelf-stability. Our study protocol for compounding polypropylene syringes and cyclic olefin copolymer vials containing norepinephrine is adapted to implementation in centralised intravenous additive services.
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Affiliation(s)
- Sixtine Gilliot
- EA 7365-GRITA-Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, CHU Lille, F-59000 Lille, France
| | - Morgane Masse
- EA 7365-GRITA-Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, CHU Lille, F-59000 Lille, France
| | - Stéphanie Genay
- EA 7365-GRITA-Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, CHU Lille, F-59000 Lille, France
| | - Damien Lannoy
- EA 7365-GRITA-Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, CHU Lille, F-59000 Lille, France
| | - Christine Barthélémy
- EA 7365-GRITA-Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, CHU Lille, F-59000 Lille, France
| | - Bertrand Décaudin
- EA 7365-GRITA-Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, CHU Lille, F-59000 Lille, France
| | - Pascal Odou
- EA 7365-GRITA-Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, CHU Lille, F-59000 Lille, France
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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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Franzese C, Thomas C, Rinaldi A, Constable K, Nakamura K, Kalbermatten A, Coyne M. The burden of at-home preparation of lyophilized parenteral medications: an analysis of contributing factors and implications for chronic disease patients and caregivers. Expert Opin Drug Deliv 2019; 16:187-198. [PMID: 30636541 DOI: 10.1080/17425247.2019.1569626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND In the acute care setting, parenteral medication errors are well-studied. However, there is comparatively little research on how these issues translate to patient- or caregiver-prepared medications in the home, particularly with reconstituted medications. METHODS This was an ethnographic study designed to identify issues associated with four reconstitution use scenarios. Preparation burden was determined by measuring the time and manipulations required to prepare reconstituted medications across three preparation phases (assembly, reconstitution, and transfer). Deviations from product instructions for use, sterility breaches, self-reported preparation complications, and supply storage conditions were also analyzed. RESULTS A total of 14 participants completed the study. Overall, preparation burden was markedly higher when purpose-built reconstitution devices were not available. The majority of participants reported experiencing at least one complication associated with their medication preparation process; the reconstitution phase was the most significant source of both instructions for use deviations and breaches in sterility. Participants reported that the volume and variety of medication preparation supplies were a significant source of burden. CONCLUSIONS At-home preparation of reconstituted medications poses several challenges for patients and caregivers. As parenteral medications continue to shift towards self-administration, manufacturers should carefully consider the usability of such products and employ purpose-built reconstitution devices whenever possible.
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Affiliation(s)
| | | | | | | | - Koji Nakamura
- b Terumo Pharmaceutical Solutions , Somerset , NJ , USA
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Patient prioritization for pharmaceutical care in hospital: A systematic review of assessment tools. Res Social Adm Pharm 2018; 15:767-779. [PMID: 30268841 DOI: 10.1016/j.sapharm.2018.09.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/18/2018] [Accepted: 09/18/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Clinical pharmacy services improve patient safety, outcomes, and care quality; however, UK clinical pharmacy services face limited resources, insufficient capacity, and patients who present with increasingly complex medication regimes and morbidities. These indicate a need for the prioritization of pharmacy services. Several prioritization tools have been developed; however, there has been no comprehensive review of such tools to date. OBJECTIVE A systematic review was conducted to provide a structured overview and description of existing assessment tools with a focus on study quality, themes, tool validity, risk factors, and high-risk drug classes. METHODS Systematic searches for English-language publications (from 1990 to September 2017) were conducted in Embase, Medline, Scopus, International Pharmaceutical Abstracts, and Web of Science. Papers in the inpatient setting and in which the tool users were pharmacists or pharmacy technicians were included. Data on each study (e.g. aim and design) and the structure of tools (e.g. risk factors) from each included study were extracted by 2 independent reviewers. A descriptive analysis was conducted to summarize these tools along with a thematic analysis of study findings. The quality of each paper was assessed using the Hawker method. RESULTS Nineteen studies involving 17 risk assessment tools were included. Most tools were developed in Europe (76.5%) and published in the last 5 years (82%). Most tools (88%) were designed to identify patients at greatest risk of adverse drug reactions, adverse drug events, or medication errors and to guide appropriate pharmaceutical care. Ten out of 17 tools (59%) were validated. None showed a measurable impact on prescription errors or adverse drug events. Keys themes identified from the studies were the positive impact of risk assessment tools on both patient care and provision of pharmacy services as well as the limitations of risk assessment tools. CONCLUSIONS Current assessment tools are heterogeneous in their content, targeting diverse patient groups and clinical settings making generalization difficult. However, an underlying theme of all studies was that tools appear to achieve their aim in directing pharmaceutical care to where it is needed most which might provide reassurance and incentive for greater adoption and development of tools across clinical pharmacy services. However, further research is required to measure objectively the impact of tools on patient outcomes and on workforce efficiency so that comparisons can be made between tools.
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