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Uramatsu M, Kimura N, Kojima T, Fujisawa Y, Oto T, Barach P. Frontline nursing staff's perceptions of intravenous medication administration: the first step toward safer infusion processes-a qualitative study. BMJ Open Qual 2024; 13:e002809. [PMID: 38942437 PMCID: PMC11216072 DOI: 10.1136/bmjoq-2024-002809] [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: 02/22/2024] [Accepted: 05/30/2024] [Indexed: 06/30/2024] Open
Abstract
OBJECTIVES Intravenous medication errors continue to significantly impact patient safety and outcomes. This study sought to clarify the complexity and risks of the intravenous administration process. DESIGN A qualitative focus group interview study. SETTING Focused interviews were conducted using process mapping with frontline nurses responsible for medication administration in September 2020. PARTICIPANTS Front line experiened nurses from a Japanese tertiary teaching hospital. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was to identify the mental models frontline nurses used during intravenous medication administration, which influence their interactions with patients, and secondarily, to examine the medication process gaps between the mental models nurses perceive and the actual defined medication administration process. RESULTS We found gaps between the perceived clinical administration process and the real process challenges with an emphasis on the importance of verifying to see if the drug was ordered for the patient immediately before its administration. CONCLUSIONS This novel and applied improvement approach can help nurses and managers better understand the process vulnerability of the infusion process and develop a deeper understanding of the administration steps useful for reliably improving the safety of intravenous medications.
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Affiliation(s)
| | - Naoko Kimura
- Tokyo Medical University Hospital, Shinjuku-ku, Japan
| | | | - Yoshikazu Fujisawa
- Department of Quality and Patient Safety, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Tomoko Oto
- Tokyo Medical University, Shinjuku-ku, Japan
| | - Paul Barach
- Jefferson College of Population Health, Philadelphia, Pennsylvania, USA
- School of Medicine, Sigmund Freud University, Vienna, Austria
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Westbrook JI, Li L, Woods A, Badgery-Parker T, Mumford V, Merchant A, Fitzpatrick E, Raban MZ. Risk Factors Associated with Medication Administration Errors in Children: A Prospective Direct Observational Study of Paediatric Inpatients. Drug Saf 2024; 47:545-556. [PMID: 38443625 PMCID: PMC11116173 DOI: 10.1007/s40264-024-01408-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Limited evidence exists regarding medication administration errors (MAEs) on general paediatric wards or associated risk factors exists. OBJECTIVE The aim of this study was to identify nurse, medication, and work-environment factors associated with MAEs among paediatric inpatients. METHODS This was a prospective, direct observational study of 298 nurses in a paediatric referral hospital in Sydney, Australia. Trained observers recorded details of 5137 doses prepared and administered to 1530 children between 07:00 h and 22:00 h on weekdays and weekends. Observation data were compared with medication charts to identify errors. Clinical errors, potential severity and actual harm were assessed. Nurse characteristics (e.g. age, sex, experience), medication type (route, high-risk medications, use of solvent/diluent), and work variables (e.g. time of administration, weekday/weekend, use of an electronic medication management system [eMM], presence of a parent/carer) were collected. Multivariable models assessed MAE risk factors for any error, errors by route, potentially serious errors, and errors involving high-risk medication or causing actual harm. RESULTS Errors occurred in 37.0% (n = 1899; 95% confidence interval [CI] 35.7-38.3) of administrations, 25.8% (n = 489; 95% CI 23.8-27.9) of which were rated as potentially serious. Intravenous infusions and injections had high error rates (64.7% [n = 514], 95% CI 61.3-68.0; and 77.4% [n = 188], 95% CI 71.7-82.2, respectively). For intravenous injections, 59.7% (95% CI 53.4-65.6) had potentially serious errors. No nurse characteristics were associated with MAEs. Intravenous route, early morning and weekend administrations, patient age ≥ 11 years, oral medications requiring solvents/diluents and eMM use were all significant risk factors. MAEs causing actual harm were 45% lower using an eMM compared with paper charts. CONCLUSION Medication error prevention strategies should target intravenous administrations and not neglect older children in hospital. Attention to nurses' work environments, including improved design and integration of medication technologies, is warranted.
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Affiliation(s)
- Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, New South Wales, 2109, Australia.
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, New South Wales, 2109, Australia
| | - Amanda Woods
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, New South Wales, 2109, Australia
| | - Tim Badgery-Parker
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, New South Wales, 2109, Australia
| | - Virginia Mumford
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, New South Wales, 2109, Australia
| | - Alison Merchant
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, New South Wales, 2109, Australia
| | - Erin Fitzpatrick
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, New South Wales, 2109, Australia
| | - Magdalena Z Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, New South Wales, 2109, Australia
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Youssef SH, Garg A, Song Y, Wylie NE, Garg S. Harmonising IV Oxycodone with Paediatric Perioperative Medications: A Compatibility Study Through Y-Type Connectors. Drug Des Devel Ther 2024; 18:899-908. [PMID: 38533429 PMCID: PMC10964778 DOI: 10.2147/dddt.s444581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 03/11/2024] [Indexed: 03/28/2024] Open
Abstract
Purpose Co-administering multiple intravenous (IV) agents via Y-connectors is a common practice in hospitalised and fasting surgical patients. However, there is a lack of reliable data confirming the physical compatibility of some combinations including IV oxycodone, a drug that is gaining increasing popularity in the perioperative period. Concern regarding physical drug incompatibilities precludes concurrent coadministration with other common drugs through a single lumen. This can result in the cessation of infusions to allow the administration of other medications, resulting in exacerbation of acute pain. This study aims to evaluate the physical compatibility of IV oxycodone with some commonly co-administered drugs and IV fluids. Methods Mixtures of oxycodone (1mg.mL-1) and the tested drugs and IV fluids were prepared in a ratio of 1:1. The mixtures were examined at 0 and 60 minutes from mixing and assessed using the European Conference Consensus Standards. This involved visual inspection (precipitation, turbidity, colour change, gas formation), spectrophotometry, and pH change. The tested drugs included ketamine, tramadol, clonidine, vancomycin, piperacillin/tazobactam, dexmedetomidine, cefotaxime, gentamicin, and paracetamol. In addition, the commonly used IV fluids tested included glucose 5% + sodium chloride 0.9% + 60 mmol potassium chloride, plasmalyte + dextrose 5%;plasmalyte + dextrose 5% + 55 mmol potassium chloride, plasmalyte + dextrose 5% + 55mmol potassium acetate, plasmalyte + dextrose 5% + 55mmol potassium dihydrogen phosphate, Hartmann's solution, Standard pediatric Total Parenteral Nutrition (TPN) 20/100 and TPN 25/150. Results IV oxycodone (1 mg.mL-1) showed no visual changes; no spectrophotometric absorption variability at 350, 410, or 550nm; and no pH changes of >0.5 at 0 or 60 minutes with any of the tested drugs or fluids in the concentrations tested. Conclusion According to European Consensus Conference Standards, IV Oxycodone at 1 mg.mL-1 is physically compatible in a ratio of 1:1 v/v with all investigated drugs and fluids tested for at least 60 minutes.
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Affiliation(s)
- Souha H Youssef
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Alka Garg
- SA Pharmacy, Women’s and Children’s Hospital, Adelaide, SA, Australia
| | - Yunmei Song
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Nicole E Wylie
- Department of Paediatric Anaesthesia, Women’s and Children’s Hospital, Adelaide, SA, Australia
| | - Sanjay Garg
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
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van Stralen SA, van Eikenhorst L, Vonk AS, Schutijser BC, Wagner C. Evaluating deviations and considerations in daily practice when double-checking high-risk medication administration: A qualitative study using the FRAM. Heliyon 2024; 10:e25637. [PMID: 38380025 PMCID: PMC10877242 DOI: 10.1016/j.heliyon.2024.e25637] [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: 06/13/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 02/22/2024] Open
Abstract
Background Double-check protocol compliance during administration is low. Regardless, most high-risk medication administrations are performed without incidents. The present study investigated the process of preparing and administrating high-risk medication and examined which variations occur in daily practice. Additionally, we investigated which considerations were taken into account when deviating from the guidelines. Methods Ten Dutch hospital wards participated. The Functional Resonance Analysis Method was applied to construct a model depicting the Dutch guidelines and a ward-overarching model visualizing daily practice. To create the ward-overarching model, eight semi-structured interviews were conducted per ward discussing the preparation and administration of high-risk medication. Work related Efficiency-Thoroughness Trade-Off rules were used to structure subconscious considerations. Results In total, 77 nurses were interviewed. Six model deviations were found between the guideline model and ward-overarching model. Notably, four variations in double-check procedures were found. Here, time pressure was an important factor. Nurses made a risk-assessment, considering for patient stability, and difficulty of calculations, to determine whether the double-check would be executed. Additionally, subconscious reasonings, such as trusting their own or colleagues expertise, weighed on the decision. Conclusion Time pressure is the most important factor that withholds nurses from performing the double-check. Nurses instead conduct a risk-assessment to decide if the double-check will be executed. The double-check can thus become habitual or unnecessary for certain medications. In future research, insights of the FRAM could be used to make ward-specific alterations for the double-check procedure of medications, that focus on feasibility in daily practice, while maintaining patient safety.
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Affiliation(s)
- Sharon A. van Stralen
- Netherlands Institute for Health Services Research (Nivel), Organization and Quality of Care, Utrecht, the Netherlands
| | - Linda van Eikenhorst
- Netherlands Institute for Health Services Research (Nivel), Organization and Quality of Care, Utrecht, the Netherlands
| | - Astrid S. Vonk
- Netherlands Institute for Health Services Research (Nivel), Organization and Quality of Care, Utrecht, the Netherlands
| | | | - Cordula Wagner
- Netherlands Institute for Health Services Research (Nivel), Organization and Quality of Care, Utrecht, the Netherlands
- Amsterdam Public Health Research Institute, Department of Quality of Care, Amsterdam, the Netherlands
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Tolera GG, Kasaye BM, Abicho TB. Knowledge and practice towards intravenous fluid therapy in children among nurses in the pediatrics emergency department of selected public hospitals. Sci Rep 2024; 14:2503. [PMID: 38291150 PMCID: PMC10828392 DOI: 10.1038/s41598-024-52921-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 01/25/2024] [Indexed: 02/01/2024] Open
Abstract
Morbidity and mortality in hospitalized patients can be increased due to errors that are caused by inadequate knowledge and unsatisfactory practice of intravenous (IV) fluid therapy among healthcare workers. The knowledge and practice of nurses are very critical to IV fluid therapy because they are the cornerstone of a subject. This study assessed nurse's knowledge and practice of IV fluid therapy. A cross-sectional study design was employed at four selected public hospitals in Addis Ababa, Ethiopia. Data were collected from 112 nurses using a structured questionnaire for knowledge and using an observational checklist for practice. Data were analyzed using SPSS version 26 computer programs. Most respondents (67%) were males; the mean age of respondents was 31.2 ± 4.3. Among participated nurses, 42% (95% CI 32.8, 51.2) and 56.3% (95% CI 47.1, 65.6) had inadequate knowledge and satisfactory practice regarding IV fluid therapy in children, respectively. A significant association was observed between nurses' intravenous fluid therapy knowledge and in-service training that nurses who had training on fluid therapy in children had 4 times adequate knowledge than those who had no training (P = 0.01), an educational qualification that master degree holders had 4.8 times adequate knowledge than first-degree holders (P = 0.04) and training institution that nurse who had taken training in governmental teaching institution had 4 times adequate knowledge than who had taken training in private teaching institution (P = 0.011). No statistically significant association was found between practice level and independent variables regarding IV fluid therapy. Nurses' knowledge of IV fluid therapy was inadequate and practice was relatively satisfactory. Continuous education and training of nurses on IV fluid therapy should be conducted regularly to improve their knowledge and practice. Further research should be employed involving other hospitals and focusing on risk factors for knowledge and practice inadequacy that are not discussed in this study.
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Affiliation(s)
- Garoma Gemechu Tolera
- Department of Emergency and Critical Care Nursing, College of Health Science, Wallaga University, Nekemte, Ethiopia
| | - Birhanu Melaku Kasaye
- Department of Emergency Medicine, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Temesgen Beyene Abicho
- Department of Emergency Medicine, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia.
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Smith SE, Perona S, Weingart SD. Exploration of Norepinephrine Dose-Capping Practices: Report From an International, Interprofessional Survey of Critical Care Clinicians. J Pharm Pract 2024:8971900241228330. [PMID: 38241786 DOI: 10.1177/08971900241228330] [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: 01/21/2024]
Abstract
Purpose: The Joint Commission standards for titrated infusions require specification of maximum rates of infusion. This practice has led to the development of protocolized maximum doses that can be overridden by provider order ("soft maximums") and to dose caps that cannot be superseded ("hard maximums"). The purpose of this study was to determine the prevalence of and attitudes towards dose capping of norepinephrine. Methods: A 20-item cross-sectional survey assessing norepinephrine dose capping practices, perceptions of norepinephrine protocols, and respondent and practice site demographics was distributed electronically to the mailing list of an international medical podcast. Responses were stratified according to use of weight-based dosing (WBD) or non-WBD of norepinephrine. The primary objective was to characterize norepinephrine dosing practices including protocolized maximum doses and/or dose capping. Categorical and continuous variables were compared using the Chi-square test and Mann-Whitney U test, respectively, with P < .05 indicating statistical significance. Results: The survey was completed by 586 physicians, nurses, pharmacists, and advanced practice providers. WBD was used by 51% and non-WBD by 47%. A standardized titration protocol was reported by 65% and dose capping was reported by 19%. The protocolized maximum dose ranged from 20-400 mcg/min for respondents using non-WBD (median [interquartile range] 30 [30-50]) and ranged from .2-10 mcg/kg/min for respondents using WBD (1 [.5-3]). The dose cap was 50 (40-123) mcg/min with non-WBD and 2 (1-3) mcg/kg/min with WBD. Conclusions: An international, multi-professional survey of critical care and emergency medicine clinicians revealed wide variability in norepinephrine dosing practices including maximum doses allowed.
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Affiliation(s)
- Susan E Smith
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Athens, GA, USA
| | - Stephen Perona
- Department of Pharmacy, Northwest Medical Center, Tucson, AZ, USA
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Tedone AM, Lanz JJ. Staying silent during a crisis: How workplace factors influence safety decisions in U.S. nurses. Soc Sci Med 2024; 341:116548. [PMID: 38171213 DOI: 10.1016/j.socscimed.2023.116548] [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: 11/04/2022] [Revised: 11/16/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024]
Abstract
RATIONALE It is critical for healthcare organizations to promote upward communication of safety information to ensure safety issues experienced on the work floor are promptly identified and addressed, especially during crisis events. OBJECTIVE This study investigates mechanisms through which workplace factors affect nurses' motivation to speak up about safety issues, and ultimately their safety behaviors, in a pandemic work environment. METHOD The work experiences of 152 frontline U.S. nurses were captured across three time-points during the height of a global pandemic. RESULTS Findings indicate that nurses who experienced a greater frequency of pandemic-related demands and/or perceived a greater social risk associated with voicing concerns were more likely to remain silent about safety issues due to job-related constraints or a fear of negatively impacting their reputation, respectively. As a consequence, nurses were more likely to bypass safety protocols while completing work tasks, especially those who had a lower risk propensity. CONCLUSION These findings advance the literature on workplace safety by investigating factors that affect employee communication and ultimately safety workarounds in nurses within the context of a global pandemic.
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Affiliation(s)
| | - Julie J Lanz
- Department of Psychology, University of Nebraska at Kearney, USA
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Park J, You SB, Ryu GW, Kim Y. Attributes of errors, facilitators, and barriers related to rate control of IV medications: a scoping review. Syst Rev 2023; 12:230. [PMID: 38093372 PMCID: PMC10717502 DOI: 10.1186/s13643-023-02386-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/08/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Intravenous (IV) medication is commonly administered and closely associated with patient safety. Although nurses dedicate considerable time and effort to rate the control of IV medications, many medication errors have been linked to the wrong rate of IV medication. Further, there is a lack of comprehensive studies examining the literature on rate control of IV medications. This study aimed to identify the attributes of errors, facilitators, and barriers related to rate control of IV medications by summarizing and synthesizing the existing literature. METHODS This scoping review was conducted using the framework proposed by Arksey and O'Malley and PRISMA-ScR. Overall, four databases-PubMed, Web of Science, EMBASE, and CINAHL-were employed to search for studies published in English before January 2023. We also manually searched reference lists, related journals, and Google Scholar. RESULTS A total of 1211 studies were retrieved from the database searches and 23 studies were identified from manual searches, after which 22 studies were selected for the analysis. Among the nine project or experiment studies, two interventions were effective in decreasing errors related to rate control of IV medications. One of them was prospective, continuous incident reporting followed by prevention strategies, and the other encompassed six interventions to mitigate interruptions in medication verification and administration. Facilitators and barriers related to rate control of IV medications were classified as human, design, and system-related contributing factors. The sub-categories of human factors were classified as knowledge deficit, performance deficit, and incorrect dosage or infusion rate. The sub-category of design factor was device. The system-related contributing factors were classified as frequent interruptions and distractions, training, assignment or placement of healthcare providers (HCPs) or inexperienced personnel, policies and procedures, and communication systems between HCPs. CONCLUSIONS Further research is needed to develop effective interventions to improve IV rate control. Considering the rapid growth of technology in medical settings, interventions and policy changes regarding education and the work environment are necessary. Additionally, each key group such as HCPs, healthcare administrators, and engineers specializing in IV medication infusion devices should perform its role and cooperate for appropriate IV rate control within a structured system.
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Affiliation(s)
- Jeongok Park
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea
| | - Sang Bin You
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Gi Wook Ryu
- Department of Nursing, Hansei University, 30, Hanse-Ro, Gunpo-Si, 15852, Gyeonggi-Do, Korea.
| | - Youngkyung Kim
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Korea.
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Assunção-Costa L, Pinto CR, Machado JFF, Valli CG, de Souza LEPF. Assessing the severity of medication administration errors identified in an observational study using a valid and reliable method. J Pharm Policy Pract 2023; 16:143. [PMID: 37964342 PMCID: PMC10648330 DOI: 10.1186/s40545-023-00653-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/07/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Epidemiological data on medication errors severity are scarce. The assessment of the prevalence and severity of medication errors may be limited because of several reasons, including a lack of standardization in the method of identifying medication administration errors and little knowledge about the appropriate assessment tools to measure severity. Thus, in this study, we aim to assess the potential severity of errors identified by direct observation in a teaching hospital. METHODS We used a validated method for assessing the potential severity of medication administration errors. Responses are scored on a 10-point scale. The 203 errors identified in a previous study were organized per similarity, resulting in 67 errors. This list was assessed by a panel of a physician, a nurse, and two pharmacists. The average score for each of the 67 errors was estimated considering the scores given by the 4 judges. Errors with a severity index < 3, between 3 and 7, and > 7 were considered minor, moderate, and severe, respectively. RESULTS Professionals classified the potential clinical significance of the errors as minor, moderate, and severe in 8.8% (18/203), 82.8% (168/203), and 8.4% (17/203) of the cases, respectively. Most errors considered potentially serious (41%, 7/17) were technical errors. Most potentially serious errors involved insulin. Regarding the administration route, nine (53%) potentially serious errors involved medications administered intravenously. CONCLUSIONS Most of the errors were considered as potentially moderated by the expert panel; however, the frequency of potentially serious errors was higher than that in previous studies using the same methodology, which highlights the need for strategies to reduce their occurrence.
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Affiliation(s)
- Lindemberg Assunção-Costa
- Department of Medicine, School of Pharmacy, Federal University of Bahia and National Institute for Phamaceutical Assistence and Pharmacoeconomy - INAFF, Rua Barão de Jeremoabo, 147, 2º andar, Campus Ondina, Salvador, Bahia, 40170-115, Brazil.
| | - Charleston Ribeiro Pinto
- Department of Medicine, School of Pharmacy, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Cleidenete Gomes Valli
- National Institute for Pharmaceutical Assistance and Pharmacoeconomics - INAFF, Salvador, Bahia, Brazil
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Grace KA, Efua SDV. Nurses' behavioural intentions towards intravenous fluid administration for pediatric patients: Application of the theory of planned behaviour. J Pediatr Nurs 2023; 73:e632-e638. [PMID: 37957080 DOI: 10.1016/j.pedn.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/06/2023] [Accepted: 11/06/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND For pediatric patients, the demand for quality and safe Intravenous Fluid (IVF) therapy is huge. This is because, compared to adults, children have a lower tolerance for IVF therapy errors and present devastating physiological responses to errors. Nurses play a vital role in IVF administration; therefore, adequate knowledge, positive attitudes, positive perceived behavioural control, and good behavioural intentions are required to achieve effective and successful therapy, patient safety and prevention of complications, and overall positive patient outcomes. This study sought to assess the behaviour of nurses towards IVF administration for pediatric patients. METHOD A cross-sectional facility-based study was designed and randomly recruited 112 nurses. The theory of planned behaviour was used as a conceptual framework to assess nurses' behavioural intentions towards IVF administration for pediatric patients. Mean scores and their respective standard deviations, reliability tests, exploratory factor analysis, and linear logistic regression were all performed using SPSS version 27, with the level of significance set at 0.05. RESULTS Nurses' behavioural intentions for IVF administration for pediatric patients were influenced by their knowledge of standards and protocols for IVF use (β = 0.320; p = 0.01), attitudes (β = 0.339; p = 0.006) subjective norms (β 0.240; p = 0.003) and perceived behavioural control (β = 0.26; p = 0.001). CONCLUSION Nurses' behavioural intentions for IVF administration were significantly influenced by their knowledge of procedures and standards for IVF administration. Additionally, the nurses' subjective norms, perceived behavioural control, and attitude towards IVF administration have a significant effect on their behavioural intentions to administer IVFs to pediatric patients. For nurses to administer IVF effectively, safely, and successfully to pediatric patients, there is a need to enhance their knowledge of standards and guidelines for IVF administration. The nurses need to have good attitudes and positive support and influence from all others to be able to administer IVFs safely and successfully to their pediatric patients.
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Affiliation(s)
- Kulley Ackah Grace
- Ghana College of Nurses and Midwives, Accra, Ghana; Englishie Amanfrom Polyclinicl-Ghana Health Service, Accra, Ghana
| | - Senoo-Dogbey Vivian Efua
- Department of Public Health, School of Nursing and Midwifery, University of Ghana, P. O. Box LG 25, Legon, Accra Ghana Legon, Accra, Ghana; Ghana Institute of Management and Public Administration (GIMPA), School of Public Service and Governance, Ghana.
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Dick-Smith F, Fry MF, Salter R, Tinker M, Leith G, Donoghoe S, Harris C, Murphy S, Elliott R. Barriers and enablers for safe medication administration in adult and neonatal intensive care units mapped to the behaviour change wheel. Nurs Crit Care 2023; 28:1184-1195. [PMID: 37614015 DOI: 10.1111/nicc.12968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Intensive care settings have high rates of medication administration errors. Medications are often administered by nurses and midwives using a specified process (the '5 rights'). Understanding where medication errors occur, the contributing factors and how best practice is delivered may assist in developing interventions to improve medication safety. AIMS To identify medication administration errors and context specific barriers and enablers for best practice in an adult and a neonatal intensive care unit. Secondary aims were to identify intervention functions (through the Behaviour Change Wheel). STUDY DESIGN A dual methods exploratory descriptive study was conducted (May to June 2021) in a mixed 56-bedded adult intensive care unit and a 6-bedded neonatal intensive care unit in Sydney, Australia. Incident monitoring data were examined. Direct semi-covert observational medication administration audits using the 5 rights (n = 39) were conducted. Brief interviews with patients, parents and nurses were conducted. Data were mapped to the Behaviour Change Wheel. RESULTS No medication administration incidents were recorded. Audits (n = 3) for the neonatal intensive care unit revealed no areas for improvement. Adult intensive care unit nurses (n = 36) performed checks for the right medication 35 times (97%) and patient identity 25 times (69%). Sixteen administrations (44%) were interrupted. Four themes were synthesized from the interview data: Trust in the nursing profession; Availability of policies and procedures; Adherence to the '5 rights' and departmental culture; and Adequate staffing. The interventional functions most likely to bring about behaviour change were environmental restructuring, enablement, restrictions, education, persuasion and modelling. CONCLUSIONS This study reveals insights about the medication administration practices of nurses in intensive care. Although there were areas for improvement there was widespread awareness among nurses regarding their responsibilities to safely administer medications. Interview data indicated high levels of trust among patients and parents in the nurses. RELEVANCE TO CLINICAL PRACTICE This novel study indicated that nurses in intensive care are aware of their responsibilities to safely administer medications. Mapping of contextual data to the Behaviour Change Wheel resulted in the identification of Intervention functions most likely to change medication administration practices in the adult intensive care setting that is environmental restructuring, enablement, restrictions, education, persuasion and modelling.
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Affiliation(s)
- Felicity Dick-Smith
- Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Margaret Fry Fry
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- Nursing and Midwifery Directorate, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Rachel Salter
- Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Matthew Tinker
- Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Grace Leith
- Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Stephanie Donoghoe
- Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Claire Harris
- Nursing and Midwifery Directorate, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Sandra Murphy
- Nursing and Midwifery Directorate, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Rosalind Elliott
- Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- Nursing and Midwifery Directorate, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
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12
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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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13
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Hogerwaard M, Stolk M, Dijk LV, Faasse M, Kalden N, Hoeks SE, Bal R, Horst MT. Implementation of barcode medication administration (BMCA) technology on infusion pumps in the operating rooms. BMJ Open Qual 2023; 12:bmjoq-2022-002023. [PMID: 37217240 DOI: 10.1136/bmjoq-2022-002023] [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: 06/20/2022] [Accepted: 05/05/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Medication administration errors (MAEs) are a major cause of morbidity and mortality. An updated barcode medication administration (BCMA) technology on infusion pumps is implemented in the operating rooms to automate double check at a syringe exchange. OBJECTIVE The aim of this mixed-methods before-and-after study is to understand the medication administrating process and assess the compliance with double check before and after implementation. METHODS Reported MAEs from 2019 to October 2021 were analysed and categorised to the three moments of medication administration: (1) bolus induction, (2) infusion pump start-up and (3) changing an empty syringe. Interviews were conducted to understand the medication administration process with functional resonance analysis method (FRAM). Double check was observed in the operating rooms before and after implementation. MAEs up to December 2022 were used for a run chart. RESULTS Analysis of MAEs showed that 70.9% occurred when changing an empty syringe. 90.0% of MAEs were deemed to be preventable with the use of the new BCMA technology. The FRAM model showed the extent of variation to double check by coworker or BCMA.Observations showed that the double check for pump start-up changed from 70.2% to 78.7% postimplementation (p=0.41). The BCMA double check contribution for pump start-up increased from 15.3% to 45.8% (p=0.0013). The double check for changing an empty syringe increased from 14.3% to 85.0% (p<0.0001) postimplementation. BCMA technology was new for changing an empty syringe and was used in 63.5% of administrations. MAEs for moments 2 and 3 were significantly reduced (p=0.0075) after implementation in the operating rooms and ICU. CONCLUSION An updated BCMA technology contributes to a higher double check compliance and MAE reduction, especially when changing an empty syringe. BCMA technology has the potential to decrease MAEs if adherence is high enough.
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Affiliation(s)
| | - Muriël Stolk
- Quality and Patientcare, Erasmus MC, Rotterdam, The Netherlands
| | | | - Mariët Faasse
- Anesthesiology, Erasmus MC, Rotterdam, The Netherlands
| | - Nico Kalden
- Department of Medical Technology/I&T, Erasmus MC, Rotterdam, The Netherlands
| | | | - Roland Bal
- School of Health Policy & Management, Erasmus Universiteit, Rotterdam, The Netherlands
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14
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Davies KM, Coombes ID, Keogh S, Hay K, Whitfield KM. Medication administration evaluation and feedback tool: Longitudinal cohort observational intervention. Collegian 2023. [DOI: 10.1016/j.colegn.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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15
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Part I: Significant reduction of lyophilization process times by using novel matrix based scaffolds. Eur J Pharm Biopharm 2023; 184:248-261. [PMID: 36529257 DOI: 10.1016/j.ejpb.2022.12.008] [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: 09/18/2022] [Revised: 12/02/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
To improve the long-term stability of drugs with limited stability (e.g., biologicals such as monoclonal antibodies, antibody drug conjugates or peptides), some pharmaceuticals endure a lengthy and cost-intensive process called lyophilization. While the shelf life of lyophilized drugs may be prolonged compared to their liquid form, the drawbacks come in the form of intensified manufacturing, preparation, and dosing efforts. The use of glass vials as the primary container unit for lyophilized products hinders their complication-free, fast and flexible use, as they require a skilled healthcare professional and an aseptic environment in which to prepare them. The feasibility of substituting glass vials with novel container designs offering the complete transfer of the lyophilizate cake into modern administration devices, while reducing the economic footprint of the lyophilization process, was investigated. The lyophilization process of a monoclonal antibody solution was studied by assessing primary drying conditions, homogeneity of the drying process, and critical quality attributes after successful lyophilization. The creation of novel container designs utilized vacuum-forming to generate confined containers with removable bottoms and rapid prototyping, including subtractive and additive manufacturing methods, to generate porous 3D structures for drug housing. The novel container designs generated lyophilizates twice as fast and achieved a threefold faster reconstitution compared to their vial counterparts, without adaptation of the processing conditions. We conclude that the use of intermediate process containers offers significant relief for healthcare professionals in terms of reduced probability of handling errors, while drug manufacturers benefit from the accelerated processing times, increased batch homogeneity, and sustainability.
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16
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Cheon YJ, Ye KN, Park KH, Kim JB, Yoon JE, Lee MK, Kim JT, An SH. Implementation of pharmacists' monitoring for intravenous drug compatibility. Eur J Hosp Pharm 2023; 30:101-106. [PMID: 36810349 PMCID: PMC9986928 DOI: 10.1136/ejhpharm-2021-003187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 08/09/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Injectable medication errors primarily occur during preparation and administration. Currently, South Korea is experiencing chronic pharmacist shortages. Moreover, pharmacists have not routinely conducted prescription monitoring for intravenous compatibility. In the present study, we analysed the implementation of a pre-issue monitoring program using recently released cloud-based software to provide information on intravenous compatibility in the pharmacy at a general hospital in South Korea. OBJECTIVES The aims of this study were to determine whether adding an intravenous drug prescription review to pharmacists' actual work scope could promote patient safety, and to assess the impact of this new task on pharmacists' workload. METHODS Data on intravenous drugs prescribed in the intensive care unit and haematology-oncology ward were prospectively collected during January 2020. Four quantitative items were evaluated: the run-time, intervention ratio, acceptance ratio, and the information completeness ratio with regard to the compatibility of intravenous drugs. RESULTS The mean run-time of two pharmacists was 18.1 min in the intensive care unit and 8.7 min in the haematology-oncology ward (p<0.001). Significant differences were also found between the intensive care unit and the haematology-oncology wards in terms of the mean intervention ratio (25.3% vs 5.3%, respectively; p<0.001) and the information completeness ratio (38.3% vs 34.0%, respectively; p=0.007). However, the mean acceptance ratio was comparable (90.4% in the intensive care unit and 100% in the haematology-oncology ward; p=0.239). The intravenous pairs that most frequently triggered interventions were tazobactam/piperacillin and famotidine in the intensive care unit, and vincristine and sodium bicarbonate in the haematology-oncology ward. CONCLUSION This study suggests that despite a shortage of pharmacists, intravenous compatibility can be monitored before issuing injectable products in all wards. Because the prescribing pattern of injections varies across wards, pharmacists' tasks should be established accordingly. To improve the completeness of information, efforts to generate more evidence should continue.
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Affiliation(s)
- Young Ju Cheon
- Department of Pharmacy, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Kyong Nam Ye
- Department of Pharmacy, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | | | - Jung Bo Kim
- Department of Pharmacy, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Ji Eun Yoon
- Department of Pharmacy, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Min Kyung Lee
- Department of Pharmacy, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Jung Tae Kim
- Department of Pharmacy, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Sook Hee An
- College of Pharmacy, Wonkwang University, Iksan, Jeollabuk-do, South Korea
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17
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Alamer F, Alanazi AT. The Impact of Smart Pump Technology in the Healthcare System: A Scope Review. Cureus 2023; 15:e36007. [PMID: 37051011 PMCID: PMC10085524 DOI: 10.7759/cureus.36007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 04/14/2023] Open
Abstract
Smart infusion pump technology prevents errors caused by parenteral therapy. This paper aims to review the recent literature about smart pump uses, cases and adverse events, and strategies to minimize these disadvantages. Literature was explored from January 2000 to November 2021 using Google Scholar, PubMed, and ScienceDirect. There were assessments of the advantages and adverse effects of using smart pumps and strategies to overcome the adverse effects of smart pumps. The advantage of using smart pumps is that they decrease errors like incorrect rate and dose. Other benefits include a decrease in medication event rates and the ability to connect smart pumps to home health providers. However, compliance rates were negatively influenced by improper smart pumps and the overriding of soft alerts, which can cause alert fatigue and drug library update delays. Recent studies have tried to address the negative issues by improving drug library compliance and decreasing alerts to avoid alert desensitization. The investigations revealed that the smart pumps reduced errors but would only prevent some programming errors. Compliance with utilizing smart pump technology is critical in stopping medication errors. Opportunities for future improvement are broad, including integrating a smart pump infusion with the hospital system, implementing auto programming, and designing smart pump devices to be lighter, smaller, and more portable instead of the heavy, large smart pump used by most hospitals today.
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Affiliation(s)
- Fatimah Alamer
- Health Informatics, King Saud Ibn Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Abdullah T Alanazi
- Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Research, King Abdullah International Medical Research Center, Riyadh, SAU
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18
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Davis S, Thompson A. Enhancing the Drug Library to Improve Infusion Pump Safety and Usability. Ann Pharmacother 2023; 57:348-349. [PMID: 35758164 DOI: 10.1177/10600280221103562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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19
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Beaudart C, Witjes M, Rood P, Hiligsmann M. Medication administration errors in the domain of infusion therapy in intensive care units: a survey study among nurses. Arch Public Health 2023; 81:23. [PMID: 36793055 PMCID: PMC9930049 DOI: 10.1186/s13690-023-01041-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Despite extensive research carried out on medication administration errors (MAEs) in the domain of infusion therapy, there is limited knowledge on nurse's perceptions on the occurrence of MAEs during infusion therapy. Since nurses are responsible for medication preparation and administration in Dutch hospitals, it is vital to understand their perspectives on the risk factors for MAEs. AIM The purpose of this study is to investigate the perception of nurses, working in adult ICUs, on the occurrence of MAEs during continuous infusion therapies. METHODS A digital web-based survey was distributed among 373 ICU nurses working in Dutch hospitals. The survey investigated nurses' perceptions on the frequency, severity of consequences and preventability of MAEs, factors for the occurrence of MAEs, and infusion pump and smart infusion safety technology. RESULTS A total of 300 nurses started to fill out the survey but only 91 of them (30.3%) fully completed it and were included in analyses. Medication-related factors and Care professional-related factors were perceived as the two most important risk categories for the occurrence of MAEs. Important risk factors contributing to the occurrence of MAEs included high patient-nurse ratio, problems in communication between caregivers, frequent staff changes and transfers of care, and no/incorrect dosage/concentration on labels. Drug library was reported as the most important infusion pump feature and both Bar Code Medication Administration (BCMA) and medical device connectivity as the two most important smart infusion safety technologies. Nurses perceived the majority of MAEs as preventable. CONCLUSIONS Based on ICU nurses' perceptions, the present study suggests that strategies to reduce MAEs in these units should focus on, among other factors, the high patient-to-nurse ratio, problems in communication between nurses, frequent staff changes and transfers of care, and no/incorrect dosage/concentration on drug labels.
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Affiliation(s)
- Charlotte Beaudart
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Maureen Witjes
- grid.5012.60000 0001 0481 6099Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands ,grid.5012.60000 0001 0481 6099Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Paul Rood
- Dutch Professional Nurses Organisation, Chapter Critical Care Nurses (V&VN IC), Utrecht, the Netherlands ,grid.450078.e0000 0000 8809 2093School of Health Studies, Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, the Netherlands ,grid.10417.330000 0004 0444 9382Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mickael Hiligsmann
- grid.5012.60000 0001 0481 6099Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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20
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Hamadalneel YB, Maatoug MM, Yousif MA. Evaluation of errors in preparation and administration of intravenous medications in critically ill patients. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2023; 34:357-365. [PMID: 37302042 DOI: 10.3233/jrs-220054] [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] [Indexed: 06/12/2023]
Abstract
BACKGROUND Intravenous medications have greater complexity and require multiple steps in their preparation and administration, which is considered a high risk for patients. OBJECTIVE To determine the incidence of intravenous medications preparation and administration errors in critically ill patients. METHODS This was an observational, cross-sectional, prospective study design. The study was performed in Wad Medani Emergency Hospital, Sudan . RESULTS All nurses working at the study setting were observed over nine days. During the study period, a total number of 236 drugs were observed and evaluated. The total error rate was 940 (33.4%), of which 136 (57.6%) errors with no harm, 93 (39.4%) errors with harm and 7 (3%) of errors associated with mortality. 17 different drug categories were involved, in which antibiotic was the highest error rate 104 (44.1%) and 39 different drugs were involved, in which metronidazole was the most drug involved 34 (14.4%). The total error rate was associated with nurse experience, OR (95% CI); 3.235 (1.834-5.706), and nurse education level, OR (95% CI); 0.125 (0.052-0.299). CONCLUSION The study reported high frequency of IV medications preparation and administration errors. Nurse education level, and experiences were influenced the total errors.
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Affiliation(s)
- Yousif B Hamadalneel
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Gezira, Wad Madani, Sudan
| | - Maha M Maatoug
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Gezira, Wad Madani, Sudan
| | - Mirghani A Yousif
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Gezira, Wad Madani, Sudan
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Assunção-Costa L, de Sousa IC, Silva RKR, do Vale AC, Pinto CR, Machado JFF, Valli CG, de Souza LEPF. Observational study on medication administration errors at a University Hospital in Brazil: incidence, nature and associated factors. J Pharm Policy Pract 2022; 15:51. [PMID: 35996122 PMCID: PMC9396806 DOI: 10.1186/s40545-022-00443-x] [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: 06/08/2022] [Accepted: 07/13/2022] [Indexed: 11/11/2022] Open
Abstract
Background Medication administration errors are frequent and cause significant harm globally. However, only a few data are available on their prevalence, nature, and severity in developing countries, particularly in Brazil. This study attempts to determine the incidence, nature, and factors associated with medication administration errors observed in a university hospital. Methods This was a prospective observational study, conducted in a clinical and surgical unit of a University Hospital in Brazil. Two previously trained professionals directly observed medication preparation and administration for 15 days, 24 h a day, in February 2020. The type of error, the category of the medication involved, according to the anatomical therapeutic chemical classification system, and associated risk factors were analyzed. Multivariate logistic regression was adopted to identify factors associated with errors. Results The administration of 561 drug doses was observed. The mean total medication administration error rate was 36.2% (95% confidence interval 32.3–40.2). The main factors associated with time errors were interruptions. Regarding technique errors, the primary factors observed were the route of administration, interruptions, and workload. Conclusions Here, we identified a high total medication administration error rate, the most frequent being technique, wrong time, dose, and omission errors. The factors associated with errors were interruptions, route of administration and workload, which agrees well with the results of other national and international studies. Supplementary Information The online version contains supplementary material available at 10.1186/s40545-022-00443-x.
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Affiliation(s)
- Lindemberg Assunção-Costa
- School of Pharmacy, Federal University of Bahia, Salvador, Bahia, Brazil. .,National Institute for Pharmaceutical Assistance and Pharmacoeconomics, Salvador, Bahia, Brazil. .,, Rua Alameda Salvador, 1057, Torre América, Sala 308, Caminho das árvores, 41820790, Salvador, Bahia, Brazil.
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22
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Knowledge and practice of intravenous infusion among nurses in university of Calabar teaching hospital. Int J Health Sci (Qassim) 2022. [DOI: 10.53730/ijhs.v6ns3.6132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This study aimed at assessing the knowledge and practice of intravenous infusion among nurses in University of Calabar Teaching Hospital. Two (2) objectives with the corresponding research questions were formulated. A descriptive research design was adopted for the study. The population and sample comprised of 160 registered nurses working in University of Calabar Teaching Hospital. Convenient sampling technique was employed to select 114 nurses to form the sample for this study. A self-developed and structured questionnaire was used to obtain data and analyzed using simple frequency and percentage tables. Findings of Results in table 2 reveals that majority 87(76.3) of the respondents said yes that As a nurse I know that intravenous infusion is carried out in most hospital by both doctors and nurses while 27(23.7%) said no. 114(100) of the respondents said yes that As a nurse I know that most management in the hospital do not allow nurses to carryout intravenous infusion on their patients for fear of replacement.
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23
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Savva G, Merkouris A, Charalambous A, Papastavrou E. Omissions and Deviations From Safe Drug Administration Guidelines in 2 Medical Wards and Risk Factors: Findings From an Observational Study. J Patient Saf 2022; 18:e645-e651. [PMID: 34508041 DOI: 10.1097/pts.0000000000000913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to record the type and frequency of errors, with an emphasis on omissions, during administration of medicines to inpatients and to investigate associated factors. METHODS This was a descriptive observational study. The medication process in 2 medical wards was observed by 2 observers using a structured observation form. χ2 Test, Kruskal-Wallis test, and regression analysis were used to explore associations between factors and errors. RESULTS From the 665 administrations observed, a total of 2371 errors were detected from which 81.2% were omissions and 18.8% were errors of commission. Omissions in the infection prevention guidelines (46.6%) and in the 5 rights of medication safety principles (35.8%) were a predominant finding. In particular, omitting to hand wash before administering a drug (98.4%), omitting to disinfect the site of injection (37.7%), and omitting to confirm the patient's name (74.4%) were the 3 most frequently observed omissions. Documentation errors (13.1%) and administration method errors (4.5%) were also detected. Regression analysis has shown that the therapeutic class of the drug administered and the number of medicines taken per patient were the 2 factors with a statistical significance that increased the risk of a higher number of errors being detected. CONCLUSIONS Errors during drug administration are still common in clinical practice, with omissions being the most common type of error. In particular, omissions in the basic infection and safety regulations seem to be a very common problem. The risk of a higher number of errors being made is increased when a cardiovascular drug is administered and when the number of medicines administered per patient is increased.
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Affiliation(s)
| | - Anastasios Merkouris
- From the Department of Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | | | - Evridiki Papastavrou
- From the Department of Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
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24
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Misko J, Rawlins M, Ridley B. Impact of a Review of a Smart Infusion Pump Library in Hematology/Oncology: Tailoring Content to Meet Specialty Needs. J Patient Saf 2022; 18:e640-e644. [PMID: 34508039 DOI: 10.1097/pts.0000000000000907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Errors involving chemotherapy or intravenous medications may cause serious patient harm. Dose error reduction software (DERS) for "smart" infusion pumps offers additional safety protection for their administration. Our institution uses DERS software hospital-wide; however, the hematology/oncology areas were noted to have reduced compliance with DERS recommendations. In response, we sought to review the DERS content and survey hematology/oncology end users' satisfaction with the software. METHODS A multidisciplinary working group was formed to review the current DERS entries for medications, fluids, and blood products. The review included details such as dose, rate, and concentrations. Dose error reduction software compliance was determined using vendor-supplied Continuous Quality Improvement software. An electronic survey assessing clinicians' satisfaction with the current DERS library and any challenges in its use was conducted before and after the review. RESULTS Ninety-one changes were made to 71 medications by the working group. Compliance with the DERS library went from 81.5% before the review to 87.3% after the review (P = 0.257). Fifty-eight survey responses were received (30 prereview and 28 postreview) with improvements in staff satisfaction with the DERS library (83.3%-92.8%, P < 0.05). Near-miss events changed after the review from 2 to 0, and the number of alerts caused by values outside the DERS library reduced from 8788 before the review to 3383 after the review (P ≤ 0.05). CONCLUSIONS Review of a hematology/oncology DERS library found improvements that better met the needs of end users. Engagement with relevant stakeholders, in conjunction with ongoing communication and review, is required to improve compliance and satisfaction with DERS.
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Affiliation(s)
- Jeanie Misko
- From the Department of Pharmacy, Fiona Stanley Hospital, Perth, Australia
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Baker DW, Campbell R, Petrovic K. Proper Titration Orders Are Essential for Patient Safety. Am J Crit Care 2022; 31:158-160. [PMID: 35229145 DOI: 10.4037/ajcc2022452] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- David W. Baker
- David W. Baker is executive vice president, Healthcare Quality Evaluation, The Joint Commission, Oakbrook Terrace, Illinois
| | - Robert Campbell
- Robert Campbell is director, Standards Interpretation Group, and director, Medication Management, The Joint Commission
| | - Kathryn Petrovic
- Kathryn Petrovic is director, Department of Standards and Survey Methods, The Joint Commission
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Kim Y, Seol J, Lee H, Lee J, Park J, Kim KG. Web-Based Intravenous Fluid Treatment Monitoring Platform in Nursing Station. Surg Innov 2022; 29:677-680. [DOI: 10.1177/15533506211065849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Intravenous fluid treatment is the most common way to take care of inpatients. Because of the global pandemic, the number of inpatients is increasing rapidly, leading to constant demand in the contactless system. Purpose In this article, we suggest a web-based intravenous fluid treatment monitoring platform in the nursing station to unburden the medical staff’s workload.
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Affiliation(s)
- Yoonji Kim
- Department of Biomedical Engineering, College of Health Science, Gachon University, Incheon, Korea
- Medical Devices R&D Center, Gachon University Gil Hospital, Incheon, Korea
| | - Jaehwang Seol
- Department of Biomedical Engineering, College of Health Science, Gachon University, Incheon, Korea
- Medical Devices R&D Center, Gachon University Gil Hospital, Incheon, Korea
| | - Hyomin Lee
- Department of Biomedical Engineering, College of Health Science, Gachon University, Incheon, Korea
- Medical Devices R&D Center, Gachon University Gil Hospital, Incheon, Korea
| | - Jaekyeong Lee
- Department of Biomedical Engineering, College of Health Science, Gachon University, Incheon, Korea
- Medical Devices R&D Center, Gachon University Gil Hospital, Incheon, Korea
| | - Jeongyun Park
- Department of Clinical Nursing, University of Ulsan, Seoul, Korea
| | - Kwang Gi Kim
- Department of Biomedical Engineering, College of Health Science, Gachon University, Incheon, Korea
- Medical Devices R&D Center, Gachon University Gil Hospital, Incheon, Korea
- Department of Health Sciences and Technology, Gachon Advanced Institute for Health Sciences and Technology (GAIHST), Gachon University, Incheon, Korea
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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] [Key Words] [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
- Corresponding Author: Pashmina Malik, PharmD, MPH, Fresenius Kabi USA, LLC, Three Corporate Dr, Lake Zurich, IL 60047 ()
| | - 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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De Basagoiti A, Antón X, Calleja A, De Miguel M, Guerra E, Loureiro B, Campino A. Analysis of standard concentrations of continuous infusions in nine Spanish neonatal intensive care units. Eur J Hosp Pharm 2022; 29:50-54. [PMID: 32554526 PMCID: PMC8717789 DOI: 10.1136/ejhpharm-2019-002194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/28/2020] [Accepted: 05/05/2020] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES The aim of this study was to describe the use of standard concentrations for continuous infusion drugs in Spanish neonatal intensive care units (NICUs). METHODS We conducted an observational multicentre study based on a survey sent by email to 9 Spanish NICUs during January and February 2018. We collected data on intravenous drugs frequently used in neonates, and their preparation. Continuous infusion drugs with a standard concentration implemented in ≥2 NICUs were selected. An analysis of the concentrations reported was performed, and the rate of adherence to international recommendations of the Institute of Safe Medication Practice (ISMP) and Vermont Oxford Network (VON) was calculated. RESULTS From 69 drugs mentioned in the survey, 14 were included in the study, with all but one (furosemide) being considered high-alert medications by the ISMP. From the 9 participating NICUs, 3 had no established standard concentrations for any of the 14 drugs selected. In the other participating NICUs, dexmedetomidine was used with a standard concentration in the 3 NICUs which used the drug, whereas furosemide showed the lowest implementation rate (a standard concentration was implemented in 2 of the 7 NICUs which used the drug). In regard to concentrations adopted in the different NICUs, 80 variations were identified for the 14 drugs. The mean number of different standard concentrations for each drug per NICU was 2 (range 1-5). Adherence to ISMP/VON recommendations varied considerably depending on the drugs, from high adherence for heparin (2/3) and fentanyl (2/3) to low adherence for norepinephrine (0/4). CONCLUSIONS The establishment of standard concentrations is highly recommended for continuous infusion medications as an effective error-prevention strategy. Nevertheless, we detected a low implementation rate in our NICUs and a lack of consistency in the concentrations selected.
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Affiliation(s)
- Amaya De Basagoiti
- Neonatology Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Xabier Antón
- Hospital Pharmacy, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Amaya Calleja
- Hospital Pharmacy, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Monike De Miguel
- Hospital Pharmacy, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Eneritz Guerra
- Neonatal Intensive Care Unit, Department of Pediatrics, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Begoña Loureiro
- Neonatal Intensive Care Unit, Department of Pediatrics, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Ainara Campino
- Hospital Pharmacy, Cruces University Hospital, Barakaldo, Bizkaia, Spain
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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: 20] [Impact Index Per Article: 6.7] [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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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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Rector K, Merchant S, Crawford R, Arnall JR, Symanowski J, Veeramreddy P, Osunkwo I. Evaluation of Intravenous Diphenhydramine Use in Patients with Sickle Cell Vaso-Occlusive Crisis. Hosp Pharm 2021; 56:725-728. [PMID: 34732930 DOI: 10.1177/0018578720954171] [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: 11/17/2022]
Abstract
Purpose: To compare the incidence of oversedation between oral and parenteral diphenhydramine therapy for treatment of opioid-induced pruritus in patients with sickle cell disease vaso-occlusive crisis (SCD VOC). Methods: This retrospective, single-center, cohort study included patients greater than or equal to 18 years old with sickle cell disease admitted for vaso-occlusive crisis who received either intravenous or oral diphenhydramine for opioid-induced pruritus. Patients were identified through ICD-9 and ICD-10 codes from June 1, 2016 through July 1, 2017. Rates of oversedation were compared between the 2 formulations. Secondary endpoints included length of stay, amount and duration of diphenhydramine, rate of acute chest and indication for IV therapy. Results: Fifty unique patients were included in the analysis representing 121 admissions. Seven patients received both formulations on separate admissions and were included in both groups. Twenty-nine percent of patients in the IV diphenhydramine group experienced oversedation (12/42) versus 13% in the oral diphenhydramine group (2/15, P = .312). The average number of admissions was significantly higher in the IV versus oral group (2.45 vs 1.20; P = .005) with average and median length of stay also significantly higher in the IV versus oral group (30.57, 16.0 vs 10.67, 10.0; P = .003). Conclusion: While there was no statistically significant difference in the rates of oversedation with use of IV versus oral diphenhydramine formulations, patients with SCD VOC who received IV diphenhydramine had more frequent admissions and a longer length of stay. Clinicians may consider oral diphenhydramine preferentially in appropriate patients over IV administration.
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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: 2] [Impact Index Per Article: 0.7] [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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Cavell GF, Mandaliya D. Magnitude of error: a review of wrong dose medication incidents reported to a UK hospital voluntary incident reporting system. Eur J Hosp Pharm 2021; 28:260-265. [PMID: 34426478 PMCID: PMC8403774 DOI: 10.1136/ejhpharm-2019-001987] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/25/2019] [Accepted: 07/30/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Our aim was to review medication-related incidents reported to a hospital voluntary incident reporting system to identify and quantify the magnitude of wrong dose errors. METHODS The study was a retrospective review of medication-related incidents reported over a 7-year period at a large acute teaching hospital in the UK, providing secondary and tertiary care for a range of clinical specialties. Medication-related incident reports submitted from all clinical settings were reviewed. Incidents submitted under the categories 'wrong dose', 'wrong dose preparation', 'wrong rate' or 'wrong quantity' and describing situations where incorrect doses were prescribed, dispensed or administered were analysed. Magnitudes of medication overdoses and underdoses reported from adult and paediatric settings were calculated. Stage of the medicines process and drug classes most commonly involved in wrong dose errors were described. RESULTS Of 12 006 reported medication incidents, 1568 described 'wrong-dose' errors: 702 (44.8%) were prescribing errors, 223 (14.2%) were dispensing errors and 643 (41%) were administration errors. Overdoses were reported more frequently than underdoses. 926 (59%) of reported wrong dose errors were overdoses, 464 (29.6%) were underdoses; the magnitude could not be determined in 178 (11.4%) of reports. Twofold and 10-fold overdoses and underdoses were the most commonly reported error magnitude, although dosing errors across a wide range of magnitudes were reported. Incidents were reported from paediatric wards (491, 31.3%), non-paediatric wards and clinical settings (880, 56.1%) and pharmacy (197, 12.6%). Prescribing errors (702, 45.9%) were reported more commonly than administration (643, 41%) and dispensing errors (223, 14.2%). Drugs acting on the central nervous system, cardiovascular drugs and anti-infectives were the drug classes most commonly involved. CONCLUSIONS Wrong dose errors occur across all inpatient settings. Wrong dose errors of all magnitudes are possible, but twofold and 10-fold errors occur most frequently. Drug classes involved in wrong dose incidents reported to a voluntary reporting system in a large acute hospital are similar to those identified using other methodologies. Harms and potential harms associated with specific drugs and error magnitudes need to be identified to inform quality improvement work to reduce the risk of patient harm.
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Affiliation(s)
- Gillian F Cavell
- Pharmacy Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Deepal Mandaliya
- Pharmacy Department, King's College Hospital NHS Foundation Trust, London, UK
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Almghairbi DS, Al Gormi KH, Marufu TC. Anaesthesia drugs preparation and administration in Libyan tertiary hospitals: a multicentre qualitative observational study. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2021. [DOI: 10.36303/sajaa.2021.27.5.2587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- DS Almghairbi
- Department of Anaesthesia and Critical Care, Faculty of Medical Technology, University of Zawia,
Libya
| | | | - TC Marufu
- Nottingham Children’s Hospital and Neonatology, Queens Medical Centre, Nottingham University Hospital,
United Kingdom
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Ibarra-Pérez R, Puértolas-Balint F, Lozano-Cruz E, Zamora-Gómez SE, Castro-Pastrana LI. Intravenous Administration Errors Intercepted by Smart Infusion Technology in an Adult Intensive Care Unit. J Patient Saf 2021; 17:430-436. [PMID: 28368966 DOI: 10.1097/pts.0000000000000374] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of the study was to investigate the efficacy of intravenous (IV) smart pumps with drug libraries and dose error reduction system (DERS) to intercept programming errors entailing high risk for patients in an adult intensive care unit (ICU). METHODS A 2-year retrospective study was conducted in the adult ICU of the Hospital Juárez de México in Mexico City to evaluate the impact of IV smart pump/DERS (Hospira MedNet) technology implementation. We conducted a descriptive analysis of the reports generated by the system's software from April 2014 through May 2016. Our study focused on the upper hard limit alerts and used the systems' variance reports and IV Medication Harm Index methodology to determine the severity of the averted overdoses for medications with the highest number of edits. RESULTS The system monitored 124,229 infusion programs and averted on 36,942 deviations of the preset safe limits. Upper hard limit alerts accounted for 26.4% of pump reprogramming events. One hundred sixty-six significant administration errors were intercepted and prevented, and IV Medication Harm Index analysis identified 83 of them as highest-risk averted overdoses with insulin accounting for 51.8% of those. The rate of compliance with the safety software during the study period was 69.8%. CONCLUSIONS Our study contributes additional evidence of the impact of IV smart pump/DERS technology. These pumps effectively intercepted severe infusion errors and significantly prevented adverse drug events related to dosing. Our results support the implementation of this technology in ICUs as a minimum safety standard and could help drive an IV infusion safety initiative in Mexico.
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Affiliation(s)
- Rebecca Ibarra-Pérez
- From the Departamento de Ciencias Químico Biológicas, Universidad de las Américas Puebla, Cholula, Puebla
| | - Fabiola Puértolas-Balint
- From the Departamento de Ciencias Químico Biológicas, Universidad de las Américas Puebla, Cholula, Puebla
| | - Elizabeth Lozano-Cruz
- Hospital Juárez de México, Unidad de Cuidados Intensivos Adultos, Ciudad de México, México
| | - Sergio E Zamora-Gómez
- Hospital Juárez de México, Unidad de Cuidados Intensivos Adultos, Ciudad de México, México
| | - Lucila I Castro-Pastrana
- From the Departamento de Ciencias Químico Biológicas, Universidad de las Américas Puebla, Cholula, Puebla
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Artificial Intelligence for Identifying the Prevention of Medication Incidents Causing Serious or Moderate Harm: An Analysis Using Incident Reporters' Views. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179206. [PMID: 34501795 PMCID: PMC8431329 DOI: 10.3390/ijerph18179206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 12/04/2022]
Abstract
The purpose of this study was to describe incident reporters’ views identified by artificial intelligence concerning the prevention of medication incidents that were assessed, causing serious or moderate harm to patients. The information identified the most important risk management areas in these medication incidents. This was a retrospective record review using medication-related incident reports from one university hospital in Finland between January 2017 and December 2019 (n = 3496). Of these, incidents that caused serious or moderate harm to patients (n = 137) were analysed using artificial intelligence. Artificial intelligence classified reporters’ views on preventing incidents under the following main categories: (1) treatment, (2) working, (3) practices, and (4) setting and multiple sub-categories. The following risk management areas were identified: (1) verification, documentation and up-to-date drug doses, drug lists and other medication information, (2) carefulness and accuracy in managing medications, (3) ensuring the flow of information and communication regarding medication information and safeguarding continuity of patient care, (4) availability, update and compliance with instructions and guidelines, (5) multi-professional cooperation, and (6) adequate human resources, competence and suitable workload. Artificial intelligence was found to be useful and effective to classifying text-based data, such as the free text of incident reports.
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Medication administration evaluation and feedback tool: Inter-rater reliability in the clinical setting. Collegian 2021. [DOI: 10.1016/j.colegn.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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38
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Fernández-Peña A, Katsumiti A, De Basagoiti A, Castaño M, Ros G, Sautua S, De Miguel M, Campino A. Drug compatibility in neonatal intensive care units: gaps in knowledge and discordances. Eur J Pediatr 2021; 180:2305-2313. [PMID: 33738517 DOI: 10.1007/s00431-021-04028-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/19/2021] [Accepted: 03/10/2021] [Indexed: 11/28/2022]
Abstract
In this work, we reviewed the compatibility data of drug combinations frequently administrated in nine Spanish neonatal intensive care units (NICUs) and analyzed the degree of agreement among three highly used databases (Micromedex, King Guide to Parenteral Admixtures, and Stabilis) through Cohen's kappa coefficient statistical analysis. Among 1945 drug combinations analyzed, 283 were compatible, 421 were potentially compatible, 216 were incompatible, 139 were controversial, and there was no data for 886 combinations. In general, the three databases showed a strong degree of agreement: Micromedex vs. King Guide (κ = 0.746; p < 0.001), King Guide vs. Stabilis (κ = 0.743; p < 0.001), and Micromedex vs. Stabilis (κ = 0.691; p < 0.001). However, in 6 of 648 (Micromedex vs. King Guide), 3 of 357 (King Guide vs. Stabilis), and 32 of 606 (Micromedex vs. Stabilis) comparisons, drug pairs were compatible according to the first database and incompatible according to the second, indicating discordances among databases.Conclusion: There is a gap in knowledge about physical compatibility of a great number of drug combinations commonly used in NICUs. Although the three databases showed strong concordance, for some drug combinations, important discrepancies were found. Thus, there is a need for further studies on drug compatibility to increase safety of intravenous administration. What is Known: • Y site-administration in NICUs is very common and some administration errors are related to the lack of information on the compatibility of intravenous drugs. • Physical compatibility data of drugs frequently used in NICUs is still very limited. What is New: • Physical compatibility data of drug combinations commonly used in Spanish NICUs was reviewed in three highly used admixture databases: Micromedex, King Guide to Parenteral Admixtures and Stabilis, and our results showed a strong degree of agreement between them, however for some drug combinations, important discrepancies were found. • Our results indicated that there is still a large gap in knowledge about physical compatibility of a great number of drug combinations commonly used in NICUs..
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Affiliation(s)
- Alba Fernández-Peña
- Osakidetza Basque Health Service, Cruces University Hospital, Department of Hospital Pharmacy, Barakaldo, Spain
| | | | - Amaya De Basagoiti
- Osakidetza Basque Health Service, Cruces University Hospital, Department of Hospital Pharmacy, Barakaldo, Spain.,Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Mikel Castaño
- Osakidetza Basque Health Service, Cruces University Hospital, Department of Hospital Pharmacy, Barakaldo, Spain
| | - Goizane Ros
- Osakidetza Basque Health Service, Cruces University Hospital, Department of Hospital Pharmacy, Barakaldo, Spain
| | - Saioa Sautua
- Osakidetza Basque Health Service, Cruces University Hospital, Department of Hospital Pharmacy, Barakaldo, Spain
| | - Monike De Miguel
- Osakidetza Basque Health Service, Cruces University Hospital, Department of Hospital Pharmacy, Barakaldo, Spain.,Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Ainara Campino
- Osakidetza Basque Health Service, Cruces University Hospital, Department of Hospital Pharmacy, Barakaldo, Spain. .,Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.
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Karahan Okuroglu G, Şahin Orak N, Mamedov F, Ecevit Alpar Ş. Development and Validation of the Safe Parenteral Medication Administration Self-Efficacy Scale. J Contin Educ Nurs 2021; 52:267-273. [PMID: 34048296 DOI: 10.3928/00220124-20210514-05] [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: 11/20/2022]
Abstract
BACKGROUND This study aimed to develop a valid and reliable measurement instrument for determining the self-efficacy perceptions of nurses concerning safe medication practices. METHOD The study was conducted at the hospital of a state university in Istanbul, Turkey, between August and December 2016. The sample consisted of 278 nurses. RESULTS The exploratory factor analysis indicated the scale had a single-factor structure that explained 47.92% of the total variance. The remaining 76 items had factor loads ranging from .50 to .87. The item-total correlations varied between .49 and .86, and Cronbach's alpha coefficient for the scale was .98. CONCLUSION The results of the analysis show the items constituting the scale have validity and reliability criteria that can measure the self-efficacy of nurses related to parenteral medication administration. [J Contin Educ Nurs. 2021;52(6):267-273.].
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40
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[An analysis of medication errors in patients admitted to surgery rooms and post-anesthetic recovery at a high-complexity hospital in Bogota, Colombia]. Salud Colect 2021; 17:e3155. [PMID: 34105334 DOI: 10.18294/sc.2021.3155] [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: 09/08/2020] [Accepted: 03/01/2021] [Indexed: 11/24/2022] Open
Abstract
Medication errors represent one of the main causes of incidents and adverse events during the perioperative period. Therefore, this study analyzes errors before, during, and after the administration of general anesthesia for abdominal surgery at a high-complexity hospital in Bogota, Colombia. A descriptive cross-sectional study was conducted with 390 patients between January and September 2019. Of the 3,677 medication administrations, some type of error was made in 60% of cases, mostly in emergency surgeries. The pharmacological group with the most errors was general anesthetics, with 32%. All identified errors constituted situations with harm potential, indicating the need to promote the standardization of activities involving the use of medications and a culture of healthcare safety in order to avoid adverse events.
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Ng YYY, Wan PW, Chan KP, Sim GG. Give Intravenous Bolus Overdose a Brake: User Experience and Perception of Safety Device. J Patient Saf 2021; 17:108-113. [PMID: 32925570 PMCID: PMC7908856 DOI: 10.1097/pts.0000000000000770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Drugs can come in concentrated solutions that require dilution before intravenous bolus administration. Upon dilution, the syringe can contain more than the required amount of drug. The user may mistakenly administer the full contents of the syringe, resulting in an overdose. In this cross-sectional study, we evaluated user experience and perception of Syringe Brake, a dosage flow restrictor device, as part of the intravenous morphine bolus administration workflow. METHODS From December 2018 to January 2019, doctors and nurses working in the emergency department of 3 public tertiary hospitals in Singapore were invited to complete a paper-based 11-item 5-point Likert scale survey questionnaire after 3 months of Syringe Brake implementation. RESULTS Overall, 77.5% (290/374; 4.11 ± 0.83) of participants were satisfied with the use of Syringe Brake to prevent medication error. Our survey results showed that the top features of Syringe Brake were ease of setting the desired volume to be administered (86.1%; 4.21 ± 0.72), allowing the drug to be titrated safely (84.8%; 4.26 ± 0.77), and giving users the confidence to avoid overdosing the patient (82.1%; 4.21 ± 0.78). Those with hands-on experience with Syringe Brake rated significantly higher for all survey statements except on the perceived ability to prevent error arising from miscommunication (adjusted odds ratio, 1.58 [0.98-2.57]; P = 0.062). CONCLUSIONS Syringe Brake shows promising potential for adoption to prevent medication errors. The device serves as a constraint to prevent accidental overdose, caused by user unfamiliarity or autopilot administration.
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Affiliation(s)
| | - Paul Weng Wan
- Department of Emergency Medicine, Singapore General Hospital
| | - Kim Poh Chan
- Department of Emergency Medicine, Sengkang General Hospital
| | - Guek Gwee Sim
- Department of Accident and Emergency, Changi General Hospital, Singapore
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Risk of Patient Harm Related to Unnecessary Dilution of Ready-to-Administer Prefilled Syringes: A Literature Review. JOURNAL OF INFUSION NURSING 2021; 43:146-154. [PMID: 32287169 DOI: 10.1097/nan.0000000000000366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Unnecessary dilution of ready-to-administer (RTA) syringes could increase the risk of patient harm attributed to errors related to incorrect dose, improper labeling, and the potential for microbial contamination. Although published guidelines endorse the use of commercially available RTA syringes, recent surveys indicate that best practices are not always implemented. The purpose of this article is to review the existing literature and to assess the incidence and nature of errors related to the unnecessary dilution of RTA intravenous (IV) push medications in the inpatient clinical setting. The PubMed database was searched to identify studies of errors related to the use of RTA syringes for IV push medications within the last 10 years. An additional search was conducted using other search engines to identify relevant articles in the grey literature. This literature review concludes that unnecessary dilution of IV push medication in RTA syringes is an unsafe practice that occurs routinely. This practice increases the risk of patient harm through errors related to incorrect dose, improper labeling of syringes, and the potential for microbial contamination of the product. Greater awareness of the risks associated with unnecessary dilution of RTA syringes is still needed to eliminate this unsafe IV push medication administration practice and to thereby further improve outcomes.
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43
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Gona OJ, Shambu SK, Madhan R. Frequency and nature of drug‐related problems in patients with acute coronary syndrome: role of the clinical pharmacist in coronary care practice. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2021. [DOI: 10.1002/jppr.1684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Oliver Joel Gona
- Research Scholar Department of Pharmacy Practice JSS College of Pharmacy JSS Academy of Higher Education and Research Mysore India
| | - Sunil Kumar Shambu
- Department of Cardiology JSS Medical College and Hospital JSS Academy of Higher Education and Research Mysore India
| | - Ramesh Madhan
- Department of Pharmacy Practice JSS College of Pharmacy JSS Academy of Higher Education and Research Mysore India
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44
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Njung'e WW, Kamolo EK. Nurses’ knowledge regarding intravenous fluid therapy at a County hospital in Kenya. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Tsegaye D, Alem G, Tessema Z, Alebachew W. Medication Administration Errors and Associated Factors Among Nurses. Int J Gen Med 2020; 13:1621-1632. [PMID: 33376387 PMCID: PMC7764714 DOI: 10.2147/ijgm.s289452] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/16/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Medication error has the potential to lead to harm to the patient. It is the leading cause of threatens trust in the healthcare system, induce corrective therapy, and prolong patients' hospitalization, produces extra costs and even death. This study aimed to assess medication administration error (MAE) and associated factors among nurses in referral hospitals of Ethiopia. METHODS Institutional-based, cross-sectional study design was used, and 422 study participants were selected using a simple random sampling method. Data were collected using a semi-structured and pre-tested self-administered questionnaire and observational checklist. The collected data were analyzed using descriptive and analytical statistics and binary logistic regression was done to identify factors associated with medication administration errors. P-value ≤ 0.05 was considered statistically significant. RESULTS Four hundred fourteen participants with a response rate of 98.1% were involved and 54.3% were females. The median age was 30 with IQR (28-34) years and the majority of them (83.8%) had BSc qualification in nursing. The prevalence of MAE in this study was 57.7% and 30.4% of them made it more than three times. Wrong time (38.6%), wrong assessment (27.5%), and wrong evaluation (26.1%) were the most frequently perpetuated medication administration errors. Significant association between medication administration errors and lack of training [AOR=2.20; 95% CI (1.09, 4.46)], unavailability of guideline [AOR=1.65; 95% CI (1.03, 2.79)], poor communication when face problem [AOR=3.31; 95% CI (2.04, 5.37)], interruption [AOR = 3.37, 95% CI (2.15, 5.28)] and failure to follow medication administration rights [AOR=1.647; 95% CI (1.00, 2.49)] was noticed. CONCLUSION MAE was high in the study area as compared to studies from Jimma University Specialized Hospital, Adigrat and Mekelle University Hospital, and the University of Gondar Referral Hospital and hence developing guidelines, providing training, and develop strategies to minimize distracters are better to be undertaken.
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Affiliation(s)
- Dejene Tsegaye
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Girma Alem
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Zenaw Tessema
- Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Wubet Alebachew
- Department of Maternal and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Berg TA, Li X, Sawhney R, Wyatt T. Agent-Based Modeling Simulation of Nurse Medication Administration Errors. Comput Inform Nurs 2020; 39:187-197. [PMID: 33787523 DOI: 10.1097/cin.0000000000000684] [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: 10/23/2022]
Abstract
It has been 20 years since the National Academy of Medicine released its report, "To Err Is Human," which shocked the healthcare community on the pervasiveness of medical error. While errors in medication administration are a significant contributor to medical error, research seeking to understand the complex systems nature and occurrence of medication administration error is limited. Computer modeling is increasingly being used in the healthcare industry to assess the impact of changes made to healthcare processes. The objective of the study is to evaluate the use of agent-based modeling, a type of computer modeling that allows the simulation of virtual individuals and their behavior, to simulate nurse performance in the medication administration process. The model explores the effect of Just-in-Time information, as an intervention, on the occurrence of medication error. The model demonstrated significant utility in understanding the interplay of the system elements of the nurse medication administration process. Therefore this approach, using systems-level computer simulation such as agent-based models, can help administrators understand the effects of changes to the medication administration process as they work to reduce errors and increase performance.
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Affiliation(s)
- Thomas A Berg
- Author Affiliations: Health Innovation Technology Simulation Laboratory, College of Nursing (Drs Berg and Wyatt), and Health Innovation Technology Simulation Laboratory Industrial and Systems Engineering (Dr Li) and Industrial and Systems Engineering (Dr Sawhney), College of Engineering, The University of Tennessee-Knoxville
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Howlett MM, Breatnach CV, Brereton E, Cleary BJ. Direct Observational Study of Interfaced Smart-Pumps in Pediatric Intensive Care. Appl Clin Inform 2020; 11:659-670. [PMID: 33027835 DOI: 10.1055/s-0040-1716527] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Processes for delivery of high-risk infusions in pediatric intensive care units (PICUs) are complex. Standard concentration infusions (SCIs), smart-pumps, and electronic prescribing are recommended medication error reduction strategies. Implementation rates in Europe lag behind those in the United States. Since 2012, the PICU of an Irish tertiary pediatric hospital has been using a smart-pump SCI library, interfaced with electronic infusion orders (Philips ICCA). The incidence of infusion errors is unknown. OBJECTIVES To determine the frequency, severity, and distribution of smart-pump infusion errors in PICUs. METHODS Programmed infusions were directly observed at the bedside. Parameters were compared against medication orders and autodocumented infusion data. Identified deviations were categorized as medication errors or discrepancies. Error rates (%) were calculated as infusions with errors and errors per opportunities for error (OEs). Predefined definitions, multidisciplinary consensus and grading processes were employed. RESULTS A total of 1,023 infusions for 175 patients were directly observed over 27 days between February and September 2017. The drug library accommodated 96.5% of infusions. Compliance with the drug library was 98.9%. A total of 133 infusions had ≥1 error (13.0%); a further 58 (5.7%) had ≥1 discrepancy. From a total of 4,997 OEs, 153 errors (3.1%) and 107 discrepancies (2.1%) were observed. Undocumented bolus doses were most commonly identified (n = 81); this was the only deviation in 36.1% (n = 69) of infusions. Programming errors were rare (0.32% OE). Errors were minor, with just one requiring minimal intervention to prevent harm. CONCLUSION The error rates identified are low compared with similar studies, highlighting the benefits of smart-pumps and autodocumented infusion data in PICUs. A range of quality improvement opportunities has been identified.
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Affiliation(s)
- Moninne M Howlett
- Department of Pharmacy, Children's Health Ireland at Crumlin, Dublin, Ireland.,School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland.,National Children's Research Centre, Crumlin, Dublin, Ireland
| | - Cormac V Breatnach
- Department of Paediatric Intensive Care, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Erika Brereton
- Department of Paediatric Intensive Care, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Brian J Cleary
- School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Pharmacy, The Rotunda Hospital, Parnell Square, Dublin, Ireland
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Zero-order drug delivery: State of the art and future prospects. J Control Release 2020; 327:834-856. [PMID: 32931897 DOI: 10.1016/j.jconrel.2020.09.020] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 01/21/2023]
Abstract
Pharmaceutical drugs are an important part of the global healthcare system, with some estimates suggesting over 50% of the world's population takes at least one medication per day. Most drugs are delivered as immediate-release formulations that lead to a rapid increase in systemic drug concentration. Although these formulations have historically played an important role, they can be limited by poor patient compliance, adverse side effects, low bioavailability, or undesirable pharmacokinetics. Drug delivery systems featuring first-order release kinetics have been able to improve pharmacokinetics but are not ideal for drugs with short biological half-lives or small therapeutic windows. Zero-order drug delivery systems have the potential to overcome the issues facing immediate-release and first-order systems by releasing drug at a constant rate, thereby maintaining drug concentrations within the therapeutic window for an extended period of time. This release profile can be used to limit adverse side effects, reduce dosing frequency, and potentially improve patient compliance. This review covers strategies being employed to attain zero-order release or alter traditionally first-order release kinetics to achieve more consistent release before discussing opportunities for improving device performance based on emerging materials and fabrication methods.
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Ni Y, Lingren T, Huth H, Timmons K, Melton K, Kirkendall E. Integrating and Evaluating the Data Quality and Utility of Smart Pump Information in Detecting Medication Administration Errors: Evaluation Study. JMIR Med Inform 2020; 8:e19774. [PMID: 32876578 PMCID: PMC7495258 DOI: 10.2196/19774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/01/2020] [Accepted: 07/03/2020] [Indexed: 11/16/2022] Open
Abstract
Background At present, electronic health records (EHRs) are the central focus of clinical informatics given their role as the primary source of clinical data. Despite their granularity, the EHR data heavily rely on manual input and are prone to human errors. Many other sources of data exist in the clinical setting, including digital medical devices such as smart infusion pumps. When incorporated with prescribing data from EHRs, smart pump records (SPRs) are capable of shedding light on actions that take place during the medication use process. However, harmoniz-ing the 2 sources is hindered by multiple technical challenges, and the data quality and utility of SPRs have not been fully realized. Objective This study aims to evaluate the quality and utility of SPRs incorporated with EHR data in detecting medication administration errors. Our overarching hypothesis is that SPRs would contribute unique information in the med-ication use process, enabling more comprehensive detection of discrepancies and potential errors in medication administration. Methods We evaluated the medication use process of 9 high-risk medications for patients admitted to the neonatal inten-sive care unit during a 1-year period. An automated algorithm was developed to align SPRs with their medica-tion orders in the EHRs using patient ID, medication name, and timestamp. The aligned data were manually re-viewed by a clinical research coordinator and 2 pediatric physicians to identify discrepancies in medication ad-ministration. The data quality of SPRs was assessed with the proportion of information that was linked to valid EHR orders. To evaluate their utility, we compared the frequency and severity of discrepancies captured by the SPR and EHR data, respectively. A novel concordance assessment was also developed to understand the detec-tion power and capabilities of SPR and EHR data. Results Approximately 70% of the SPRs contained valid patient IDs and medication names, making them feasible for data integration. After combining the 2 sources, the investigative team reviewed 2307 medication orders with 10,575 medication administration records (MARs) and 23,397 SPRs. A total of 321 MAR and 682 SPR dis-crepancies were identified, with vasopressors showing the highest discrepancy rates, followed by narcotics and total parenteral nutrition. Compared with EHR MARs, substantial dosing discrepancies were more commonly detectable using the SPRs. The concordance analysis showed little overlap between MAR and SPR discrepan-cies, with most discrepancies captured by the SPR data. Conclusions We integrated smart infusion pump information with EHR data to analyze the most error-prone phases of the medication lifecycle. The findings suggested that SPRs could be a more reliable data source for medication error detection. Ultimately, it is imperative to integrate SPR information with EHR data to fully detect and mitigate medication administration errors in the clinical setting.
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Affiliation(s)
- Yizhao Ni
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Todd Lingren
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Hannah Huth
- Wake Forest Center for Healthcare Innovation, Wake Forest School of Medicine, Winston Salem, NC, United States.,Indiana University, Bloomington, IN, United States
| | - Kristen Timmons
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Krisin Melton
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.,Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Eric Kirkendall
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.,Wake Forest Center for Healthcare Innovation, Wake Forest School of Medicine, Winston Salem, NC, United States.,Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, NC, United States
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Su WTK, Lehto MR, Degnan DD, Yih Y, Duffy VG, DeLaurentis P. Healthcare Professionals Risk Assessments for Alert Overrides in High-Risk IV Infusions Using Simulated Scenarios. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2020; 40:1342-1354. [PMID: 32339316 DOI: 10.1111/risa.13489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 03/02/2020] [Accepted: 03/18/2020] [Indexed: 06/11/2023]
Abstract
This study aimed to use healthcare professionals' assessments to calculate expected risk of intravenous (IV) infusion harm for simulated high-risk medications that exceed soft limits and to investigate the impact of relevant risk factors. We designed 30 infusion scenarios for four high-risk medications, propofol, morphine, insulin, and heparin, infused in adult intensive care unit (AICU) and adult medical and surgical care unit (AMSU). A total of 20 pharmacists and 5 nurses provided their assessed expected risk of harm in each scenario. Descriptive statistics, analysis of variance with least square mean, and post hoc test were conducted to test the effects of field limit type, soft (SoftMax), and hard maximum drug limit types (HardMax), and care area-medication combination on risk of harm. The results showed that overdosing scenarios with continuous and bolus dose limit types were assessed with significantly higher risks than those of bolus dose rate type. An overdose infusion in AICU over a large SoftMax was assessed to be of higher risk than over a small one, but not in AMSU. For overdose infusions with three levels of drug amount, greater drug amount in AICU and AMSU was assessed to have higher risk, except insignificant risk difference between the infusions with higher and moderate drug amount in AMSU. This study obtained expected risk for simulated high-risk IV infusions and found that different field limit and SoftMax types can affect expected risk based on healthcare professionals' perspectives. The findings will be regarded as benchmarks for validating risk quantification models in future research.
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Affiliation(s)
- Wan-Ting K Su
- Department of Public Health Sciences, Henry Ford Health System, One Ford Place, Detroit, MI, USA
| | - Mark R Lehto
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
| | - Dan D Degnan
- Professional Programs Laboratory, Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, USA
- Regenstrief Center for Healthcare Engineering, Purdue University, Gerald D. and Edna E. Mann Hall, West Lafayette, IN, USA
| | - Yuehwern Yih
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
- Regenstrief Center for Healthcare Engineering, Purdue University, Gerald D. and Edna E. Mann Hall, West Lafayette, IN, USA
| | - Vincent G Duffy
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
| | - Poching DeLaurentis
- Regenstrief Center for Healthcare Engineering, Purdue University, Gerald D. and Edna E. Mann Hall, West Lafayette, IN, USA
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