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Nunes GDK, Antunes LMS, da Silva RN, da Silva RC. Labelling of intravenous drug delivery devices in critically ill patients: A scoping review. Nurs Crit Care 2024; 29:274-286. [PMID: 37882508 DOI: 10.1111/nicc.12994] [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: 05/08/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Labelling is a strategy that contributes to the correct and faster identification of drugs, minimizing misidentification. There is a gap in knowledge on optimal labelling standards for intravenous (IV) devices applied to the care of critically ill patients. AIM The goal of this article was to map existing knowledge on the labelling of IV drug delivery devices in critically ill patients for the prevention of medication errors. STUDY DESIGN This was a scoping review conducted according to the JBI methodology in the LILACS, MEDLINE, CINAHL, IBECS, Scopus, Embase and Web of Science databases, and on the websites of specialized institutions. Searches were conducted up to December 2022 for scientific articles and grey literature that addressed the labelling of IV devices in intensive care units, emergency departments, and anaesthesia units. The data were collected using a structured form and were later classified, summarized, and aggregated to map the knowledge related to the review question. RESULTS Twenty-one documents were included, which demonstrated variability in label use with IV drug delivery devices. The following features of structure and design stood out: printed format, colour coding, letter size differentiation, and the use of sturdy material. In terms of information, the name of the drug, dose, date and time of preparation, identification of the patient, and who prepared it were found. CONCLUSIONS The identified patterns contributed to the reduction of drug misidentification and the development of timelier drug labelling and administration. RELEVANCE TO CLINICAL PRACTICE The evidence supports the development of standardized labels for the prevention of medication errors.
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Affiliation(s)
- Geovane de Kassio Nunes
- Federal University of Rio de Janeiro, Anna Nery School of Nursing, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lucas Malta Souza Antunes
- Federal University of Rio de Janeiro, Anna Nery School of Nursing, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rodrigo Nogueira da Silva
- Federal University of Rio de Janeiro, Anna Nery School of Nursing, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafael Celestino da Silva
- Federal University of Rio de Janeiro, Anna Nery School of Nursing, Rio de Janeiro, Rio de Janeiro, Brazil
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Gilliot S, Martin Mena A, Genay S, Masse M, Thibaut M, Carta N, Lannoy D, Négrier L, Barthélémy C, Décaudin B, Odou P. Factors influencing accuracy when preparing injectable drug concentrations in appliance with clinical practice: a norepinephrine case study. Eur J Hosp Pharm 2024; 31:168-170. [PMID: 35882533 PMCID: PMC10895172 DOI: 10.1136/ejhpharm-2022-003358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/12/2022] [Indexed: 11/04/2022] Open
Abstract
Errors in injectable preparations with high-risk drugs can be fatal. This study aimed to identify the factors influencing the accuracy of high-risk injectable drug concentrations in appliances used for intensive care unit preparation practices. Norepinephrine (NE) was chosen as an example of a high-risk medication drug. The concentration (0.2 and 0.5 mg/mL), the diluent (sodium chloride 0.9% and 5% dextrose), and the container type (prefilled- and empty-infusion bag and syringe) were tested as potential variability factors. An ultraviolet spectrophotometric method was used for NE dosage. 108 NE solutions were prepared by five individuals (pharmacists or laboratory technicians) with clinical experience as well as experience in the aseptic preparation of solutions. The container type was found to be the only factor influencing the accuracy of NE concentration. NE solutions in syringes proved to be the most accurate while preparations in prefilled bags tended to underdose NE.
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Affiliation(s)
- Sixtine Gilliot
- Institute of Pharmacy, CHRU Lille Pôle Spécialités Médicochirurgicales, Lille, Hauts-de-France, France
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
| | - Anthony Martin Mena
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
| | - Stéphanie Genay
- Institute of Pharmacy, CHRU Lille Pôle Spécialités Médicochirurgicales, Lille, Hauts-de-France, France
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
| | - Morgane Masse
- Institute of Pharmacy, CHRU Lille Pôle Spécialités Médicochirurgicales, Lille, Hauts-de-France, France
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
| | - Manon Thibaut
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
| | - Natacha Carta
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
| | - Damien Lannoy
- Institute of Pharmacy, CHRU Lille Pôle Spécialités Médicochirurgicales, Lille, Hauts-de-France, France
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
| | - Laura Négrier
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
| | - Christine Barthélémy
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
| | - Bertrand Décaudin
- Institute of Pharmacy, CHRU Lille Pôle Spécialités Médicochirurgicales, Lille, Hauts-de-France, France
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
| | - Pascal Odou
- Institute of Pharmacy, CHRU Lille Pôle Spécialités Médicochirurgicales, Lille, Hauts-de-France, France
- ULR-7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, Lille, Hauts-de-France, France
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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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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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Keuler N, Bouwer A, Coetzee R. Pharmacists' Approach to Optimise Safe Medication Use in Paediatric Patients. PHARMACY 2021; 9:pharmacy9040180. [PMID: 34842828 PMCID: PMC8628964 DOI: 10.3390/pharmacy9040180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/02/2021] [Accepted: 10/09/2021] [Indexed: 11/22/2022] Open
Abstract
Paediatric patients are unique, yet challenging patients to care for by pharmacists. Paediatric medicine use requires special consideration. Pharmacists play an important role in educating and counselling patients, carers, and healthcare workers. Further, pharmacists have the necessary knowledge and skills to optimise safe medicine use in paediatric patients. This article provides basic principles for safe practices in paediatric medicine by following the nine rights of medication administration.
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Affiliation(s)
- Nicole Keuler
- School of Pharmacy, University of the Western Cape, Cape Town 7535, South Africa;
- Correspondence:
| | - Annatjie Bouwer
- Centralized Monitoring Solutions, IQVIA, Bloemfontein 9301, South Africa;
| | - Renier Coetzee
- School of Pharmacy, University of the Western Cape, Cape Town 7535, South Africa;
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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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Investigation of interventions to reduce nurses' medication errors in adult intensive care units: A systematic review. Aust Crit Care 2021; 35:466-479. [PMID: 34353726 DOI: 10.1016/j.aucc.2021.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 05/19/2021] [Accepted: 05/23/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Medication errors in adult intensive care units (ICUs) are both frequent and harmful. For nurses, these errors may be multifactorial and multidisciplinary, extending from prescription stage to monitoring of patient response to medication. Therefore, diverse interventions have been developed to optimise the medication process to prevent such errors. OBJECTIVES The objective of this systematic review was to identify research investigating interventions that may be effective in reducing the rate of nurses' medication errors in adult ICUs. METHODS A systematic search was undertaken of three databases: Cumulative Index of Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online, and EMCARE using a combination of key terms related to "medication errors", "nurses", "interventions", and "intensive care units". The search was limited to studies published in English between 2009 and 2019. Independent screening, quality appraisal, and data extraction were undertaken by two reviewers. RESULTS A total of 464 records were identified from database searches. Eleven studies met inclusion criteria: ten were quasi-experimental designs and one was a randomised controlled trial. Studies examined six types of interventions: prefilled syringes, barcode-assisted medication administration, an automated dispensing system, nursing education programs, a protocolised program logic form, and a preventive interventions program with protocols and pharmacist-supported supervision and monitoring. Findings revealed that a prefilled syringe, nurses' education programs, and the protocolised program logic form were most effective in reducing medication errors. For the barcode-assisted medication administration, automated dispensing systems, and a preventive interventions program with protocols and pharmacist-supported supervision and monitoring, results showed wide variability in effectiveness. CONCLUSION This review found that the evidence for effective interventions to reduce nurses' medication errors in adult ICUs is limited, due largely to inconsistencies in research design and methods. Therefore, further studies such as randomised controlled trials focusing on a single intervention are required to provide robust evidence of the effectiveness of interventions.
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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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Kurttila M, Saano S, Laaksonen R. Describing voluntarily reported fluid therapy incidents in the care of critically ill patients: Identifying, and learning from, points of risk at the national level. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 2:100012. [PMID: 35481122 PMCID: PMC9030324 DOI: 10.1016/j.rcsop.2021.100012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 11/18/2022] Open
Abstract
Background Fluid therapy is a common intervention in critically ill patients. Fluid therapy errors may cause harm to patients. Thus, understanding of reported fluid therapy incidents is required in order to learn from them and develop protective measures, including utilizing expertise of pharmacists and technology to improve patient safety at the national level. Objectives To describe fluid therapy incidents voluntarily reported in intensive care and high dependency units (ICUs) to a national incident reporting system, by investigating the error types, fluid products, consequences to patients and actions taken to alleviate them, and to identify at which phase of the medication process the incidents had occurred and had been detected. Methods Medication related voluntarily reported incident (n = 7623) reports were obtained from all ICUs in 2007–2017. Incidents concerning fluid therapy (n = 2201) were selected. The retrospective analysis utilized categorized data and narrative descriptions of the incidents. The results were expressed as frequencies and percentages. Results Most voluntarily reported incidents had occurred during the dispensing/preparing phase (n = 1306, 59%) of the medication process: a point of risk. Most incidents (n = 1975, 90%) had reached the patient and passed through many phases in the medication process and nursing shift change checks before detection. One third of the errors (n = 596, 30%) were reported to have caused consequences to patients. One quarter (n = 492, 25%) of the errors were reported to have required an additional procedure to alleviate or monitor the consequences. Conclusions Utilizing national incident report data enabled identifying systemic points of risk in the medication process and learning to improve patient safety. To prevent similar incidents, initial interventions should focus on the dispensing/preparing phase before implementing active medication identification procedures at each phase of the medication process and nursing shift changes. Strengthening clinical pharmacy services, utilizing technology, coordinated by IV Fluid Coordinators and Medication Safety Officers, could improve patient safety in the ICUs.
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Affiliation(s)
- Minna Kurttila
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland
- KUH Pharmacy, Hospital Pharmacy of Kuopio University Hospital (KUH), Finland
- Corresponding author at: KUH Pharmacy, Hospital Pharmacy of Kuopio University Hospital (KUH), PL 100, 70029 KYS, Finland.
| | - Susanna Saano
- KUH Pharmacy, Hospital Pharmacy of Kuopio University Hospital (KUH), Finland
| | - Raisa Laaksonen
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland
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