Systematic evaluation of errors occurring during the preparation of intravenous medication
Open Access
- 1 January 2008
- journal article
- Published by CMA Impact Inc. in CMAJ : Canadian Medical Association Journal
- Vol. 178 (1), 42-48
- https://doi.org/10.1503/cmaj.061743
Abstract
Introduction: Errors in the concentration of intravenous medications are not uncommon. We evaluated steps in the infusion-preparation process to identify factors associated with preventable medication errors. Methods: We included 118 health care professionals who would be involved in the preparation of intravenous medication infusions as part of their regular clinical activities. Participants performed 5 infusion-preparation tasks (drug-volume calculation, rounding, volume measurement, dose-volume calculation, mixing) and prepared 4 morphine infusions to specified concentrations. The primary outcome was the occurrence of error (deviation of > 5% for volume measurement and > 10% for other measures). The secondary outcome was the magnitude of error. Results: Participants performed 1180 drug-volume calculations, 1180 rounding calculations and made 1767 syringe-volume measurements, and they prepared 464 morphine infusions. We detected errors in 58 (4.9%, 95% confidence interval [CI] 3.7% to 6.2%) drug-volume calculations, 30 (2.5%, 95% CI 1.6% to 3.4%) rounding calculations and 29 (1.6%, 95% CI 1.1% to 2.2%) volume measurements. We found 7 errors (1.6%, 95% CI 0.4% to 2.7%) in drug mixing. Of the 464 infusion preparations, 161 (34.7%, 95% CI 30.4% to 39%) contained concentration errors. Calculator use was associated with fewer errors in dose-volume calculations (4% v. 10%, p = 0.001). Four factors were positively associated with the occurence of a concentration error: fewer infusions prepared in the previous week (p = 0.007), increased number of years of professional experience (p = 0.01), the use of the more concentrated stock solution (p < 0.001) and the preparation of smaller dose volumes (p < 0.001). Larger magnitude errors were associated with fewer hours of sleep in the previous 24 hours (p = 0.02), the use of more concentrated solutions (p < 0.001) and preparation of smaller infusion doses (p < 0.001). Interpretation: Our data suggest that the reduction of provider fatigue and production of pediatric-strength solutions or industry-prepared infusions may reduce medication errors.Keywords
This publication has 34 references indexed in Scilit:
- In-house, overnight physician staffing: A cross-sectional survey of Canadian adult and pediatric intensive care units*Critical Care Medicine, 2006
- Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry SystemPublished by American Academy of Pediatrics (AAP) ,2005
- Managing fatigue: It's about sleepSleep Medicine Reviews, 2005
- Discrepancies between ordered and delivered concentrations of opiate infusions in critical careCritical Care Medicine, 2003
- Reengineering Intravenous Drug and Fluid Administration Processes in the Operating RoomAnesthesiology, 2002
- Random and systematic medication errors in routine clinical practice: a multicentre study of infusions, using acetylcysteine as an exampleBritish Journal of Clinical Pharmacology, 2001
- Stability of morphine sulphate in saline under simulated patient administration conditionsJournal of Clinical Pharmacy & Therapeutics, 1997
- The Economics of a Pharmacy-Based Central Intravenous Additive Service for Paediatric PatientsPharmacoEconomics, 1996
- Age-related amrinone pharmacokinetics in a pediatric populationCritical Care Medicine, 1994
- Accuracy and Variability of Intravenous Theophylline PreparationsTherapeutic Drug Monitoring, 1990