Procedural and documentation variations in intravenous infusion administration: a mixed methods study of policy and practice across 16 hospital trusts in England

Dominic Furniss,Imogen Lyons,Ann Blandford,Anna L Cox,Astrid Mayer,Bryony Dean Franklin,Gillian Chumbley,Galal Galal-Edeen,Jolien Vos,Li Wei

doi:10.1186/s12913-018-3025-x

Abstract

BackgroundProcedural and documentation deviations relating to intravenous (IV) infusion administration can have important safety consequences. However, research on such deviations is limited. To address this we investigated the prevalence of procedural and documentation deviations in IV infusion administration and explored variability in policy and practice across different hospital trusts.MethodsWe conducted a mixed methods study. This involved observations of deviations from local policy including quantitative and qualitative data, and focus groups with clinical staff to explore the causes and contexts of deviations. The observations were conducted across five clinical areas (general medicine, general surgery, critical care, paediatrics and oncology day care) in 16 National Health Service (NHS) trusts in England. All infusions being administered at the time of data collection were included. Deviation rates for procedural and documentation requirements were compared between trusts. Local data collectors and other relevant stakeholders attended focus groups at each trust. Policy details and reasons for deviations were discussed.ResultsAt least one procedural or documentation deviation was observed in 961 of 2008 IV infusions (deviation rate 47.9%; 95% confidence interval 45.5–49.8%). Deviation rates at individual trusts ranged from 9.9 to 100% of infusions, with considerable variation in the prevalence of different types of deviation. Focus groups revealed lack of policy awareness, ambiguous policies, safety and practicality concerns, different organisational priorities, and wide variation in policies and practice relating to prescribing and administration of IV flushes and double-checking.ConclusionsDeviation rates and procedural and documentation requirements varied considerably between hospital trusts. Our findings reveal areas where local policy and practice do not align. Some policies may be impractical and lack utility. We suggest clearer evidence-based standardisation and local procedures that are contextually practical to address these issues.

Highlights

Procedural and documentation deviations relating to intravenous (IV) infusion administration can have important safety consequences
This study aims to investigate the prevalence of procedural and documentation deviations related to IV infusion administration as part of a larger study of IV medication administration practices across 16 National Health Service (NHS) trusts in England [4], and to explore variability in policy and practice across these trusts
Rates of deviation were affected by both the level of detail required by local policy and clinicians’ policy awareness

Summary

Introduction

Procedural and documentation deviations relating to intravenous (IV) infusion administration can have important safety consequences In 2007, recommendations were made in a Patient Safety Alert for England and Wales to reduce errors in injectable medicines, including risk-assessing procedures and products, reviewing protocols, providing technical information, competency-based training, and conducting an annual medicines management audit [5]. It highlighted how procedures should be “clearly documented, reflect local circumstances and describe safe practice that all practitioners can reasonably be expected to achieve. Ten years on from this alert, it is not known whether and how health care organisations have adapted their procedures in light of this advice or how well these procedures are adhered to in practice

Objectives

Methods

Results

Discussion

Conclusion