Parenteral Medication Administration Research Articles

Pharmacist administered parenteral medications: A descriptive report of an inpatient training program

AbstractIntroductionParenteral medication administration is a crucial aspect of in‐hospital patient care and has been historically managed by nurses and physicians. Despite pharmacists' extensive training in the medication use process, their underutilization in medication administration stems from various factors, including the lack of formalized training, limited awareness by other healthcare professionals, and unclear legal guidance. This report discusses the implementation and outcomes of a pharmacist medication administration program at a large academic medical center.MethodsThe initiative began by revising hospital policies, enabling pharmacists to administer medications during emergencies. Documentation and communication protocols were established. Training included an online module and hands‐on sessions covering various topics with a focus on parenteral medication administration and medication safety. Following completion of the program, competency of pharmacists was assessed by pharmacists experienced in intravenous administration using simulated patient case scenarios. Following implementation, the frequency and characteristics of pharmacist administered medications were captured and described.ResultsThirty pharmacists, including 11 residents, participated. Seven pharmacists administered 349 doses of medications to 284 patients in emergency situations. Administrations by pharmacists included 227 titratable infusions, 72 intermittent or continuous infusions, 49 intravenous pushes, and 1 intranasal naloxone. Classes of medications included high risk products such as vasopressors, sedatives, antiarrhythmics, and thrombolytics. No extravasations or infiltrations were reported.ConclusionImplementation of the pharmacist medication administration program signifies significant progress in strengthening the pharmacists' role in patient care at the bedside specifically highlighting the competency of pharmacists to administer parenteral products during emergency situations. The absence of adverse events highlights the feasibility and safety of integrating pharmacists into the bedside team. As the landscape of health‐system pharmacy evolves, embracing standardized training programs like ours reemphasize pharmacists' essential contributions to the multidisciplinary healthcare teams, ultimately enhancing patient care and safety.

Cannabis use among patients presenting to the emergency department for psychosis: Associations with restraint use, medication administration, psychiatric hospitalization, and repeat visits

Cannabis use is associated with increased severity of psychotic symptoms and the risk of acute agitation and aggressive behavior in inpatient (IP) and outpatient settings. Whether or not cannabis use is associated with increased acuity of psychosis-related ED presentations and risk of repeat ED visits for psychosis is unclear. In this retrospective study of 2,134 ED visits for acute psychosis, we investigated the risk of physical restraint, parenteral medication administration, psychiatric hospitalization, and recurrent ED visits. We examined ED visits between March 1, 2019 and February 28, 2021 based on urinary Tetrahydrocannabinol (THC) screen status (positive vs negative vs no screen). The risk of physical restraint, parenteral antipsychotic, and benzodiazepine administration was significantly greater in ED visits with a positive THC screen compared to those with a negative or no THC screen. We did not find an association between a positive urinary THC screen and IP hospitalization or the risk of recurrent ED presentation for psychosis within 90 days. These findings suggest that positive urinary THC may predict acute agitation or acuity of symptoms in ED settings and underscores the importance of screening for THC during ED presentations for psychosis.

PREVALENCE OF PHLEBITIS AMONG PATIENTS RECEIVING PERIPHERAL INTRAVENOUS THERAPY IN A TERTIARY CARE HOSPITAL IN INDIA

Background: Phlebitis is a common complication associated with the use of peripheral intravenous catheters. Main uses of a peripheral intravenous catheter are infusions, blood sampling, administration of parenteral medications and blood products. It is one of the commonly performed procedure in hospital. Almost all of hospital admissions lead to intravenous catheter placement. Aim:To assess the prevalence of phlebitis among patients on peripheral intravenous catheter and identify predisposing factors of phlebitis in patients. Methodology: 398adult patients in wards, with Peripheral intravenous catheter (PIVC) were included in the study during a period of 4 months. Catheter insertion site of these patients were observed for signs of phlebitis using Visual Infusion Phlebitis scale, until discharge or until the resite of next catheter. The data collection and analysis included patient demographic details and data related to catheter (including number of attempts during insertion, experience of staff performing the cannulation, reasons for removal etc.), as well as the data on the type of administered medications and intravenous therapy. Results:A total of 398 patients were enrolled, among which 228 were males and 170 were females. A total of 192 patients (48.24%) showed one or other early signs of phlebitis. Among these 192 patients with early signs of phlebitis, 128 patients (66.67%) had score 1 in VIP scale while 64 patients (20.47%) had score 2 and 3.Phlebitis was found to be associated with mobility status of the patients (<0.001). Conclusion:This study showed a high prevalence of phlebitis among inpatients in wards. However, most of these cases were mild Grade 1 phlebitis.Its crucial to train and upskill staffs on PIVC insertion and monitoring to ensure proper placement and assessment. Daily assessment of insertion site and need for PIVC and patient awareness on PIVC maintenance is crucial in prevention of phlebitis.

Development and Validation of the Safe Parenteral Medication Administration Self-Efficacy Scale.

This study aimed to develop a valid and reliable measurement instrument for determining the self-efficacy perceptions of nurses concerning safe medication practices. 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. 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. 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.].

Using simulation and inter-professional education to teach infection prevention during resuscitation

Introduction: During resuscitations, healthcare professionals (HCPs) find balancing the need for timely resuscitation and adherence to infection prevention (IP) measures difficult. This study explored the effects of an innovative teaching method, using in-situ simulation and inter-professional education to enhance compliance to IP through better inter-professional collaboration. Methods: The study was conducted in the Surgical Intensive Care Unit (SICU) in a 1200-beds teaching hospital. HCPs working in the SICU were conveniently allocated to the intervention or control group based on their work roster. The intervention group attended an in-situ simulated scenario on managing cardiac arrest in an infectious patient. The control group completed the standard institution-wide infection control eLearning module. Outcomes measured were: (a) attitudes towards inter-professional teamwork [TeamSTEPPS Teamwork Attitudes Questionnaire (TAQ)], (b) infection prevention knowledge test, (c) self-evaluated confidence in dealing with infectious patients and (d) intensive care unit (ICU) audits on infection prevention compliance during actual resuscitations. Results: 40 HCPs were recruited. 29 responded (71%) to the pre- and post-workshop questionnaires. There were no significant differences in the TeamSTEPPS TAQ and infection prevention knowledge score between the groups. However, ICU audits demonstrated a 60% improvement in IP compliance for endotracheal tube insertion and 50% improvement in parenteral medication administration. This may be attributed to the debriefing session where IP staff shared useful tips on compliance to IP measures during resuscitation and identified threats that could deter IP compliance in SICU. Conclusion: Learning infection prevention through simulated inter-professional education (IPE) workshops may lead to increased IP compliance in clinical settings.

Erros na administração de medicamentos via parenteral: Perspectiva dos técnicos de enfermagem

Resumo Objetivo: Analisar a compreensão dos técnicos de enfermagem sobre os erros e eventos adversos relacionados a administração de medicamentos via parenteral. Métodos: Estudo de abordagem qualitativa, descritivo e exploratório. Realizado com 25 técnicos de enfermagem em um hospital universitário do Nordeste no período de março a junho de 2017. Para coleta dos dados, utilizou-se um roteiro de entrevista com perguntas abertas. Na análise de dados utilizou-se o método da Classificação Hierárquica Descendente através do software IRAMUTEQ e para análise [...]

Mistriaged Advanced Life Support Patients in a Two-Tiered, Suburban Emergency Medical Services System.

IntroductionEmergency medical services (EMS) systems exist to provide prehospital care in diverse environments throughout the world. Advanced Life Support (ALS) services can provide advanced care including 12-lead electrocardiogram (ECG), endotracheal intubation and parenteral medication administration. Basic Life Support (BLS) can provide basic care such as splinting, wound care and cardiopulmonary resuscitation. ALS can release patients to BLS for transport to the hospital, and this is an area of high risk. Our study examines patients who were triaged and admitted to a critical care location, including an intensive care unit (ICU), cardiac catheterization laboratory, or operating room (OR).MethodsThe analysis included data from 2007–2015 of all patients who were triaged. We evaluated demographics, admission diagnoses, and dispositions using descriptive statistics. Diagnoses were grouped into categories based on the system.ResultsWe found that 372/17,639 (2%) of patients were mistriaged to BLS and admitted to a critical care location. The average age was 64. The most common diagnosis categories were neurological (24%), gastrointestinal (GI)/abdominal pain (15%), respiratory (12%), and cardiac (12%).ConclusionIt is uncommon for patients triaged from ALS to BLS to be admitted to an ICU, catheterization lab or OR, with a rate of 2%. Neurological, GI, respiratory, and cardiac diagnoses were the most frequent categories of patient complaints that were mistriaged. This study should lead to further studies to examine this patient population.

Using "Med Libs" to Review Principles of Parenteral Medication Administration.

Using "Med Libs" to Review Principles of Parenteral Medication Administration.

State of Rib Fracture Care: A NTDB Review of Analgesic Management and Surgical Stabilization

Thoracic analgesia plays a key role in management and outcomes of rib fractures and can generally be broken down into oral or parenteral medication administration and regional analgesia. Surgical stabilization of rib fractures (SSRF) may be an underused resource in the management of rib fractures. This study describes recent trends in rib fracture management and outcomes. National Trauma Data Bank datasets from 2008 to 2014 were reviewed. Patients with three or more rib fractures were identified, and the frequencies of epidural analgesia (EA), other regional analgesia, and SSRF were analyzed. Those older than 65 years were more likely to be admitted to the ICU but had shorter ICU length of stay, lower intubation, and need for tracheostomy rates. In addition, those older than 65 years had about 2.5 times higher mortality (6.3% vs 2.6%, P < 0.001). EA was used in only 3 per cent of the population and more commonly in the older than 65 years group (3.7% vs 2.8%, P < 0.001). Regardless of age, SSRF was more commonly performed when compared with the placement of EA (5.8% vs 3%). This difference was even greater in the younger than 65 years group, where 7 per cent underwent SSRF. Utilization of EA remains low nationally. SSRF should be considered not only for chest wall stabilization but also as an analgesic modality in selected patients. A more complete accounting of analgesic care in rib fracture patients is needed to allow a more detailed analysis of analgesia for rib fracture-related pain to elucidate optimal treatment.

Experiences with Lean Six Sigma as improvement strategy to reduce parenteral medication administration errors and associated potential risk of harm

In this controlled before-after study the effect of improvements, derived from Lean Six Sigma strategy, on parenteral medication administration errors and the potential risk of harm was determined.During baseline measurement,...

The effect of education intervention on parenteral medication preparation and administration among nurses in a general intensive care unit

AbstractThe preparation and administration of parenteral medications in intensive care units is associated with high error rates. Lack of knowledge has been identified as the main reason for these errors. This study aims to measure the effects of education intervention on the incidence and types of parenteral medication preparation and administration errors, adherence to good practices, and the accuracy of drug infusions' concentrations. This prospective, pre‐ and post‐interventional study was conducted in a General Intensive Care Unit of a tertiary teaching hospital in Malaysia using an observation method. The preparation and administration of parenteral medications by the nurses was observed directly during pre‐ and post‐intervention. The concentrations of drug infusions (noradrenaline) prepared by the nurses were analysed. The education intervention significantly reduced the error rate from 79% to 50% (p &lt; 0.001), and improved good practices' adherence. However, there was no significant difference in the concentration error rate of the drug infusions prepared in pre‐ (48%) and post‐intervention (53%) (p = 0.70). Future studies may look into the effectiveness of providing practical sessions targeting skills and technique to improve the quality of the drug infusions prepared.

Myeloablative Allogeneic Hematopoietic Cell Transplantation Performed without Routine Inpatient Admission: A Single Center Experience of 462 Consecutive Patients

Patients undergoing allogeneic hematopoietic cell transplants (Allo-HCT) using myeloablative preparative regimens are usually admitted to an inpatient transplant unit from the start of the conditioning regimen until hematopoietic recovery (on average 25-35 days). Historically, the rationale for routine inpatient care during this period has been the facilitation of administration of parenteral medications, prevention of mold infections and the monitoring and management of acute toxicities. However, advances in supportive care and other technologies may allow outpatient management during this period. We analyzed outcomes of all consecutive patients who underwent myeloablative allo-HCT as defined by the CIBMTR (Giralt 2009, BBMT) with planned total outpatient management at our center. Patient characteristics and outcome data were prospectively entered into our institutional database from which they were extracted for this analysis. Patients were scheduled to receive their conditioning regimen and post-transplant care in our purpose-built outpatient clinic. Patients received their stem cell infusion on the inpatient unit and were planned to be discharged home the same day except patients receiving haploidentical transplants who were planned to be discharged on day +5 to accommodate the early cytokine release syndrome commonly seen in such patients (Solomon BBMT 2012). Subsequent admissions were for significant complications necessitating inpatient management only. Our technical approach to total outpatient management of myeloablative allo-HCT was as previously described (Solomon BMT 2010, 45: 468-475). Patients (n=462) were transplanted consecutively between 4/08 and 12/15. Patient characteristics were: median age 46; male (53%); race - white 79%, black 18%, Asian 2%; diagnosis- AML 42%, ALL 21%, MDS/MPS 21%, NHL/HL/CLL 13%, other 3%; donor type - MRD 48%, MUD 35%, Haplo 17%, CBT <1%; graft source- PBSC 87%, BM 12%, BM+PBSC 1%; regimen-busulfan based 60%, TBI based 39%, other 1%; DRI -low 16%, intermediate 48%, high 26%, v. high 10%; HCT-CI- 0-2 (64%), ≥3(36%). The conditioning regimen was entirely delivered in the outpatient clinic as planned in 377 patients (82%). Of 85 (18%) patients who received some of their conditioning regimen in the inpatient setting, in 42(49%) this was to receive drugs not administrable or reimbursed in the outpatient setting, and in 43(51%) it was for management of toxicity. The majority of patients were discharged within 24 hours of stem cell infusion (311 -67%) with the median day of discharge for the remaining patients being d+13 (range d+2 to d+75). Following discharge after stem cell infusion, 82 patients (18%) were never readmitted, days to readmission for the remainder were 0-5 (40%), 6-9 (24%), > 10 (18%). For readmitted patients, most frequent reasons were - febrile neutropenia 33%, mucositis 29%, and lower GI toxicity 4.5%. Median total length of inpatient stay through d+100 was 16 d (range 1-98). Fungal infections were documented in only 3 patients (1%) through d +100. With a median follow-up for surviving patients of 52 months (6-218 months), K-M estimates of survival and DFS at 1 yr are 70% and 61% and at 4 years are 52% and 47% respectively. Cumulative incidences (CI) of non-relapse mortality (NRM) and relapse at 1 yr are 17% and 21% and at 4 yrs are 24% and 29% (Fig.1). CI of acute GVHD grade 2-4 and 3-4 at 6 months were 28% and 10%. CI of moderate to severe, and severe chronic GVHD at 4 years were 30% and 12%. On multivariate analysis, receipt of any part of the conditioning regimen as inpatient was a significant negative factor for survival (HR 1.99, p<0.001), DFS (HR 1.74, p =0.001) and NRM (HR 2.06, p=0.004). These data show that myeloablative allo-HCT performed without routine inpatient admission from conditioning through neutrophil recovery is feasible with low rates of NRM and fungal infection. Median total inpatient stay through d +100 can be reduced to 16 days and nearly 20% of patients can avoid any inpatient stay through d +100. With mature follow-up outcomes appear similar or superior to those commonly reported using a traditional inpatient approach. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

150 years in pursuit of optimal pain relief during labour.

Pharmacological relief of pain during childbirth has been both praised and vilified by the public and by physicians. When Simpson first described anaesthetising a woman for childbirth in 1847, strong criticism followed from the medical community and the public. Was it safe? Was it wise to intervene in a natural process? Would it affect the course of labour or the neonate? Simpson contended that pain is without physiological value and only degrades and destroys those who experience it (Caton The history of obstetric anesthesia, in Chestnut's Obstetric Anesthesia. Amsterdam: Elsevier 2014:3–12). By 1860, public opinion changed and women began requesting pain relief from their obstetricians. Pain during childbirth lost its theological connotation and became a biological process to be studied scientifically. Technology was developed that allowed administration of parenteral medications, and ‘twilight sleep’, a popular combination of morphine analgesia and scopolamine for amnesia, was introduced in 1902. Reports of newborn depression soon followed, suggesting placental transmission of the anaesthetic agents. These concerns led to studies of placental structure and appropriate maternal dosing. In the early twentieth century, spinal anaesthesia using cocaine was described for labour analgesia, but women often developed what was probably hypotensive shock with fetal bradycardia. The technique was not well accepted. Obstetric leaders of the day opined that spinal anaesthesia was unlikely to be successfully adopted for obstetric practice and certainly not in preference to general anaesthesia (Lea. J Obstet Gynaecol Br Emp 1902;1:71–88). A review by Sturrock entitled The Relief of Pain in Labour stated that ‘provided the technique of administration is mastered and the risks are recognized, there is little doubt that [twilight sleep] is safe and efficient,’ but insisted that ‘spinal anesthesia is contraindicated during pregnancy and labour,’ (Sturrock. J Obstet Gynaecol Br Emp 1939;46:426–42). Just as regional anaesthesia techniques for labour were becoming commonplace in the 1970s, the ‘natural childbirth’ movement appeared, arguing that women could ‘avoid labour pain if they learned to abolish their fears’. Anaesthesia for labour again fell out of favour. Modern obstetric anaesthesia practice presents options to the pregnant woman, allowing her individualise her labour experience. Fleet et al. offer yet another option for labouring women (BJOG 2015;122:984–993) Fentanyl, a short-acting opioid without active metabolites, was given by intranasal or subcutaneous routes and compared with intramuscular pethidine. Women receiving fentanyl were more satisfied and had less sedation and nausea. Their neonates had fewer nursery admissions and less difficulty establishing breastfeeding. No intravenous line is necessary, and the intranasal route is patient-controlled and does not require painful injections. A statement from the American Society of Anesthesiologists and the American College of Obstetricians and Gynecologists states: ‘Labor causes severe pain for many women. There is no other circumstance where it is considered acceptable for an individual to experience untreated severe pain, amenable to safe intervention, while under a physician's care…maternal request is a sufficient medical indication for pain relief during labor,’ (AGOG No 259. Obstet Gynecol 2004;104:213). Options for pain relief continue to expand. None declared. Completed disclosure of interests form available to view online as supporting information.

Parenteral drug administration errors by nursing staff on an acute medical admissions ward during day duty.

Parenteral therapy is a route of administration for drugs which are poorly absorbed via the oral route and it can provide a rapid response during an emergency. However, poorly prepared and/or administered parenteral therapy can cause potential harm to patients such as thrombus formation, severe hypersensitivity reactions and infection. Very few studies have investigated the incidence of medication errors associated with parenteral drug administration. To determine the error rate during preparation and administration of parenteral medications by nursing staff and to propose strategies to reduce the error rate during parenteral administration. A direct, disguised observation technique was used. The first author (JB) observed and recorded errors that occurred during the preparation and administration of parenteral medications on an admissions ward between 8.00 am and 4.30 pm from Monday to Friday for a 4-week period during December 1998. The staff were told that the observer was timing the administration; therefore they were not aware of the true nature of the study. This study was approved by the hospital audit committee. Drug administration was witnessed for a 4-week period providing 107 opportunities for error. 27 errors were observed which equated to an error rate of 25.2% [95% confidence interval (CI) 17.0 to 33.5%] including wrong time errors. Excluding wrong time errors, the most frequently occurring type of error, reduced the error rate to 10.3% (95% CI 3.8 to 14.9%). The error rate was lower than reported in the literature, this may be due to different methodologies, small sample size or effective nursing training and operating procedures. In the observed hospital, only nursing staff who have completed a training package are allowed to administer parenteral medications. Based on our small study, and 2 previous small studies, we can conclude that parenteral medication administration errors are common in the UK; however, these studies are too small-scale to detect rare and serious errors.

Nursing students' performance: administering injections in laboratory and clinical area.

Little research has been done regarding the teaching of psychomotor nursing skills in order to achieve an appropriate level of proficiency. This study examined the skill of parenteral medication administration, comparing laboratory proficiency to clinical proficiency over time. Subjects included 35 associate degree nursing students. The Spielberger State-Trait Anxiety Inventory was used as well as an injection performance skill check list. There was no significant change in the number of errors between the laboratory "check-out" and the first clinical performance, nor was anxiety related to skill performance. Further study related to psychomotor skill acquisition is needed.