Preparation Of Intravenous Medications Research Articles

Systemic Causes of In-Hospital Intravenous Medication Errors: A Systematic Review.

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. 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. 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. 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.

Variability of intravenous medication preparation in Australian and New Zealand intensive care units.

In Australia and New Zealand, there are no established standards for the final presentations of prepared intravenous medications in Intensive Care Units (ICUs). Variability has the potential to contribute to deficiencies in safety, efficiency and cost effectiveness. This study aimed to examine the variability in the preparation of intravenous medications in ICUs. An electronic survey was distributed to critical care pharmacists in Australia and New Zealand via an established email group. The preparation of vasopressors, inotropes, sedation, analgesia, heparin, insulin and neuromuscular blockers were examined. Respondents were asked about initial presentation, final concentration prepared, who prepared and current safety practices used. Questions also addressed opinions and attitudes to safety practices and responsibility for leading change. Forty responses to the survey were received, representing 17% of ICUs in Australia and New Zealand. Significant variation in final concentration was observed for all infusions except insulin and esmolol. The final volumes varied significantly for all drugs. The majority of infusions were prepared by nursing staff with only a small number of pre-prepared presentations currently in use. Labelling was usually hand-written with some colour-coding. Most respondents identified safety and efficiency but not cost effectiveness as likely to be improved by the use of pre-prepared infusions. Most respondents felt 'government' or peak clinical bodies should lead practice standardization. Significant variation exists in the preparation of intravenous medications across ICUs in Australia and New Zealand. Nationally or regionally coordinated rationalization and standardization could improve safety and efficiency and potentially reduce the barrier of cost.

Errores en la preparación de fármacos intravenosos en una Unidad de Cuidados Intensivos Neonatal. Una potencial fuente de eventos adversos

IntroductionTo determine the rate of errors during preparation of intravenous drugs in a regional Neonatal Intensive Care Unit (NICU). MethodsA prospective observational study was performed on 24 non-consecutive working days. The vancomycin and tobramycin solutions administered were analysed to determine drug concentrations. We defined 2 types of error: 1) calculation error, when the deviation between the dose prescribed by the physician and theoretical dose administered, according to calculations performed by the nurse, was greater than ±10%, and 2) precision error, when the deviation between the theoretical concentration and that determined by the laboratory was greater than ±10%. ResultsA total of 91 samples were collected, 52 of vancomycin and 39 of tobramycin. Calculation errors were detected in 4.6% of samples. Precision errors were identified in 37.9% of the total sample. ConclusionsAlthough the errors reported did not produce adverse clinical consequences, our findings point out a potential source of severe complications. Better methods in the preparation of intravenous medications in NICU are needed.

Outbreak of Mycobacterium mucogenicum Bloodstream Infections among Patients with Sickle Cell Disease in an Outpatient Setting

To study an outbreak of Mycobacterium mucogenicum bloodstream infections in an outpatient setting. Outbreak investigation and retrospective chart review. University outpatient clinic. Patients. Patients whose blood cultures tested positive for M. mucogenicum in May or June 2008. An outbreak investigation and a review of infection control practices were conducted. During the process, environmental culture samples were obtained. Isolates from patients and the environment were genotyped with the DiversiLab typing system to identify the source. Chart reviews were conducted to study the management and outcomes of the patients. Four patients with sickle cell disease and implanted ports followed in the same hematology outpatient clinic developed blood cultures positive for M. mucogenicum. A nurse in the clinic had prepared intravenous port flushes on the sink counter, using a saline bag that was hanging over the sink throughout the shift. None of the environmental cultures grew M. mucogenicum except for the tap water from 2 rooms, 1 of which had a faucet aerator. The 4 patient isolates and the tap water isolate from the room with the aerator were found to have greater than 98.5% similarity. The subcutaneous ports were removed, and patients cleared their infections after a course of antibiotic therapy. The source of the M. mucogenicum bacteremia outbreak was identified by genotyping analysis as the clinic tap water supply. The preparation of intravenous medications near the sink was likely an important factor in transmission, along with the presence of a faucet aerator.

Medication errors: causes, prevention and reduction.

Medication errors: causes, prevention and reduction.

Staphylococcus aureus bloodstream infections among patients undergoing electroconvulsive therapy traced to breaks in infection control and possible extrinsic contamination by propofol.

Infectious complications associated with electroconvulsive therapy (ECT) are extremely unusual. When five of nine patients undergoing ECT at one facility on June 20, 1996 developed Staphylococcus aureus bloodstream infection (BSI), an investigation was initiated. A retrospective cohort study, a procedure review, and observational and microbiologic studies were performed. A case was defined as any patient who had ECT at Facility A from June 1, 1995 through June 20, 1996 and developed S. aureus BSI <30 days after ECT. The post-ECT S. aureus BSI rate was significantly greater on the epidemic day than the pre-epidemic period, (i.e., June 1, 1995 through June 19, 1996) (5 of 9 vs 0 of 54 patients, P < 0.001). All patients during the study period received propofol before ECT. Case patients were more likely than noncase patients to have higher maximum temperature after ECT (median 103.9 degrees F vs 100.0 degrees F, P < 0.03) and a greater time from preparation of intravenous medications to infusion (median 2.1 vs 1.1 h, P = 0.01). All case-patient S. aureus isolates were indistinguishable by pulsed field gel electrophoresis. Our investigation suggests that the ECT-associated S. aureus BSIs were associated with infection control breaks, which possibly led to the extrinsic contamination of propofol. Prevention of propofol-associated infectious complications requires aseptic preparation and use immediately before infusion.

A Probabilistic Batch Size Model for Perishable Products

A batch size model developed for the therapeutic product problem has been instrumental in assisting the staff of a large general hospital to resolve problems associated with the transactional process of the preparation of intravenous medications for administration. The model is a variation of a basic profit maximisation model and is characterised by variable batch preparation cost, a variable planning period, fixed per unit base cost, and zero shortage costs since preparation of a new batch can take place without delay. The variable planning period is transformed into a fixed planning horizon which is at least several multiples of the planning period and is fixed. Development of the model is presented and illustrated with a hypothetical situation, followed by a real case — the determination of the optimal batch size for the intravenous drug, Cefazolin.