A national scoping survey of standard infusions in paediatric and neonatal intensive care units in the United Kingdom

Oskarsdottir, Thorunn; Harris, David; Sutherland, Adam; Wignell, Andrew; Christiansen, Nanna

doi:10.1111/jphp.12992

Cited by 16 publications

(16 citation statements)

References 27 publications

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“…[9][10][11] Although various national projects to standardize infusions are ongoing, [12][13][14] the use of weight-based infusions and traditional infusion pumps remain common in many European pediatric and neonatal intensive care units. [14][15][16] Heavily reliant on mathematical calculations, with dilution and manipulation of adult dosage forms commonly required, serious risk of infusion error remains. 10,[17][18][19] Technology-generated errors (TGEs) are one of the unintended consequences of HIT implementation.…”

Section: Background and Significancementioning

confidence: 99%

The Impact of Technology on Prescribing Errors in Pediatric Intensive Care: A Before and After Study

et al. 2020

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Background Increased use of health information technology (HIT) has been advocated as a medication error reduction strategy. Evidence of its benefits in the pediatric setting remains limited. In 2012, electronic prescribing (ICCA, Philips, United Kingdom) and standard concentration infusions (SCIs)—facilitated by smart-pump technology—were introduced into the pediatric intensive care unit (PICU) of an Irish tertiary-care pediatric hospital. Objective The aim of this study is to assess the impact of the new technology on the rate and severity of PICU prescribing errors and identify technology-generated errors. Methods A retrospective, before and after study design, was employed. Medication orders were reviewed over 24 weeks distributed across four time periods: preimplementation (Epoch 1); postimplementation of SCIs (Epoch 2); immediate postimplementation of electronic prescribing (Epoch 3); and 1 year postimplementation (Epoch 4). Only orders reviewed by a clinical pharmacist were included. Prespecified definitions, multidisciplinary consensus and validated grading methods were utilized. Results A total of 3,356 medication orders for 288 patients were included. Overall error rates were similar in Epoch 1 and 4 (10.2 vs. 9.8%; p = 0.8), but error types differed (p < 0.001). Incomplete and wrong unit errors were eradicated; duplicate orders increased. Dosing errors remained most common. A total of 27% of postimplementation errors were technology-generated. Implementation of SCIs alone was associated with significant reductions in infusion-related prescribing errors (29.0% [Epoch 1] to 14.6% [Epoch 2]; p < 0.001). Further reductions (8.4% [Epoch 4]) were identified after implementation of electronically generated infusion orders. Non-infusion error severity was unchanged (p = 0.13); fewer infusion errors reached the patient (p < 0.01). No errors causing harm were identified. Conclusion The limitations of electronic prescribing in reducing overall prescribing errors in PICU have been demonstrated. The replacement of weight-based infusions with SCIs was associated with significant reductions in infusion prescribing errors. Technology-generated errors were common, highlighting the need for on-going research on HIT implementation in pediatric settings.

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Section: Background and Significancementioning

confidence: 99%

The Impact of Technology on Prescribing Errors in Pediatric Intensive Care: A Before and After Study

et al. 2020

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“…Although barcoded ready-to-administer infusions and bidirectional pump interfaces have potential to mitigate some but not all such errors, these are unlikely to be widely available in Europe for some time. 11,36 For example, the inadvertent administration of a morphine bolus of 40 microgram/kg rather than 40 micrograms to a 4-kg infant is difficult to prevent in an environment where use of the bolus function is commonplace. Even with appropriate bolus limits, pediatric and neonatal patients remain at risk where differences between patient weights in kilograms are of the same magnitude as normal dose ranges.…”

Section: Contributory Factorsmentioning

confidence: 99%

Direct Observational Study of Interfaced Smart-Pumps in Pediatric Intensive Care

et al. 2020

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Background Processes for delivery of high-risk infusions in pediatric intensive care units (PICUs) are complex. Standard concentration infusions (SCIs), smart-pumps, and electronic prescribing are recommended medication error reduction strategies. Implementation rates in Europe lag behind those in the United States. Since 2012, the PICU of an Irish tertiary pediatric hospital has been using a smart-pump SCI library, interfaced with electronic infusion orders (Philips ICCA). The incidence of infusion errors is unknown. Objectives To determine the frequency, severity, and distribution of smart-pump infusion errors in PICUs. Methods Programmed infusions were directly observed at the bedside. Parameters were compared against medication orders and autodocumented infusion data. Identified deviations were categorized as medication errors or discrepancies. Error rates (%) were calculated as infusions with errors and errors per opportunities for error (OEs). Predefined definitions, multidisciplinary consensus and grading processes were employed. Results A total of 1,023 infusions for 175 patients were directly observed over 27 days between February and September 2017. The drug library accommodated 96.5% of infusions. Compliance with the drug library was 98.9%. A total of 133 infusions had ≥1 error (13.0%); a further 58 (5.7%) had ≥1 discrepancy. From a total of 4,997 OEs, 153 errors (3.1%) and 107 discrepancies (2.1%) were observed. Undocumented bolus doses were most commonly identified (n = 81); this was the only deviation in 36.1% (n = 69) of infusions. Programming errors were rare (0.32% OE). Errors were minor, with just one requiring minimal intervention to prevent harm. Conclusion The error rates identified are low compared with similar studies, highlighting the benefits of smart-pumps and autodocumented infusion data in PICUs. A range of quality improvement opportunities has been identified.

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“…They identified serious errors before implementation of smart pumps. [16] ThorunnOskarsdottir et.al, have discussed about the usage of intravenous infusions pediatric and neonatal units. Only weight-based traditional methods are being used in United Kingdom and so it is important of publishing the SCI, but also there is no real value of standardization.…”

Section: Literature Surveymentioning

confidence: 99%

Design and Development of a Low cost, Smart Infusion Pump to deliver Medications for patients Using LabVIEW Interface with Arduino

Sankaran,

Deny,

Rajasekaran

et al. 2019

IJEAT

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An infusion pump is a medical device that delivers fluids such as nutrients into a patient’s body in controlled amount. They are widely used in clinical settings such as hospitals, nursing homes etc. There are many types of infusion pumps including large volume, patient-controlled analgesia and insulin pumps. Some are designed mainly for stationary use at a patient’s bedside, because infusion pumps are frequently used to administer critical fluids, including high-risk medications, pump failures and can have significant implications for patient’s safety. From 2005 to 2009, FDA received approximately 56,000 reports of adverse events associated with the use of infusion pumps, including numerous injuries and deaths. Some of the problems include software problems, alarm errors, inadequate design, broken components, battery failures, spark, and shock. In order to overcome these problems, our team came up with an idea to rectify. Our project is very compact in size when compared to the ordinary syringe pump. It can be lifted with single hand since it is weightless and the components used in our project are reliable, cost efficient and user friendly.

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A national scoping survey of standard infusions in paediatric and neonatal intensive care units in the United Kingdom

Cited by 16 publications

References 27 publications

The Impact of Technology on Prescribing Errors in Pediatric Intensive Care: A Before and After Study

The Impact of Technology on Prescribing Errors in Pediatric Intensive Care: A Before and After Study

Direct Observational Study of Interfaced Smart-Pumps in Pediatric Intensive Care

Design and Development of a Low cost, Smart Infusion Pump to deliver Medications for patients Using LabVIEW Interface with Arduino

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