Adherence to standard medication infusion concentrations and its impact on paediatric intensive care patient outcomes

Cree, Michele; Stöcker, Christian; Tu, Qiang; Scaini, Loretta

doi:10.1016/j.aucc.2017.07.003

Cited by 8 publications

(13 citation statements)

References 5 publications

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“…The sharing of event log data allowing independent third-party review and system-wide learning NHS England and Department of Health and Social Care Aseptic Services Redesign [9] and regional equivalents [10] To increase manufacturing capacity in the NHS to free up nursing capacity for care, and support work already delivered in standardisation of injectable medicines [11][12][13][14] Standardise intravenous products where possible Global Digital Exemplar (GDE) programme [15] Drive to implement sophisticated electronic medicines administration systems in digitally mature organisations Targeted funding for enhancements and provision of closed loop medication administration systems (e.g. barcode medication verification)…”

Section: Areas Of Discussion At the Symposiummentioning

confidence: 99%

Developing Strategic Recommendations for Implementing Smart Pumps in Advanced Healthcare Systems to Improve Intravenous Medication Safety

et al. 2022

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Avoidable harm associated with medication is a persistent problem in health systems and the use of preprogrammed infusion devices ('smart pumps') and data monitoring is seen as a core approach to mitigating and reducing the incidence of these harms. However, smart pumps are costly to procure, configure and maintain (in both human and financial terms) and are often poorly implemented. Variation in the manner in which medicines are prepared and used within complex modern healthcare systems exacerbates these challenges, and a strategic human-centred approach is needed to support their implementation. A symposium of 36 clinical and academic medication safety experts met virtually to discuss the current 'state of the art' and to propose strategic recommendations to support the implementation of medication administration technology to improve medication safety. The recommendations were that health systems (1) standardise infusion concentrations to facilitate the development of ready-to-administer formulations of frequently used medicines, and support 'out of the box' programming of infusion devices; (2) develop and implement drug libraries using human-centred approaches and the aforementioned standard concentrations, with a theoretical understanding of how devices are used in practice; (3) develop standardised metrics and outcomes to support the interpretation of data produced by infusion devices; (4) involve all stakeholders in the development of drug libraries and metrics to ensure broad understanding of the devices, their benefits and limitations; and (5) leverage input into device design, working with manufacturers and users. Using this strategic approach, it is then possible to envisage and plan real-world implementation studies using a uniform approach to quantify improvements in safety, efficiency and cost effectiveness.

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Section: Areas Of Discussion At the Symposiummentioning

confidence: 99%

Developing Strategic Recommendations for Implementing Smart Pumps in Advanced Healthcare Systems to Improve Intravenous Medication Safety

et al. 2022

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“…lww.com/JPS/A612). The studies were conducted in the United States (n = 16), [47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62] the United Kingdom (n = 7), [63][64][65][66][67][68][69] Australia (n = 3), [70][71][72] Brazil (n = 3), [73][74][75] Spain (n = 3), [76][77][78] Mexico (n = 2), 79,80 Saudi Arabia (n = 2), 81,82 Singapore (n = 2), 83,84 Canada (n = 1), 85 China (n = 1), 86 France (n = 1), 87 Germany (n = 1), 88 Italy (n = 1), 89 Netherlands (n = 1), 90 and Switzerland FIGURE 2. Outline of the narrative review process, analysis of the included articles (n = 63), and comparison to our previous systematic reviews.…”

Section: Description Of Studies Exploring Systemic Defenses To Preven...mentioning

confidence: 99%

Evolution of Intravenous Medication Errors and Preventive Systemic Defenses in Hospital Settings—A Narrative Review of Recent Evidence

Kuitunen,

Airaksinen,

Holmström

2024

J Patient Saf

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Objectives Intravenous drug administration has been associated with severe medication errors in hospitals. The present narrative review is based on a systematic literature search, and aimed to describe the recent evolution in research on systemic causes and defenses in intravenous medication errors in hospitals. Methods This narrative review was based on Reason’s theory of systems-based risk management. A systematic literature search covering the period from June 2016 to October 2021 was conducted on Medline (Ovid). We used the search strategy and selection criteria developed for our previous systematic reviews. The included articles were analyzed and compared to our previous reviews. Results The updated search found 435 articles. Of the 63 included articles, 16 focused on systemic causes of intravenous medication errors, and 47 on systemic defenses. A high proportion (n = 24, 38%) of the studies were conducted in the United States or Canada. Most of the studies focused on drug administration (n = 21/63, 33%) and preparation (n = 19/63, 30%). Compared to our previous review of error causes, more studies (n = 5/16, 31%) utilized research designs with a prospective risk management approach. Within articles related to systemic defenses, smart infusion pumps remained most widely studied (n = 10/47, 21%), while those related to preparation technologies (n = 7/47, 15%) had increased. Conclusions This narrative review demonstrates a growing interest in systems-based risk management for intravenous drug therapy and in introducing new technology, particularly smart infusion pumps and preparation systems, as systemic defenses. When introducing new technologies, prospective assessment and continuous monitoring of emerging safety risks should be conducted.

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“…6,7 The Institute for Safe Medication Practices as well as the Vermont Oxford Network, therefore, recommend patient-specific drug concentrations to be abolished, making standard concentrations for medication infusions a requirement for hospital accreditation in the United States and Canada. [8][9][10] However, using standardized drug concentrations, fixed ratios between volume rate and dose rate per body weight (by altering the drug concentration relative to the patient's body weight) are no longer achievable. Thus, for the proper interpretation of the actual amount of active substance per body weight, a calculation is required.…”

Section: Background and Significancementioning

confidence: 99%

Implementation of 2D Barcode Medication Labels and Smart Pumps in Pediatric Acute Care: Lessons Learned

et al. 2023

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Background: In pediatric intensive care, prescription, administration, and interpretation of drug doses are weight-dependent. The use of standardized concentrations simplifies the preparation of drugs and increases safety. For safe administration as well as easy interpretation of intravenous drug dosing regimens with standardized concentrations, the display of weight-related dose rates on the infusion device is of pivotal significance. Objectives: We report on challenges in the implementation of a new information technology-supported medication workflow. The workflow was introduced on eight beds in the pediatric heart surgery intensive care unit as well as in the pediatric anesthesia at the University of Bonn Medical Center. The proposed workflow utilizes medication labels generated from prescription data from the electronic health record. The generated labels include a 2D barcode to transfer data to the infusion devices. Methods Clinical and technical processes were agilely developed. The reliability of the system under real-life conditions was monitored. User satisfaction and potential for improvement were assessed. In addition, a structured survey among the nursing staff was carried out. The questionnaire addressed usability as well as the end-users’ perception of effects on patient safety. Results: The workflow has been applied 44111 times during the pilot phase. A total of 114 known failures in the technical infrastructure were observed. The survey showed good ratings for usability and safety (median "school grade" 2 or B for patient safety, intelligibility, patient identification and handling). The medical management of the involved acute care facilities rated the process as clearly beneficial regarding patient safety, suggesting a rollout to all pediatric intensive care areas. Conclusions: A medical information technology-supported medication workflow can increase user satisfaction and patient safety as perceived by the clinical end-users in pediatric acute care. The successful implementation benefits from an interdisciplinary team, active investigation of possible associated risks, and technical redundancy.

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Adherence to standard medication infusion concentrations and its impact on paediatric intensive care patient outcomes

Cited by 8 publications

References 5 publications

Developing Strategic Recommendations for Implementing Smart Pumps in Advanced Healthcare Systems to Improve Intravenous Medication Safety

Developing Strategic Recommendations for Implementing Smart Pumps in Advanced Healthcare Systems to Improve Intravenous Medication Safety

Evolution of Intravenous Medication Errors and Preventive Systemic Defenses in Hospital Settings—A Narrative Review of Recent Evidence

Implementation of 2D Barcode Medication Labels and Smart Pumps in Pediatric Acute Care: Lessons Learned

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