Designing and evaluating an automated intravenous dosage medication calculation tool for reducing the time of stat medication administration in a pediatric emergency department

Abstract

Background: Urgent medications are regularly prescribed using the term "stat", which indicates that the medication should be administered within 30 min after it is ordered. However, many hospitals struggle to reliably administer stat medications within 30 min after they are ordered. This study involved developing and evaluating an automated intravenous dosage medication calculation tool (AIVDMCT) for reducing the time between the order and administration of stat medications to children at a pediatric emergency department (PED) in Saudi Arabia. Methods: This prospective observational study evaluated data from before (June-December 2016) and after (June-December 2017) the AIVDMCT was implemented for high-risk medications in our PED. Patients were considered eligible if they were <14 years old, weighed <40 kg, and required stat intravenous (IV) medications at the PED of our tertiary care hospital. Results: Implementation of the AIVDMCT significantly reduce the intervals between the time of order (TO) and the time of preparation (TP) (average time: 8.05 AE 3.42 min) and between the TP and the time of administration (TA) (average time: 3.74 AE 1.70 min). Furthermore, the interval from the TO to the TA was significantly reduced after the AIVDMCT was implemented (average time: 11.79 AE 4.48 min, P < 0.001). Conclusion:The AIVDMCT was associated with a significant reduction in the interval from the TO to the TA. This increased the proportion of stat medications that were delivered within the 30-min target window.

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

“…The systematic search on Medline (Ovid) found 47 articles describing systemic defenses to prevent IV MEs published between June 2016 and October 2021 (Supplementary file 3, http://links.lww.com/JPS/A612). The studies were conducted in the United States (n = 16), 47–62 the United Kingdom (n = 7), 63–69 Australia (n = 3), 70–72 Brazil (n = 3), 73–75 Spain (n = 3), 76–78 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 (n = 1) 91 . Some studies (n = 2) were carried out in multiple countries 92,93 .…”

“…A lot of variation between the study designs and research methods was identified (Supplementary file 3, http://links.lww.com/JPS/A613). The designs used in more than one study were observational simulation studies (n = 8), 48,53,67,83,85,88,89,91 retrospective analysis of drug preparation reports (n = 6), 47,51,57,59,60,93 mixed-methods studies (n = 5), 63,64,68,69,76 observational studies (n = 5), 49,50,56,58,81 retrospective analysis of smart infusion pump alert log data (n = 5), 55,62,77,80,82 studies measuring costs or cost effectiveness of the studied defense (n = 4), 66,74,87,90 observational intervention studies (n = 3), 61,71,73 retrospective or observational studies measuring drug consumption (n = 2), 52,79 chart reviews (n = 2), 70,72 and studies to design and develop systemic defenses (n = 2) 65,92 . Other methods included an analysis of administration error reports (n = 1), 54 a survey study (n = 1), 84 healthcare failure mode and effects analysis (HFMEA) (n = 1), 86 a systematic review (n = 1), 78 and a systematic review with a meta-analysis (n = 1) 75 …”

“…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.…”

“…92,93 The studies were conducted in hospital settings without a specification of a specialty area (n = 10), 55,56,[61][62][63]66,73,76,82,90 adult ICU (n = 9), 49,50,52,69,75,[78][79][80]92 hospital pharmacy (n = 7), 47,51,[57][58][59][60]93 pediatric intensive care unit (n = 5), 65,68,72,74,77 pediatric hospital (n = 3), 54,64,71 emergency department (n = 2), 70,84 anesthesia department (n = 1), 87 cancer hospital (n = 1), 86 and pediatric emergency department (n = 1). 81 Some studies (n = 8) were carried out in simulated environments comprising an anesthesia setting (n = 2), 83,88 hospital setting (n = 2), 48,67 ICU (n = 1), 85 NICU (n = 1), 89 operating room (n = 1),…”

“…91 A lot of variation between the study designs and research methods was identified (Supplementary file 3, http://links.lww.com/JPS/A613). The designs used in more than one study were observational simulation studies (n = 8), 48,53,67,83,85,88,89,91 retrospective analysis of drug preparation reports (n = 6), 47,51,57,59,60,93 mixed-methods studies (n = 5), 63,64,68,69,76 observational studies (n = 5), 49,50,56,58,81 FIGURE 4. Evolution of systemic defenses to prevent IV MEs.…”