Discrepancies between ordered and delivered concentrations of opiate infusions in critical care

Parshuram, Christopher S.; Ng, Geraldine; Ho, Tommy; Klein, Julia; Moore, Aideen M.; Bohn, Desmond; Koren, Gideon

doi:10.1097/01.ccm.0000089638.83803.b2

Cited by 78 publications

(58 citation statements)

References 22 publications

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“…Adapa et al 11 reported that preparing infusions at the bedside in this emergent simulation resulted in an odds ratio of 17.0 (95% CI, 5.2-55) for making a medication error compared with preparing the infusions in a calmer environment or having the infusions prepared in the pharmacy. Other evidence [12][13][14][15] has highlighted the error-prone nature of preparing critical infusions at the bedside, including vasopressors and opioids. Task analysis 16 has identified a total of 41 potential steps in the process of preparing a drug infusion, providing 41 opportunities for error during the fast-paced environment of medical emergencies.…”

Section: Simulationmentioning

confidence: 99%

Medication Errors in Cardiopulmonary Arrest and Code-Related Situations

Flannery

Parli

2016

American Journal of Critical Care

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) was searched to identify relevant published studies on the overall frequency, types, and examples of medication errors during medical emergencies involving cardiopulmonary resuscitation and related situations, and the breakdown by type of error. The overall frequency of medication errors during medical emergencies, specifically situations related to resuscitation, is highly variable. Medication errors during such emergencies, particularly cardiopulmonary resuscitation and surrounding events, are not well characterized in the literature but may be more frequent than previously thought. Depending on whether research methods included database mining, simulation, or prospective observation of clinical practice, reported occurrence of medication errors during cardiopulmonary resuscitation and surrounding events has ranged from less than 1% to 50%. Because of the chaos of the resuscitation environment, errors in prescribing, dosing, preparing, labeling, and administering drugs are prone to occur. System-based strategies, such as infusion pump policies and code cart management, as well as personal strategies exist to minimize medication errors during emergency situations.

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Section: Simulationmentioning

confidence: 99%

Medication Errors in Cardiopulmonary Arrest and Code-Related Situations

Flannery

Parli

2016

American Journal of Critical Care

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“…6 The process of ordering, preparing, and administering continuous medication infusions offers several opportunities for error. 4,[7][8][9] Providing the correct weight-adjusted dose (at an acceptable rate, concentration, and volume) usually requires a multivariable calculation; moreover, a new calculation must be performed whenever the dose is changed. The need for individualized concentrations makes drip preparation a high-frequency and time-consuming task for the pharmacy.…”

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confidence: 99%

Standard Drug Concentrations and Smart-Pump Technology Reduce Continuous-Medication-Infusion Errors in Pediatric Patients

et al. 2005

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ABSTRACT. Objective. To determine if combining standard drug concentrations with "smart-pump" technology reduces reported medication-infusion errors. Design. Preintervention and postintervention comparison of reported medication errors related to infusion therapies during the calendar years 2002 and 2003.Setting. A 242-bed university-affiliated tertiary pediatric hospital.Intervention. Change in continuous-medication-infusion process, comprising the adoption of (1) standard drug concentrations, (2) "smart" syringe pumps, and (3) human-engineered medication labels. Main Outcome Measures. Comparison of reported continuous-medication-infusion errors before and after the intervention.Results. The number of reported errors dropped by 73% for an absolute risk reduction of 3.1 to 0.8 per 1000 doses. Preparation errors that occurred in the pharmacy decreased from 0.66 to 0.16 per 1000 doses; the number of 10-fold errors in dosage decreased from 0.41 to 0.08 per 1000 doses.Conclusions. The use of standard drug concentrations, smart syringe pumps, and user-friendly labels reduces reported errors associated with continuous medication infusions. Standard drug concentrations can be chosen to allow most neonates to receive needed medications without concerns related to excess fluid administration. M edication errors are a major source of potential and actual harm in pediatric patients. [1][2][3] Pediatric patients are at greater risk for medication error than adult patients because of the need for weight-based dosing and individualized dose calculation for most medications. Effective communication about symptoms and elicitation of pertinent clinical findings is often difficult in children. 2,4 Medical complexity and the need for multiple medications places hospitalized children at an even greater risk; nowhere is this more evident than in intensive care units. [2][3][4][5] Continuous medication infusions are a category of medications delivered to hospitalized patients that often include "high-alert" medications. As defined by the Institute of Safe Medication Practice, highalert medications are drugs that bear a heightened risk of causing significant patient harm when used in error and may lead to devastating complications for patients. 6 The process of ordering, preparing, and administering continuous medication infusions offers several opportunities for error. 4,[7][8][9] Providing the correct weight-adjusted dose (at an acceptable rate, concentration, and volume) usually requires a multivariable calculation; moreover, a new calculation must be performed whenever the dose is changed. The need for individualized concentrations makes drip preparation a high-frequency and time-consuming task for the pharmacy. The appropriate information must be entered correctly into the pump initially and when changes are made.Several common practices influence the likelihood of continuous-medication-infusion errors. The "rule of 6" is a calculation aid that was developed originally to facilitate rapid dose calculation and drip preparation in ...

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“…15 Direct assessment of intravenous drug infusions received by patients has suggested that up to 65% of infusions have unacceptable concentrations by industry standards despite routine safety practises. [16][17][18][19][20][21][22][23] We performed a systematic evaluation of the preparation process for intravenous infusions to identify factors associated with preventable medication errors.…”

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confidence: 99%