A Multi-hospital Before–After Observational Study Using a Point-Prevalence Approach with an Infusion Safety Intervention Bundle to Reduce Intravenous Medication Administration Errors

Abstract

Registered at ClinicalTrials.gov, identifier: NCT02359734.

Intravenous Infusion Administration: A Comparative Study of Practices and Errors Between the United States and England and Their Implications for Patient Safety

“…The introduction of smart infusion devices, standards, or the interventions introduced by Schnock et al [9] are not instant solutions to the problem of intravenous infusion administration errors, and may be better considered as ‘probes’ to better understand what does and does not work in a particular context, and what might work well in the future [34]. Thus, the question is not whether smart infusion devices are safer than traditional infusion devices, whether particular standards are optimal, or whether a particular intervention will universally lead to safer practices, but whether particular configurations of technology, procedures, practices and people are likely to enhance or diminish safety.…”

“…Reporting on smart infusion device implementation in one hospital, Keohane et al [8] highlight the importance of creating a culture in which staff value their own competence and patient safety, and in which technology is easy to use correctly and implementation is viewed as a process of continual upgrade. Schnock et al [9] introduced an infusion safety intervention bundle in nine United States (US) hospitals comprising eight interventions to address areas of medication labelling and tube tagging, administration of unauthorised medications and smart infusion device use. Different components of the bundle were adopted and adapted by different hospitals, and local contextual factors influenced uptake and effectiveness of the interventions.…”

Intravenous infusion practices across England and their impact on patient safety: a mixed-methods observational study

“…Our current view of IV medication administration as a complex domain is supported by recent work by Schnock et al, 87 who introduced an infusion safety intervention bundle into their participating hospitals. This comprised eight interventions to address areas of IV labelling and tube tagging (e.g.…”

“…Our data do not support this view, and neither does the most recent published study from the USA. 87 This might have been true in the days when IV infusion administrations were delivered via gravity feed, but we have searched for evidence that errors in IV infusion administration are resulting in patient harm and have found little. In practice, we identified only one error likely to lead to patient harm out of 2008 observations, and Schnock et al 7,87 have reported similarly small numbers.…”

“…This is consistent with the view of Vincent and Amalberti, 53 particularly in their distinction between high reliability and ultra-safe systems. The introduction of smart pumps, and the interventions introduced by Schnock et al, 87 if used with a 'checklist mentality', risk trying to push IV infusion administration towards the ultra-safe end of the spectrum, when all the evidence we have gathered in the ECLIPSE study points in the other direction, towards IV infusion administration being a high-reliability system whereby safety is maintained through the professionalism of teams, not through the imposition of barriers. This does not mean that localised interventions are ineffective, but that they should be treated as 'probes' 63,65 to better understand what does and does not work in a particular context, and what might work well in the future.…”