Accuracy of preparation of i.v. medication syringes for anesthesiology

Abstract

Analysis of different i.v. formulations of four medications prepared in syringes by anesthesiologists revealed a high rate of discrepancies between ordered and actual drug concentrations, suggesting a need for increased institutional efforts to prevent errors during the preparation process.

Accuracy of intravenous and enteral preparations involving small volumes for paediatric use: a review

“…Analyses of the content of unused syringes containing drugs regularly used in anaesthesiology (fentanyl, thiopental, lidocaine, atracurium) revealed that 29% showed drug concentrations outside the specified acceptability range and 4% contained more than twice the targeted drug concentration. Errors closely correlated with multiple dilutions of high-strength formulations, and hence measurements of small volumes of initial drug solution, and these were seen particularly in preparations involving fentanyl 41. The complexity of preparation, often involving multiple calculations, was implicated in dilution error.…”

“…A number of publications suggest that a high incidence of imprecision and dilution errors occur in the preparation of intravenous medicines and the preparation of small volumes of medicines is inaccurate 13 26 41 56…”

“…Errors are commonly found when infusions are prepared at the point of care13 26 41 52 and improvements are made when a centralised system for preparation is used 26 47. However, both methods yield worrying deviations from the required stated concentrations.…”

The challenges of anaesthesia for the next decade

“…Concentration measurements conducted on these syringes found similar results: the differences between expected and measured concentrations were greater than 50% in 8% of the cases, and greater than 100% in 4% of the cases. 8 The incidence of discrepancies was highest in the paediatric operating room. The measures adopted to improve practice involved changes in syringe labelling with the use of specific colours, and of new standards in drug labelling with recording of weight, volume and concentration and lastly with the introduction of prefilled syringes to remove the risk of dilution error altogether.…”

A three-year study of a first-generation chemotherapy-compounding robot

“…preparations for anesthesiology and chemotherapy has been reported to involve higher rates of discrepancy from designated ranges of acceptability. 3,7 A study that assessed the accuracy of volumetric technique in the preparation of chemotherapy doses found that 71.7% of the doses prepared were within ±5% and 87.4% were within ±10% of the ordered dose. 8 The study authors suggested that "the process of volumetric technique alone is not sufficient to accurately prepare chemotherapy doses, and a focus of improving the process of preparing i.v.…”