Errors and discrepancies in the administration of intravenous infusions: a mixed methods multihospital observational study

Abstract

IntroductionIntravenous medication administration has traditionally been regarded as error prone, with high potential for harm. A recent US multisite study revealed few potentially harmful errors despite a high overall error rate. However, there is limited evidence about infusion practices in England and how they relate to prevalence and types of error.ObjectivesTo determine the prevalence, types and severity of errors and discrepancies in infusion administration in English hospitals, and to explore sources of variation, including the contribution of smart pumps.MethodsWe conducted an observational point prevalence study of intravenous infusions in 16 National Health Service hospital trusts. Observers compared each infusion against the medication order and local policy. Deviations were classified as errors or discrepancies based on their potential for patient harm. Contextual issues and reasons for deviations were explored qualitatively during observer debriefs.ResultsData were collected from 1326 patients and 2008 infusions. Errors were observed in 231 infusions (11.5%, 95% CI 10.2% to 13.0%). Discrepancies were observed in 1065 infusions (53.0%, 95% CI 50.8% to 55.2%). Twenty-three errors (1.1% of all infusions) were considered potentially harmful; none were judged likely to prolong hospital stay or result in long-term harm. Types and prevalence of errors and discrepancies varied widely among trusts, as did local policies. Deviations from medication orders and local policies were sometimes made for efficiency or patient need. Smart pumps, as currently implemented, had little effect, with similar error rates observed in infusions delivered with and without a smart pump (10.3% vs 10.8%, p=0.8).ConclusionErrors and discrepancies are relatively common in everyday infusion administrations but most have low potential for patient harm. Better understanding of performance variability to strategically manage risk may be a more helpful tactic than striving to eliminate all deviations.

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

“…This combined study draws on the observation of 3172 infusion administrations. Across those, as discussed by Lyons et al, 68 the only clear conclusion is that medication administered by gravity feed is more likely to result in patient harm than medication administered via infusion pumps. Neither the US nor the English study identified any events in which patient safety was significantly compromised, resulting in death or serious harm.…”

“…There were 88 patient ID discrepancies, counting each once per patient. Reproduced from Lyons et al 68 © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved.…”

“…a Some infusions were affected by more than one type of discrepancy; therefore, the number and percentage of infusions affected by at least one error or discrepancy of any type is not the sum of each deviation type. Reproduced from Lyons et al 68 © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved.…”

“…Chapter Methods T his chapter includes material reproduced or adapted from Blandford et al 1 and Lyons et al 68 These articles are distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.…”

“…Administration of piperacillin/tazobactam was delayed by approximately 30 minutesReproduced from Lyons et al68 © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved.…”