Exploring the Current Landscape of Intravenous Infusion Practices and Errors (ECLIPSE): protocol for a mixed-methods observational study

Blandford, Ann; Furniss, Dominic; Lyons, Imogen; Chumbley, Gillian; Iacovides, Ioanna; Wei, Li; Cox, Anna L.; Mayer, Astrid; Schnock, Kumiko O.; Bates, David W.; Dykes, Patricia C.; Bell, Helen; Franklin, Bryony Dean

doi:10.1136/bmjopen-2015-009777

Cited by 28 publications

(35 citation statements)

References 17 publications

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“…Our PPI workshop took place in the context of a larger project called ECLIPSE (Exploring the Current Landscape of Intravenous Infusion Practices and Error) [ 1 ]. ECLIPSE seeks to investigate different intravenous infusion practices in English hospitals and how these relate to the prevalence of error, in order to make recommendations for safer infusions.…”

Section: Methodsmentioning

confidence: 99%

Patient and public involvement in patient safety research: a workshop to review patient information, minimise psychological risk and inform research

et al. 2016

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Plain English summaryPatient safety is a growing research area. However, although patients and the public are increasingly involved in clinical research, there is little guidance on how best to involve patients in patient safety research. Here we focus on how patients can contribute to the design of patient safety research.We conducted a workshop with patients as part of a project exploring errors and safety in the delivery of intravenous medication (medication given via a vein). The workshop was designed to explore how best to engage with hospital inpatients about these issues, to generate research topics, and to inform researchers about patients’ experiences. Nine patients participated, each of whom had previously received intravenous medication. Participants advised against using terms such as ‘error’; they also advocated caution when using terms such as ‘safety’ when describing the study to patients as this may worry some who had not thought about these issues before. We received thorough and useful feedback on our patient information sheets to ensure they were clear and understandable to patients. Patients also shared rich experiences with us about their treatment, which emphasised the need to extend our research focus to include a wider range of factors affecting quality and safety.Abstract Background Patient safety has attracted increasing attention in recent years. This paper explores patients’ contributions to informing patient safety research at an early stage, within a project on intravenous infusion errors. Currently, there is little or no guidance on how best to involve patients and the wider public in shaping patient safety research, and indeed, whether such efforts are worthwhile. Method We ran a 3-hour workshop involving nine patients with experience of intravenous therapy in the hospital setting. The first part explored patients’ experiences of intravenous therapy. We derived research questions from the resulting discussion through qualitative analysis. In the second part, patients were asked for feedback on patient information sheets considering both content and clarity, and on two potential approaches to framing our patient information: one that focused on research on safety and error, the other on quality improvement. Results The workshop led to a thorough review of how we should engage with patients. Importantly, there was a clear steer away from terms such as ‘error’ and ‘safety’ that could worry patients. The experiences that patients revealed were also richer than we had anticipated, revealing different conceptions of how patients related to their treatment and care, their role in safety and use of medical devices, the different levels of information they preferred, and broader factors impacting perceptions of their care. Conclusion Involving patients at an early stage in patient safety research can be of great value. Our workshop highlighted sensitivities around potentially worrying patients about risks that they might not have considered previously, and how to address these. Patient ...

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Section: Methodsmentioning

confidence: 99%

Patient and public involvement in patient safety research: a workshop to review patient information, minimise psychological risk and inform research

et al. 2016

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“…Some trusts required all IV giving sets to be labelled, whereas others were more selective. Focus group participants agreed that there were two main reasons for labelling giving sets: (1) to distinguish between multiple giving sets, and (2) to indicate when giving sets need to be changed. Trusts A and O had designed their policy to directly address these points (i.e.…”

Section: Procedural and Documentation Variations In Intravenous Infusmentioning

confidence: 99%

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

Blandford

Furniss

Galal-Edeen

et al. 2020

Health Serv Deliv Res

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Background Intravenous (IV) medication administration has traditionally been regarded to be error-prone with high potential for harm. A recent US multisite study revealed surprisingly 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. Objectives To determine the prevalence, types and severity of errors and discrepancies in infusion administration in English hospitals, and to explore sources of variation in errors, discrepancies and practices, including the contribution of smart pumps. Design Phase 1 comprised an observational point-prevalence study of IV infusions, with debrief interviews and focus groups. Observers compared each infusion against the medication order and local policy. Deviations were classified as either errors or discrepancies based on their potential for patient harm. Contextual issues and reasons for deviations were explored qualitatively during observer debriefs, and analytically in supplementary analyses. Phase 2 comprised in-depth observational studies at five of the participating sites to better understand causes of error and how safety is maintained. Workshops were held with key stakeholder groups, including health professionals and policy-makers, the public and industry. Setting Sixteen English NHS hospital trusts. Results Point-prevalence data were collected from 1326 patients and 2008 infusions. In total, 240 errors were observed in 231 infusions and 1489 discrepancies were observed in 1065 infusions. Twenty-three errors (1.1% of all infusions) were considered potentially harmful; one might have resulted in short-term patient harm had it not been intercepted, but none was judged likely to prolong hospital stay or result in long-term harm. Types and prevalence of deviations varied widely among trusts, as did local policies. Deviations from medication orders and local policies were sometimes made for efficiency or to respond to patient need. Smart pumps, as currently implemented, had little effect. Staff had developed practices to manage efficiency and safety pragmatically by working around systemic challenges. Limitations Local observers may have assessed errors differently across sites, although steps were taken to minimise differences through observer training, debriefs, and review and cleaning of data. Each in-depth study involved a single researcher, and these were limited in scale and scope. Conclusions Errors and discrepancies are common in everyday infusion administration but most have low potential for patient harm. Findings are best understood by viewing IV infusion administration as a complex adaptive system. Better understanding of performance variability to strategically manage risk may be more helpful for improving patient safety than striving to eliminate all deviations. Future work There is potential value in reviewing policy around IV infusion administration to reduce unnecessary variability, manage staff workload and engage patients, while retaining the principle that policy has to be fit for purpose, contextualised to the particular ward situation and treatment protocol, and sensitive to the risks of different medications. Further work on understanding infusion administration as a complex adaptive system might deliver new insights into managing patient safety. Funding This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 7. See the NIHR Journals Library website for further project information.

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“…Os termos de buscas relacionados a entrega de medicamentos por sistemas de infusões intravenosos unidos ao simulador resultaram em uma baixa incidência de trabalhos disponíveis na literatura. Porém, há relatos atuais de pesquisadores que apresentam elevada expectativa por trabalhos futuros sobre o tema com foco em melhorias em sistemas intravenosos capazes de auxiliar as ações de tomadas de decisões médicas [Piper et al 2018, Yu et al 2017, Blandford et al 2016].…”

Section: Trabalhos Relacionadosunclassified

SPODi: Simulador do Perfil Operacional de Dispositivos Intravenosos para Auxilio à Tomada de Decisões Médicas

Ferreira¹,

Barbosa

Gruendemann³

et al. 2019

Anais Do Simpósio Brasileiro De Computação Aplicada À Saúde (SBCAS 2019)

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Infusion procedures are among the most common in hospitals and have a high volume of adverse events in their operation. This paper presents a simulator, called SPODi, that allows an agile construction of the operational profiles of intravenous devices, enabling them to be evaluated when adverse events occur during the period of use. SPODi simulator was validated with real data extracted from a physical prototype (SPODi _Med) which was specifically build with this function. The results obtained, considering a 95% confidence interval when applying the t Student statistical test, indicate that SPODi can be used to infer the behavior of real infusion equipment.Resumo. Os procedimentos de infusão estão entre os mais usuais em hospitais e apresentam um volume elevado de eventos adversos na sua operação. Este artigo apresenta um simulador, denominado SPODi, que permite uma construção ágil dos perfis operacionais de dispositivos intravenosos, possibilitando que os mesmos possam ser avaliados quando da ocorrência de eventos adversos durante o período de seu uso. O simulador SPODi foi validado com dados reais extraídos de um protótipo físico (SPODi_Med) construído especificamente para essa finalidade. Os resultados obtidos, considerando um intervalo de confiança de 95 % quando da aplicação do teste estatístico t Student, apontam que o SPODi pode ser empregado para inferir o comportamento de um equipamento real de infusão. IntroduçãoOs dispositivos médicos modernos, com a intenção de qualificar o esforço de gerência por parte dos profissionais da saúde, muitas vezes exploram operações autônomas nos diferentes procedimentos que realizam [Dey et al. 2018]. Entre os procedimentos clínicos mais rotineiros em hospitais, estão os tratamentos que empregam os sistemas intravenosos. Cerca de 80% dos pacientes hospitalizados carecem de recursos terapêuticos intravenosos [Cheng et al. 2016]. A entrega de medicamento intravenosa é prescrita considerando as ações das diferentes concentrações da absorção do medicamento na corrente sanguínea ao longo do tempo para diferentes métodos de entrega.Os equipamentos de infusoterapia são utilizados em situações que exigem diferentes decisões por parte dos profissionais de saúde, as quais geram impactos diversos no tratamento do paciente. Assim, uma forma de contribuir para as decisões médicas consiste

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Exploring the Current Landscape of Intravenous Infusion Practices and Errors (ECLIPSE): protocol for a mixed-methods observational study

Cited by 28 publications

References 17 publications

Patient and public involvement in patient safety research: a workshop to review patient information, minimise psychological risk and inform research

Patient and public involvement in patient safety research: a workshop to review patient information, minimise psychological risk and inform research

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

SPODi: Simulador do Perfil Operacional de Dispositivos Intravenosos para Auxilio à Tomada de Decisões Médicas

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