Improving the safety of continuously infused fluids in the emergency department

Abstract

When an unexpected crisis happens to patients with multiple continuous infusion fluids in the emergency department (ED), nurses need to recognize specific medication promptly and accurately for appropriate action. This study aims to evaluate the efficiency of colour-coded label system in ED fluids during an uneventful crisis simulation event. Promptness and accuracy of finding the correct fluid between the pre- and postintervention in each three groups (emergency nurses, intensive care unit nurses and nursing students) for three different scenarios (potassium, heparin and normal saline scenario) were assessed. Time improvement for all three groups from pre- to postintervention for all three scenarios were statistically significant (P < 0.001). There were no incorrect fluids indicated by all three groups of participants at postintervention analysis. Colour-coded labelling system in a simulated environment significantly improved the promptness and accuracy of finding the correct fluid from multiple infused continuous fluids.

Systemic Defenses to Prevent Intravenous Medication Errors in Hospitals: A Systematic Review

“… 24 , 32 – 76 The studies were conducted in 11 countries, which included the United States (n = 22), 24 , 34 , 36 , 38 – 40 , 47 , 51 – 55 , 57 , 59 , 60 , 62 , 65 , 67 , 70 , 71 , 74 , 75 Canada (n = 8), 32 , 33 , 41 , 42 , 44 , 45 , 66 , 76 Germany (n = 4), 48 , 63 , 68 , 69 the United Kingdom (n = 3), 46 , 49 , 72 New Zealand (n = 2), 35 , 43 Spain (n = 2), 50 , 64 Australia (n = 1), 61 Brazil and the United States (n = 1), 73 France (n = 1), 58 Israel (n = 1), 56 and Korea (n = 1). 37 Altogether, 30 studies (65%) were carried out in North America. Most of the studies were conducted in a hospital setting (n = 34), 35 , 40 – 48 , 50 – 52 , 54 – 56 , 58 – 65 , 67 – 76 and some in simulated hospital environments (n = 11).…”

“… 24 , 40 , 42 , 51 , 58 , 62 – 67 Besides preventing prescribing errors, computerized orders and decision support systems were found to contribute toward safe dispensing, 53 administration, 34 , 38 , 57 and treatment monitoring 38 , 74 , 75 by preventing errors related to interpretation of orders, calculation tasks, and follow-up. In addition to systemic defenses related to closed-loop medication management systems, prefilled syringes 39 , 49 and color-coded systems 36 , 37 , 39 were found to reduce errors in high-risk environments and situations, such as operating rooms and resuscitation.…”

“…Four of these were analyses of incident reports, medication error reports, or adverse drug event data, 41,43,59,67 and 2 were observational reviews of patient records. 44,60 The remaining 38 studies (83%) [32][33][34][36][37][38][39][40]42,[45][46][47][48][49][50][51][52][53][54][55][56][57][58][61][62][63][64][65][66][68][69][70][71][72][73][74][75][76] applied an observational study design without large magnitude of effect, which is why they were graded as low quality. Controlled low-quality studies (n = 31) applied variable designs: simulation studies (n = 11) [32][33][34][36]…”

“…Systemic defenses, including features of closed-loop medication management systems, appeared in 61% of the studies Measures used in more than one study Medication errors (n = 25) Detection methods: direct observation (n = 8), [32][33][34][35][36][37][38][39] self-reporting (n = 4), [40][41][42][43] patient record review (n = 4), [44][45][46][47] analyses of infusion concentrations (n = 3), [48][49][50] medication record review (n = 1), 51 order review (n = 1), 52 observation of infusion labels (n = 1), 53 automated compounding workflow system (n = 1), 54 self-reporting in the control group and errors detected by the system in the intervention group (n = 1), 55 self-reporting in the control group and drug chart review in the intervention group (n = 1) 56 Time to task completion (n = 12) Detection methods: direct observation (n = 9), 34,[36][37][38][39]49,53,56,57 electronic system time-stamps (n = 2), 47,55 self-reporting (n = 1) 58 Adverse drug events 59 and clinical incidents 43,58,60,61 (n = 5) Detection methods: self-reporting (n = 2), 43,61 patient ...…”

Design and production of a demountable modular infusion pump

“…When designing an infusion pump, it is important to remember that any device must prevent medical errors and infusion risks and must ensure patient safety Cho, Chung & Hong, 2013;O'Shea, 2013). Medical errors related to infusion pumps are very common and can be fatal.…”