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

Abstract

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Prevalence and determinants of intravenous admixture preparation errors: A prospective observational study in a university hospital

“…The identified determinants point to factors related to the complexity of preparations and working conditions. Strategies may include increased use of ready-to-administer medication [10,11,16], support from pharmacy staff [11], focused educational programmes [60], or interruption management interventions [57,60]. Especially increased used of ready-to-administer medication, pharmacy or industry manufactured, is very promising [10,11,16], as it has been shown to be cost-effective [16].…”

“…Strategies may include increased use of ready-to-administer medication [10,11,16], support from pharmacy staff [11], focused educational programmes [60], or interruption management interventions [57,60]. Especially increased used of ready-to-administer medication, pharmacy or industry manufactured, is very promising [10,11,16], as it has been shown to be cost-effective [16]. However, preparation on wards will still be needed, as not all medications are suitable to be produced in a ready-to administer form, for example because of stability issues.…”

“…Therefore, it remains crucial for nursing staff to prepare intravenous admixtures regularly and to receive tailored education on this matter. Future studies should focus on the effectiveness of preventive strategies [11] and on potential determinants insufficiently identified by our study (e.g. workload and nurse characteristics) as well as the underlying causes of IAPEs specifically.…”

“…This study showed that IAPEs, including potentially harmful IAPEs, are common in clinical practice, which merits implementation of effective systemic defences to improve patient safety. Previously investigated strategies to reduce the number of IAPEs include quite comprehensive and costly interventions such as automated preparation systems [ 11 , 14 , 15 ] and centralising intravenous admixture preparation to hospital pharmacies [ 11 – 13 , 59 ]. Our study identified determinants that may be the focus of other interventions.…”

“…Several strategies have been explored to reduce the number of IAPEs [8,10,11], such as implementing pharmacy-based centralised intravenous admixture services (CIVAS) [11][12][13] or automated preparation systems [11,14,15]. These strategies might be cost-effective by preventing adverse drug events [16], which are associated with substantial costs, ranging from approximately €1000 to €7000 per event [17].…”