publication . Article . Other literature type . 2018

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

Lyons, Imogen; Furniss, Dominic; Blandford, Ann; Chumbley, Gillian; Iacovides, Ioanna; Wei, Li; Cox, Anna; Mayer, Astrid; Vos, Jolien; Galal-Edeen, Galal H.; ...
Open Access English
  • Published: 01 Nov 2018
  • Country: United Kingdom
Abstract
<jats:sec><jats:title>Introduction</jats:title><jats:p>Intravenous 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.</jats:p></jats:sec><jats:sec><jats:title>Objectives</jats:title><jats:p>To 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 p...
Subjects
free text keywords: Original Research, 1506, medication safety, patient safety, information technology, Information technology, medication safety, patient safety, Emergency medicine, medicine.medical_specialty, medicine, Observational study, Prevalence, Local policy, Intravenous Infusions, Medication administration, Type I and type II errors, Family medicine, business.industry, business, Harm
21 references, page 1 of 2

1 McDowell SE, Mt-Isa S, Ashby D, et al. Where errors occur in the preparation and administration of intravenous medicines: a systematic review and Bayesian analysis. Qual Saf Healthcare 2010;19:341&#x96;5.

2 Franklin BD, Taxis K, Barber N. Parenteral drug errors. Reported error rates are likely to be underestimation. BMJ 2009;338:b1814. [OpenAIRE]

3 Ohashi K, Dalleur O, Dykes PC, et al. Benefits and risks of using smart pumps to reduce medication error rates: a systematic review. Drug Saf 2014;37:1011&#x96;20.

4 Schnock KO, Dykes PC, Albert J, et al. The frequency of intravenous medication administration errors related to smart infusion pumps: a multihospital observational study. BMJ Qual Saf 2017;26:131&#x96;40.

5 Husch M, Sullivan C, Rooney D, et al. Insights from the sharp end of intravenous medication errors: implications for infusion pump technology. Qual Saf Health Care 2005;14:80&#x96;6. [OpenAIRE]

6 Blandford A, Furniss D, Lyons I, et al. Exploring the Current Landscape of Intravenous Infusion Practices and Errors (ECLIPSE): protocol for a mixed-methods observational study. BMJ Open 2016;6:e009777.

7 Hollnagel E, Wears RL, Braithwaite J. From Safety-I to Safety-II: a white paper. The resilient health care net. Published simultaneously by the University of Southern Denmark, USA: University of Florida and Australia: Macquarie University, 2015. [OpenAIRE]

8 Vincent C, Amalberti R. Safer healthcare. Cham: Springer International Publishing, 2016. [OpenAIRE]

9 Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42:377&#x96;81.

10 Hartwig SC, Denger SD, Schneider PJ. Severity-indexed, incident report-based medication error-reporting program. Am J Hosp Pharm 1991;48:2611&#x96;6. [OpenAIRE]

11 Fahmy S, Garfield S, Furniss D, et al. A comparison of two methods of assessing the potential clinical importance of medication errors. Safety in Health 2018;4.

12 Hollnagel E. FRAM, the functional resonance analysis method: modelling complex socio-technical systems. Farnham: Ashgate Publishing Ltd, 2012. [OpenAIRE]

13 Westbrook JI, Rob MI, Woods A, et al. Errors in the administration of intravenous medications in hospital and the role of correct procedures and nurse experience. BMJ Qual Saf 2011;20:1027&#x96;34.

14 Keers RN, Williams SD, Cooke J, et al. Prevalence and nature of medication administration errors in health care settings: a systematic review of direct observational evidence. Ann Pharmacother 2013;47:237&#x96;56.

15 McLeod MC, Barber N, Franklin BD. Methodological variations and their effects on reported medication administration error rates. BMJ Qual Saf 2013;22:278&#x96;89.

21 references, page 1 of 2
Abstract
<jats:sec><jats:title>Introduction</jats:title><jats:p>Intravenous 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.</jats:p></jats:sec><jats:sec><jats:title>Objectives</jats:title><jats:p>To 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 p...
Subjects
free text keywords: Original Research, 1506, medication safety, patient safety, information technology, Information technology, medication safety, patient safety, Emergency medicine, medicine.medical_specialty, medicine, Observational study, Prevalence, Local policy, Intravenous Infusions, Medication administration, Type I and type II errors, Family medicine, business.industry, business, Harm
21 references, page 1 of 2

1 McDowell SE, Mt-Isa S, Ashby D, et al. Where errors occur in the preparation and administration of intravenous medicines: a systematic review and Bayesian analysis. Qual Saf Healthcare 2010;19:341&#x96;5.

2 Franklin BD, Taxis K, Barber N. Parenteral drug errors. Reported error rates are likely to be underestimation. BMJ 2009;338:b1814. [OpenAIRE]

3 Ohashi K, Dalleur O, Dykes PC, et al. Benefits and risks of using smart pumps to reduce medication error rates: a systematic review. Drug Saf 2014;37:1011&#x96;20.

4 Schnock KO, Dykes PC, Albert J, et al. The frequency of intravenous medication administration errors related to smart infusion pumps: a multihospital observational study. BMJ Qual Saf 2017;26:131&#x96;40.

5 Husch M, Sullivan C, Rooney D, et al. Insights from the sharp end of intravenous medication errors: implications for infusion pump technology. Qual Saf Health Care 2005;14:80&#x96;6. [OpenAIRE]

6 Blandford A, Furniss D, Lyons I, et al. Exploring the Current Landscape of Intravenous Infusion Practices and Errors (ECLIPSE): protocol for a mixed-methods observational study. BMJ Open 2016;6:e009777.

7 Hollnagel E, Wears RL, Braithwaite J. From Safety-I to Safety-II: a white paper. The resilient health care net. Published simultaneously by the University of Southern Denmark, USA: University of Florida and Australia: Macquarie University, 2015. [OpenAIRE]

8 Vincent C, Amalberti R. Safer healthcare. Cham: Springer International Publishing, 2016. [OpenAIRE]

9 Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42:377&#x96;81.

10 Hartwig SC, Denger SD, Schneider PJ. Severity-indexed, incident report-based medication error-reporting program. Am J Hosp Pharm 1991;48:2611&#x96;6. [OpenAIRE]

11 Fahmy S, Garfield S, Furniss D, et al. A comparison of two methods of assessing the potential clinical importance of medication errors. Safety in Health 2018;4.

12 Hollnagel E. FRAM, the functional resonance analysis method: modelling complex socio-technical systems. Farnham: Ashgate Publishing Ltd, 2012. [OpenAIRE]

13 Westbrook JI, Rob MI, Woods A, et al. Errors in the administration of intravenous medications in hospital and the role of correct procedures and nurse experience. BMJ Qual Saf 2011;20:1027&#x96;34.

14 Keers RN, Williams SD, Cooke J, et al. Prevalence and nature of medication administration errors in health care settings: a systematic review of direct observational evidence. Ann Pharmacother 2013;47:237&#x96;56.

15 McLeod MC, Barber N, Franklin BD. Methodological variations and their effects on reported medication administration error rates. BMJ Qual Saf 2013;22:278&#x96;89.

21 references, page 1 of 2
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publication . Article . Other literature type . 2018

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

Lyons, Imogen; Furniss, Dominic; Blandford, Ann; Chumbley, Gillian; Iacovides, Ioanna; Wei, Li; Cox, Anna; Mayer, Astrid; Vos, Jolien; Galal-Edeen, Galal H.; ...