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Errors in the administration of intravenous medications in hospital and the role of correct procedures and nurse experience
  1. Johanna I Westbrook1,
  2. Marilyn I Rob1,
  3. Amanda Woods1,
  4. Dave Parry2
  1. 1Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, Australia
  2. 2Radiofrequency Identification Applications Laboratory, School of Computing and Mathematical Sciences, Auckland University of Technology, Auckland, New Zealand
  1. Correspondence to Johanna I Westbrook, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Level 1 AGSM Building, University of New South Wales, Kensington 2052, Sydney, Australia; j.westbrook{at}unsw.edu.au

Abstract

Background Intravenous medication administrations have a high incidence of error but there is limited evidence of associated factors or error severity.

Objective To measure the frequency, type and severity of intravenous administration errors in hospitals and the associations between errors, procedural failures and nurse experience.

Methods Prospective observational study of 107 nurses preparing and administering 568 intravenous medications on six wards across two teaching hospitals. Procedural failures (eg, checking patient identification) and clinical intravenous errors (eg, wrong intravenous administration rate) were identified and categorised by severity.

Results Of 568 intravenous administrations, 69.7% (n=396; 95% CI 65.9 to 73.5) had at least one clinical error and 25.5% (95% CI 21.2 to 29.8) of these were serious. Four error types (wrong intravenous rate, mixture, volume, and drug incompatibility) accounted for 91.7% of errors. Wrong rate was the most frequent and accounted for 95 of 101 serious errors. Error rates and severity decreased with clinical experience. Each year of experience, up to 6 years, reduced the risk of error by 10.9% and serious error by 18.5%. Administration by bolus was associated with a 312% increased risk of error. Patient identification was only checked in 47.9% of administrations but was associated with a 56% reduction in intravenous error risk.

Conclusions Intravenous administrations have a higher risk and severity of error than other medication administrations. A significant proportion of errors suggest skill and knowledge deficiencies, with errors and severity reducing as clinical experience increases. A proportion of errors are also associated with routine violations which are likely to be learnt workplace behaviours. Both areas suggest specific targets for intervention.

  • Medication errors
  • intravenous medications
  • nurses
  • patient safety
  • information technology
  • quality of care
  • healthcare quality
  • health services research
  • medication safety

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Footnotes

  • Funding This research was funded by National Health and Medical Research Grants 455270 and 568612.

  • Competing interests None.

  • Ethics approval Study hospital and the University of Sydney.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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