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Errors and discrepancies in the administration of intravenous infusions: a mixed methods multihospital observational study
  1. Imogen Lyons1,
  2. Dominic Furniss1,
  3. Ann Blandford1,
  4. Gillian Chumbley2,
  5. Ioanna Iacovides3,
  6. Li Wei4,
  7. Anna Cox1,
  8. Astrid Mayer5,6,
  9. Jolien Vos1,
  10. Galal H Galal-Edeen1,7,
  11. Kumiko O Schnock8,9,
  12. Patricia C Dykes9,10,
  13. David W Bates8,9,
  14. Bryony Dean Franklin4,11
  1. 1 UCL Interaction Centre, University College London, London, UK
  2. 2 Pain Management Centre, Imperial College Healthcare NHS Trust, London, UK
  3. 3 Institute of Educational Technology, Open University, Milton Keynes, UK
  4. 4 Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
  5. 5 UCL Medical School, University College London, London, UK
  6. 6 Royal Free London NHS Foundation Trust, London, UK
  7. 7 Faculty of Computers and Information, Cairo University, Cairo, Egypt
  8. 8 Brigham and Women’s Hospital, Boston, Massachusetts, USA
  9. 9 Harvard Medical School, Boston, Massachusetts, USA
  10. 10 Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
  11. 11 Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Professor Bryony Dean Franklin, Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust/UCL School of Pharmacy, London, W6 8RF, UK; bryony.franklin{at}nhs.net

Abstract

Introduction 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.

Objectives 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 pumps.

Methods We conducted an observational point prevalence study of intravenous infusions in 16 National Health Service hospital trusts. Observers compared each infusion against the medication order and local policy. Deviations were classified as errors or discrepancies based on their potential for patient harm. Contextual issues and reasons for deviations were explored qualitatively during observer debriefs.

Results Data were collected from 1326 patients and 2008 infusions. Errors were observed in 231 infusions (11.5%, 95% CI 10.2% to 13.0%). Discrepancies were observed in 1065 infusions (53.0%, 95% CI 50.8% to 55.2%). Twenty-three errors (1.1% of all infusions) were considered potentially harmful; none were judged likely to prolong hospital stay or result in long-term harm. Types and prevalence of errors and discrepancies varied widely among trusts, as did local policies. Deviations from medication orders and local policies were sometimes made for efficiency or patient need. Smart pumps, as currently implemented, had little effect, with similar error rates observed in infusions delivered with and without a smart pump (10.3% vs 10.8%, p=0.8).

Conclusion Errors and discrepancies are relatively common in everyday infusion administrations but most have low potential for patient harm. Better understanding of performance variability to strategically manage risk may be a more helpful tactic than striving to eliminate all deviations.

  • medication safety
  • patient safety
  • information technology

This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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Footnotes

  • Contributors As per previous submission.

  • Funding This work is supported by the National Institute for Health Research (NIHR) grant [12/209/27], from the Health Services and Delivery Research (HS&DR) stream. The research is also supported by the NIHR Imperial Patient Safety Translational Research Centre. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval NHS Research Ethics Committee (14/SC/0290)

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

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