RT Journal Article
SR Electronic
T1 The frequency of intravenous medication administration errors related to smart infusion pumps: a multihospital observational study
JF BMJ Quality & Safety
JO BMJ Qual Saf
FD BMJ Publishing Group Ltd
SP 131
OP 140
DO 10.1136/bmjqs-2015-004465
VO 26
IS 2
A1 Schnock, Kumiko O
A1 Dykes, Patricia C
A1 Albert, Jennifer
A1 Ariosto, Deborah
A1 Call, Rosemary
A1 Cameron, Caitlin
A1 Carroll, Diane L
A1 Drucker, Adrienne G
A1 Fang, Linda
A1 Garcia-Palm, Christine A
A1 Husch, Marla M
A1 Maddox, Ray R
A1 McDonald, Nicole
A1 McGuire, Julie
A1 Rafie, Sally
A1 Robertson, Emilee
A1 Saine, Deb
A1 Sawyer, Melinda D
A1 Smith, Lisa P
A1 Stinger, Kristy Dixon
A1 Vanderveen, Timothy W
A1 Wade, Elizabeth
A1 Yoon, Catherine S
A1 Lipsitz, Stuart
A1 Bates, David W
YR 2017
UL http://qualitysafety.bmj.com/content/26/2/131.abstract
AB Introduction Intravenous medication errors persist despite the use of smart pumps. This suggests the need for a standardised methodology for measuring errors and highlights the importance of identifying issues around smart pump medication administration in order to improve patient safety.Objectives We conducted a multisite study to investigate the types and frequency of intravenous medication errors associated with smart pumps in the USA.Methods 10 hospitals of various sizes using smart pumps from a range of vendors participated. Data were collected using a prospective point prevalence approach to capture errors associated with medications administered via smart pumps and evaluate their potential for harm.Results A total of 478 patients and 1164 medication administrations were assessed. Of the observed infusions, 699 (60%) had one or more errors associated with their administration. Identified errors such as labelling errors and bypassing the smart pump and the drug library were predominantly associated with violations of hospital policy. These types of errors can result in medication errors. Errors were classified according to the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). 1 error of category E (0.1%), 4 of category D (0.3%) and 492 of category C (excluding deviations of hospital policy) (42%) were identified. Of these, unauthorised medication, bypassing the smart pump and wrong rate were the most frequent errors.Conclusion We identified a high rate of error in the administration of intravenous medications despite the use of smart pumps. However, relatively few errors were potentially harmful. The results of this study will be useful in developing interventions to eliminate errors in the intravenous medication administration process.