RT Journal Article
SR Electronic
T1 Errors and discrepancies in the administration of intravenous infusions: a mixed methods multihospital observational study
JF BMJ Quality & Safety
JO BMJ Qual Saf
FD BMJ Publishing Group Ltd
SP 892
OP 901
DO 10.1136/bmjqs-2017-007476
VO 27
IS 11
A1 Imogen Lyons
A1 Dominic Furniss
A1 Ann Blandford
A1 Gillian Chumbley
A1 Ioanna Iacovides
A1 Li Wei
A1 Anna Cox
A1 Astrid Mayer
A1 Jolien Vos
A1 Galal H Galal-Edeen
A1 Kumiko O Schnock
A1 Patricia C Dykes
A1 David W Bates
A1 Bryony Dean Franklin
YR 2018
UL http://qualitysafety.bmj.com/content/27/11/892.abstract
AB 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.