Abstract
Introduction
We previously found a high rate of errors in the administration of intravenous medications using smart infusion pumps.
Objectives/Design
An infusion safety intervention bundle was developed in response to the high rate of identified errors. A before–after observational study with a prospective point-prevalence approach was conducted in nine hospitals to measure the preliminary effects of the intervention.
Main Outcome Measures
Primary outcome measures were overall errors and medication errors, with the secondary outcome defined as potentially harmful error rates.
Results
We assessed a total of 418 patients with 972 medication administrations in the pre-intervention period and 422 patients with 1059 medication administrations in the post-intervention period. The overall error rate fell from 146 to 123 per 100 medication administrations (p < 0.0001), and the medication error rate also decreased from 39 to 29 per 100 medication administrations (p = 0.001). However, there was no significant change in the potentially harmful error rate (from 0.5 to 0.8 per 100 medication administrations, p = 0.37). An intervention component aiming to reduce labeling-not-completed errors was effective in reducing targeted error rates, but other components of the intervention bundle did not show significant improvement in the targeted errors.
Conclusion
Development and implementation of the intervention bundle was successful at reducing overall and medication error rates, but some errors remained and the potentially harmful error rate did not change. The error-rate reductions were not always correlated with the specific individual interventions. Further investigation is needed to identify the best strategies to reduce the remaining errors.
Clinical Trials Registration
Registered at ClinicalTrials.gov, identifier: NCT02359734.
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Acknowledgements
We gratefully acknowledge the Association for the Advancement of Medical Instrumentation (AAMI) and the CareFusion Foundation for funding for this study (2012–2015) as well as Timothy W. Vanderveen, Mary Logan, JD, CAE, Marilyn Neder Flack, and Sarah Fanta Lombardi, MPH, for supporting the study. We also acknowledge our national smart pump project collaborators, Kristy D. Stinger, Jo Anna Lamott, RPh, MBA, Anne Bane, RN, MSN, Elizabeth Buckley, RN, Amy Chouinard, RN, Bob Feroli, PharmD, Beverly King, RN, Carol Luppi, BS RN, Kathleen McIntosh, RN, Johnston S. Morrison, MSN RN, CPPS, Katie Outten, MSN, Lisa Smith, and Julie Zimmerman, MS, RN, CNS, CCRN, for conducting the study and sharing insights.
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Funding
This study was funded by the AAMI and the CareFusion Foundation (2012–2015).
Ethical approval
This study was approved by all study sites’ institutional review boards. All of the data collected were de-identified in the electronic data collection tool, which did not include any protected health information.
Conflicts of interest
Kumiko Schnock, Patricia Dykes, Catherine Yoon, Stuart Lipsitz, and David Bates received research grants from the CareFusion Foundation. Jennifer Albert, Caitlin Cameron, Nicole Macdonald, Ray Maddox, Sally Rafie, Emilee Robertson, Melinda Sawyer, and Elizabeth Wade received honoraria from the CareFusion Foundation for their participation. Deborah Ariosto, Diane Carroll, Adrienne Drucker, Rosemary Duncan, Marla Husch, Julie McGuire, Linda Fang, and Moreen Donahue declare that they have no conflict of interest. David Bates is a coinventor on patent no. 6029138 held by Brigham and Women’s Hospital on the use of decision support software for medical management, licensed to the Medicalis Corporation. He holds a minority equity position in the privately held company Medicalis, which develops web-based decision support for radiology test ordering. He serves on the board for SEA Medical Systems, which makes intravenous pump technology. He consults for EarlySense, which makes patient safety monitoring systems. He receives equity and cash compensation from QPID, Inc., a company focused on intelligence systems for electronic health records. He receives cash compensation from CDI (Negev), Ltd, which is a not-for-profit incubator for health IT startups. He receives equity from Enelgy, which makes software to support evidence-based clinical decisions. He receives equity from ValeraHealth, which makes software to help patients with chronic diseases. He receives equity from Intensix, which makes software to support clinical decision-making in intensive care. He receives equity from MDClone, which takes clinical data and produces de-identified versions of it. His financial interests have been reviewed by Brigham and Women’s Hospital and Partners HealthCare in accordance with their institutional policies.
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Schnock, K.O., Dykes, P.C., Albert, J. et al. A Multi-hospital Before–After Observational Study Using a Point-Prevalence Approach with an Infusion Safety Intervention Bundle to Reduce Intravenous Medication Administration Errors. Drug Saf 41, 591–602 (2018). https://doi.org/10.1007/s40264-018-0637-3
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DOI: https://doi.org/10.1007/s40264-018-0637-3