A twitter nurse colleague (@chemosabe) shared an interesting article recently:
Errors in the administration of intravenous medications in hospital and the role of correct procedures and nurse experience Johanna I Westbrook, Marilyn I Rob, Amanda Woods, Dave Parry BMJ Qual Saf 2011;20:1027-1034 Published Online First: 20 June 2011
The objective of the study was to measure the frequency, type and severity of intravenous administration errors in hospitals and the associations between errors, procedural failures and nurse experience.
The study used prospective observations 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 categorized by severity.
The results of the study showed 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.
The study conclusion is 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.
Even with the differences in practice between the US and Australia, their study findings were interesting.
- The percentage of compliance with medication administration procedures (Table 2) was not surprising. In the US, we continue to improve our medication administration systems and procedures in order to reduce medication errors. However, just like in this study, errors still happen. Perhaps the “human factor” contribute to the low compliance – the procedures are there but it doesnt do anybody any good if compliance is not 100%?
- Infusion pumps do not always prevent errors: The study reported Infusion pumps were rarely used (17.6% of 256 infusions). Use of a pump was not associated with a significant decrease in error rate (pump: 13.3% (6/45 infusions) vs no pump: 18.5% (39/211); χ2=0.6790, df=1, p=0.4099), nor serious error rate (pump: 83.3% serious errors vs no pump: 46.2%; χ2=2.8766, df=1, p=0.0899). Nurses with <6 years experience were less likely than experienced nurses to use an infusion pump (9.3% vs 23.6%; χ2=8.92, df=1, p=0.0028).
- The median nursing experience of the 107 nurses was 6 years (range <1–43 years). Logistic regression showed that during the first 6 years of nursing experience the risk of error declined by 10.9% with each successive year of experience (table 6). After this point, further experience provided no additional benefit. I agree, the inexperienced nurses may need more training to prevent errors but sometimes, the more experienced nurses become ‘complacent” and thus can still be error prone.
For more information on the study – click here Thanks to Glen Quinn (@chemosabe) for sharing this article.
Quote of the day: You can’t make the same mistake twice, the second time, it’s not a mistake, it’s a choice.