Sonia Pinkney1, Mark Fan1, Katherine Chan2, Christine Koczmara3, Christopher Colvin1, Farzan Sasangohar4, Caterina Masino1, Anthony Easty2, Patricia Trbovich5. 1. HumanEra, University Health Network, Toronto, Ontario, Canada. 2. HumanEra, University Health Network, Toronto, Ontario, Canada ; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada. 3. Institute for Safe Medication Practices Canada, Toronto, Ontario, Canada. 4. HumanEra, University Health Network, Toronto, Ontario, Canada ; Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada. 5. HumanEra, University Health Network, Toronto, Ontario, Canada ; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada ; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Administering multiple intravenous (IV) infusions to a single patient via infusion pump occurs routinely in health care, but there has been little empirical research examining the risks associated with this practice or ways to mitigate those risks. OBJECTIVES: To identify the risks associated with multiple IV infusions and assess the impact of interventions on nurses' ability to safely administer them. DATA SOURCES AND REVIEW METHODS: Forty nurses completed infusion-related tasks in a simulated adult intensive care unit, with and without interventions (i.e., repeated-measures design). RESULTS: Errors were observed in completing common tasks associated with the administration of multiple IV infusions, including the following (all values from baseline, which was current practice): setting up and programming multiple primary continuous IV infusions (e.g., 11.7% programming errors)identifying IV infusions (e.g., 7.7% line-tracing errors)managing dead volume (e.g., 96.0% flush rate errors following IV syringe dose administration)setting up a secondary intermittent IV infusion (e.g., 11.3% secondary clamp errors)administering an IV pump bolus (e.g., 11.5% programming errors)Of 10 interventions tested, 6 (1 practice, 3 technology, and 2 educational) significantly decreased or even eliminated errors compared to baseline. LIMITATIONS: The simulation of an adult intensive care unit at 1 hospital limited the ability to generalize results. The study results were representative of nurses who received training in the interventions but had little experience using them. The longitudinal effects of the interventions were not studied. CONCLUSIONS: Administering and managing multiple IV infusions is a complex and risk-prone activity. However, when a patient requires multiple IV infusions, targeted interventions can reduce identified risks. A combination of standardized practice, technology improvements, and targeted education is required.
BACKGROUND: Administering multiple intravenous (IV) infusions to a single patient via infusion pump occurs routinely in health care, but there has been little empirical research examining the risks associated with this practice or ways to mitigate those risks. OBJECTIVES: To identify the risks associated with multiple IV infusions and assess the impact of interventions on nurses' ability to safely administer them. DATA SOURCES AND REVIEW METHODS: Forty nurses completed infusion-related tasks in a simulated adult intensive care unit, with and without interventions (i.e., repeated-measures design). RESULTS: Errors were observed in completing common tasks associated with the administration of multiple IV infusions, including the following (all values from baseline, which was current practice): setting up and programming multiple primary continuous IV infusions (e.g., 11.7% programming errors)identifying IV infusions (e.g., 7.7% line-tracing errors)managing dead volume (e.g., 96.0% flush rate errors following IV syringe dose administration)setting up a secondary intermittent IV infusion (e.g., 11.3% secondary clamp errors)administering an IV pump bolus (e.g., 11.5% programming errors)Of 10 interventions tested, 6 (1 practice, 3 technology, and 2 educational) significantly decreased or even eliminated errors compared to baseline. LIMITATIONS: The simulation of an adult intensive care unit at 1 hospital limited the ability to generalize results. The study results were representative of nurses who received training in the interventions but had little experience using them. The longitudinal effects of the interventions were not studied. CONCLUSIONS: Administering and managing multiple IV infusions is a complex and risk-prone activity. However, when a patient requires multiple IV infusions, targeted interventions can reduce identified risks. A combination of standardized practice, technology improvements, and targeted education is required.
Authors: Juliana J Brixey; David J Robinson; Craig W Johnson; Todd R Johnson; James P Turley; Jiajie Zhang Journal: ANS Adv Nurs Sci Date: 2007 Jan-Mar Impact factor: 1.824
Authors: David R Moss; Karsten Bartels; Gregory L Peterfreund; Mark A Lovich; Nathaniel M Sims; Robert A Peterfreund Journal: Anesth Analg Date: 2009-11 Impact factor: 5.108