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      Comparative Safety, Efficiency, and Nursing Preference Among 3 Methods for Intravenous Push Medication Preparation: A Randomized Crossover Simulation Study

      Journal of Patient Safety
      Lippincott Williams & Wilkins
      prefilled syringes, intravenous push medication, randomized trial, nursing practice, medication safety

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          The aim of this study was to compare total time for drug preparation, associated errors, and nurses' preferences among 3 different intravenous (IV) push medication methods.

          Research Design

          A randomized crossover simulation design was used to compare total time for drug preparation and incidence of medication preparation errors between BD Simplist (BDS), Carpuject (CJ), and traditional vial-and-syringe process (TVSP). Three medication preparation areas were created to mimic a hospital setting. Twenty-four critical care nurses were asked to prepare an IV dose of diphenhydramine, ketorolac, and morphine in random order using BDS, CJ, and TVSP, also in random order. Total time for the preparation of each drug was measured. Medication preparation errors were noted. At the start of the study, nurses were surveyed about their stress levels regarding aspects of IV push medications. At completion, nurses were asked to rank order from the most to the least preferred administration method.


          Mean time in seconds for drug preparation was significantly shorter ( P < 0.004) with BDS (28.7; 95% confidence interval [CI], 23.3–34.2) and CJ (28.3; 95% CI, 23.1–33.5) compared with TSVP (65.8; 95% CI, 57.7–73.9). The time difference between BDS and CJ was not statistically significant. Medication preparation errors were significantly reduced with BDS compared with both CJ and TVSP (1.4% versus 77.8% versus 73.6%; P < 0.001). The BDS was ranked by nurses as the most preferred method.


          The BD Simplist system for IV push medications may offer nurses an opportunity to reduce steps and reduce errors during medication preparation.

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          Most cited references20

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          The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group.

          To assess the additional resource utilization associated with an adverse drug event (ADE). Nested case-control study within a prospective cohort study. The cohort included 4108 admissions to a stratified random sample of 11 medical and surgical units in 2 tertiary-care hospitals over a 6-month period. Cases were patients with an ADE, and the control for each case was the patient on the same unit as the case with the most similar pre-event length of stay. Postevent length of stay and total costs. Incidents were detected by self-report stimulated by nurses and pharmacists and by daily chart review, and were classified as to whether they represented ADEs. Information on length of stay and charges was obtained from billing data, and costs were estimated by multiplying components of charges times hospital-specific ratios of costs to charges. During the study period, there were 247 ADEs among 207 admissions. After outliers and multiple episodes were excluded, there were 190 ADEs, of which 60 were preventable. In paired regression analyses adjusting for multiple factors, including severity, comorbidity, and case mix, the additional length of stay associated with an ADE was 2.2 days (P=.04), and the increase in cost associated with an ADE was $3244 (P=.04). For preventable ADEs, the increases were 4.6 days in length of stay (P=.03) and $5857 in total cost (P=.07). After adjusting for our sampling strategy, the estimated postevent costs attributable to an ADE were $2595 for all ADEs and $4685 for preventable ADEs. Based on these costs and data about the incidence of ADEs, we estimate that the annual costs attributable to all ADEs and preventable ADEs for a 700-bed teaching hospital are $5.6 million and $2.8 million, respectively. The substantial costs of ADEs to hospitals justify investment in efforts to prevent these events. Moreover, these estimates are conservative because they do not include the costs of injuries to patients or malpractice costs.
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            Errors in administration of parenteral drugs in intensive care units: multinational prospective study

            Objective To assess on a multinational level the frequency, characteristics, contributing factors, and preventive measures of administration errors in parenteral medication in intensive care units. Design Observational, prospective, 24 hour cross sectional study with self reporting by staff. Setting 113 intensive care units in 27 countries. Participants 1328 adults in intensive care. Main outcome measures Number of errors; impact of errors; distribution of error characteristics; distribution of contributing and preventive factors. Results 861 errors affecting 441 patients were reported: 74.5 (95% confidence interval 69.5 to 79.4) events per 100 patient days. Three quarters of the errors were classified as errors of omission. Twelve patients (0.9% of the study population) experienced permanent harm or died because of medication errors at the administration stage. In a multiple logistic regression with patients as the unit of analysis, odds ratios for the occurrence of at least one parenteral medication error were raised for number of organ failures (odds ratio per increase of one organ failure: 1.19, 95% confidence interval 1.05 to 1.34); use of any intravenous medication (yes v no: 2.73, 1.39 to 5.36); number of parenteral administrations (per increase of one parenteral administration: 1.06, 1.04 to 1.08); typical interventions in patients in intensive care (yes v no: 1.50, 1.14 to 1.96); larger intensive care unit (per increase of one bed: 1.01, 1.00 to 1.02); number of patients per nurse (per increase of one patient: 1.30, 1.03 to 1.64); and occupancy rate (per 10% increase: 1.03, 1.00 to 1.05). Odds ratios for the occurrence of parenteral medication errors were decreased for presence of basic monitoring (yes v no: 0.19, 0.07 to 0.49); an existing critical incident reporting system (yes v no: 0.69, 0.53 to 0.90); an established routine of checks at nurses’ shift change (yes v no: 0.68, 0.52 to 0.90); and an increased ratio of patient turnover to the size of the unit (per increase of one patient: 0.73, 0.57 to 0.93). Conclusions Parenteral medication errors at the administration stage are common and a serious safety problem in intensive care units. With the increasing complexity of care in critically ill patients, organisational factors such as error reporting systems and routine checks can reduce the risk for such errors.
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              National study on the distribution, causes, and consequences of voluntarily reported medication errors between the ICU and non-ICU settings.

              To compare the distribution, causes, and consequences of medication errors in the ICU with those in non-ICU settings.

                Author and article information

                J Patient Saf
                J Patient Saf
                Journal of Patient Safety
                Lippincott Williams & Wilkins
                September 2019
                16 June 2016
                : 15
                : 3
                : 238-245
                From the []Visante Inc, St. Paul, Minnesota
                []Center for Medication Safety Advancement, Purdue University College of Pharmacy, Fishers, Indiana.
                Author notes
                Correspondence: Maureen Burger, RN, MSN, CPHQ, CPPS, FACHE, 7905 Morningside Dr, Indianapolis, IN (e-mail: mburger@ 123456visanteinc.com ).
                PTS50086 00011
                Copyright © 2016 The Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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                prefilled syringes,intravenous push medication,randomized trial,nursing practice,medication safety


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