Parenteral Drug Administration Errors in the ICU
Parenteral Drug Administration Errors in the ICU
Abstract & Commentary
By David J. Pierson, MD, Editor, Professor, Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, is Editor for Critical Care Alert.
Synopsis: In this study of errors in parenteral drug administration to 1328 patients in 113 ICUs in 27 countries, most units reported errors, and overall there were 74.5 errors per 100 patient days. Although most of the errors resulted in no obvious harm to the patient, 12 instances resulted in permanent harm or death.
Source: Valentin A, et al. Errors in administration of parenteral drugs in intensive care units. BMJ 2009;338:b814.
This study was carried out by the research group on quality improvement of the European Society of Intensive Care Medicine. It was a prospective 24-hour cross-sectional observational study in which nurses, physicians, and other ICU staff recorded instances of errors in parenteral drug administration (wrong dose, wrong drug, wrong route, wrong time, or missed medication) to patients in their units. A data reporting form was placed at each bedside, which was available to everyone caring for the patient and permitted each caregiver to see any medication errors recorded by previous documenters. Data were recorded for all patients older than age 18 who were present in the ICU at any time during the designated 24-hour study period.
Staff in 113 ICUs in 27 countries on 5 continents participated in the study, and data were recorded for 1328 patients. Participating units were of all types and sizes, and average occupancy exceeded 90%. The patients (mean, age 63 years; 60% men) were on average fairly ill, with a median sequential organ failure assessment (SOFA) score of 5, indicating dysfunction or failure of more than one organ system, and a median NEMS (nine equivalents of nursing manpower use) score of 27, indicating a level of care representing 59% of the workload that 1 ICU nurse can perform in 24 hours.
In the 1328 patients, 861 parenteral medication errors affecting 441 patients were reported during the 24-hour study period. There were 74.5 (95% confidence interval, 69.5%-79.4%) errors per 100 patient days. Most errors were related to wrong time of administration (45%), missed medication (30%), or wrong dose (14%). Permanent harm or death resulted from the error in 12 patients (0.9%). Medication errors were more likely in patients with more organ failures, the use of intravenous medication, more different parenteral drug administrations, more patients per nurse, and higher ICU occupancy rate. Fewer errors were recorded in units with basic monitoring, an existing critical incident reporting system, an electronic medication prescribing system, and an increased ratio of patient turnover to the size of the unit. The authors concluded that parenteral drug administration errors are common in ICUs and represent an important safety issue. They noted that organizational factors such as error reporting systems and routine checks can reduce the risk for such errors.
Commentary
This study's findings should come as no surprise to clinicians working in the ICU. Administration errors related to parenteral medications are common, and although most of them relate to missed or mistimed doses they can have serious adverse impact for the patient. Because of several limitations in the study's design (e.g., the use of self-report for data acquisition, the possibility of duplicate reporting of the same incident, and the limited information about the errors reported), its findings should be interpreted more confidently in a qualitative than a quantitative sense. It is noteworthy (and encouraging) that administration errors were fewer in ICUs with electronic order entry, routine checks of infusion pumps and other administration devices, and an established incident reporting system. As the authors note, these and other organizational and systems measures represent potential avenues for reducing the incidence of medication-related errors in the ICU.
This study was carried out by the research group on quality improvement of the European Society of Intensive Care Medicine.Subscribe Now for Access
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