Hospital Pharmacist
Vol 10 No 4 p141
April 2003

News summary

IV errors are common, says report

Almost half of all intravenous (IV) doses made up in hospital wards are associated with errors according to the BMJ (2003;326:684). Making up doses requiring multiple-step preparation, or administering a bolus, are particularly susceptible to error.

Katja Taxis from the department of practice and policy, School of Pharmacy, University of London observed nurses as they prepared and administered IV drugs on wards in two hospitals for 6–10 consecutive days, and recorded any errors they made. Health care professionals, including pharmacists, assessed the severity of errors.

Over 200 of 430 IV doses contained at least one mistake. The errors associated with three (1 per cent) of the doses had potentially severe consequences, 126 (29 per cent) had potentially moderate consequences and 83 (19 per cent) had potentially minor consequences.

The potentially severe errors, which all occurred at the preparation stage, were:

• Preparing the whole contents of a vial containing 125,000iu of heparin as a continuous infusion

• Not mixing the final solution on injecting 750mg vancomycin into a saline infusion bag

• Not preparing a new adrenaline (epinephrine) infusion on time, resulting in the treatment being interrupted

Potentially moderate errors included administering furosemide too rapidly and omitting a lunchtime dose of cefuroxime because of a ward transfer. Potentially minor errors included using too little water to prepare co-amoxiclav and administering amoxycillin too rapidly. Overall, preparation errors occurred in 32 doses (7 per cent), administration errors in 155 doses (36 per cent) and both types of error in 25 doses (6 per cent).

Among the possible strategies for reducing risks are purchasing ready-prepared IV drugs from pharmaceutical companies and centralised preparation of IV drugs by pharmacy staff. Dr Taxis and co-author Professor Nick Barber suggest, however, that centralised preparation in the pharmacy is not necessarily cost effective and may introduce other errors, such as mistakes in transmission from the ward to the preparation department. Moreover, nurses who have to prepare drugs in an emergency may make serious errors if they are no longer used to preparing IV doses. Technical solutions, such as a pump that prevents fast administration of bolus doses, warning labels put on drugs by pharmacy staff, and staff training could reduce errors.

Professor Barber told Hospital Pharmacist of his concern that nurses' training did not always cover the practical issues of making up IV doses in sufficient detail. Hospital pharmacists could help provide better training to nurses.