Elsevier

Australian Critical Care

Volume 22, Issue 3, August 2009, Pages 141-143
Australian Critical Care

Research review
Errors in administration of parenteral medications are a serious safety problem in intensive care units

Valentin A, Capuzzo M, Guidet B, Moreno R, Metnitz B, Bauer P, Metnitz P. Research Group on Quality Improvement of the European Society of Intensive Care Medicine and the Sentinel Events Evaluation Study Investigators. Errors in administration of parenteral drugs in intensive care units: multinational prospective study. BMJ 2009;338:b814, doi:10.1136/bmj.b814.
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Summary

This research review aimed to critically appraise the study by Valentin et al. on administration errors for parenteral medications in intensive care units.

Section snippets

Objectives of the study

The objectives of this multinational study were to assess the frequency, characteristics, contributing factors and preventative measures of administration errors for parenteral medications in intensive care units (ICUs), and to determine the impact of parenteral medication errors and outcomes for patients.

Design, setting and participants of the study

A prospective, observational design was undertaken, involving 113 ICUs from 27 countries across five continents, including Australia. All nurses and physicians working in the ICUs on a nominated study day were invited to complete a structured questionnaire about whether a parenteral medication error had occurred.

Research process

A coordinator at each participating unit was responsible for managing data collection, briefing the research team, and providing characteristics about the ICU, staff work patterns and patients. Questionnaires were located at each patient's bedside and could therefore contain consecutive entries from several staff members. Information was sought on if a parenteral medication error had occurred, the time it had occurred, and the contributing factors and situational factors. The impact of each

Results

The final study sample comprised 1328 patients and most of the ICUs were of a mixed nature, including medical, surgical and trauma patients. In total, 861 medication errors affecting 441 patients were reported for the 24-h study day and there were 74.5 errors per 100 patient days. Most common errors related to wrong time of administration (n = 386), missed medication (n = 259), followed by wrong dose (n = 118), wrong drug (n = 61) and wrong route (n = 37). The most common classes of medications

Conclusion

The results show that certain strategies can be implemented in an attempt to reduce the incidence of parenteral medication errors. Routine checks of infusion pumps and intravenous lines should be undertaken by nurses at the start of every working shift. Information can be then conveyed at the change of shift during handover in effort to address or prevent errors. A critical incident reporting system should be readily available in all units. In addition, inexperienced nurses and physicians

Critique

The article is extremely well-written, clear and readable. The liberal use of tables and headings allows for ease of understanding and the ability to locate specific information. The study was well-conducted and due to its multinational and prospective nature, it is possible to generalise findings across countries. It is obvious that the investigators had good collaborative relationships with coordinators of participating units, to bring about good compliance with completion of questionnaires.

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