Project to improve quality of drug administration

Salas E, Bastida M, Grau S, Vilar Mª J, Ferrández O, Portabella J, Ortiz P, Miro M, Rubio L, Cuixart I, Cabello M

Background

9.04

7.39

2.63.5

9.7510.1

5.7

8.69.3

12.4

10.911.1

3.93.2

10.2

13.7

0

2

4

6

8

10

12

14

16

NY UC A L D NZ CA S

NY:New York;UC:Utah and Colorado;A:Australia;L:London;D:DenmarkNZ:New Zealand;CA:Canada;S:Spain

Incidence of patients suffering adverse healthcare-related events

Background

At the point of drug administration, errors have traditionally been more difficult to detect and clearly, the consequences of error more serious

Administration errors in hospitals

41 errors per 100 opportunities for error

Lisby M, Nielsen LP, Mainz J. Qual health care 2005; 17:15-22.

Background In Spain -retrospective study in 24 hospitals -hospitalised patients who had a case record and

were discharged during June 4-10, 2005 -identification of possible AE: Screening Guide from

the Adverse event Identification Project (IDEA)

RESULTS

5,624 case records-8.4% patients with AE related to hospital care

-37.4% of the AE were related to medication

Aranaz JM, Aibar C, Vitaller J, Ruiz P. Estudio Nacional sobre los Efectos Adversos ligados a la hospitalización. ENEAS, 2005.

Background

- Drug administration is the last step of the therapeutic care and one potential source of errors

- Implementation of strategies affecting this step could be relevant for reducing errors related to drug administration

Objective

Assessment of nurses’ knowledge of drug administration to provide them with information through a computer tool

Design It was performed in a 900-bed hospital trust, IMAS

(Esperança, Psiquiatric, Mar, Geriàtric) in Barcelona

The study period was from February to June 2006

Multidisciplinary team: pharmacists, nurses and computer programmers

Statistical analysis

-Student t test for parametrical variables

-Chi-square test and “U” Mann Whitney test for non parametrical variables

-CI 95% and p<0.05 for significance

A survey of 44 questions was handed out to a randomized number of nurses from different medical wards and shifts

125/127 surveys were answered

Results

-awareness of drug guide and protocol availability

-adverse drug event record

-oral drug administration

-reconstitution, dilution, administration and stability of parenteral drugs (M vs E, G and P; p<0.001)

-errors related to medication

-awareness of a medication errors reporting system

Statistical differences between hospitals:

Results

Statistical differences between nurse shifts:

-oral drug administration

-reconstitution, dilution, administration and stability of parenteral drugs (N vs M and A; p<0.001)

Results Drug classes whose administration was problematic: • antimicrobials• parenteral drugs• opiates

Differences were not found between different hospitals or shifts

0 5 10 15 20 25 30

antimicrobials

parenteraldrugs

opiates

Interventions

According to the obtained results, pharmacists introduced information about drug administration

drug administration paper chart

drug administration computerized chart

Information included Parenteral drugs

-Reconstitution -Dilution -Compatibility with fluids -Administration rate -Stability -Photosensitivity

Oral drugs -Drug-food and beverages interactions -Drug-herbal medicines interactions -Possibility of crushing

Information sources Databases Micromedex Medline Iowa

Books-Borgsdorf LR, Cada DJ, Cirigliano M, Covington TR, Generali JA, Hussar DA et al, editors. Drug facts and comparisons. St Louis:Facts and comparisons;2006.

-Seetman SC, editor. Martindale: the complet drug reference. London:Pharmaceutical Press;2004.

-Trissel LA. Handbook on injectable drugs. Bethesda:American Society of Health-System Pharmacists;2005.

-McEvoy GK, Miller J, Litvak K, Dewey DR, Bollinger LA, Shick J et al, editors. AHFS Drug Information. Bethesda:American Society of Health-System Pharmacists;2004.- Baxter K, editor. Stockley’s drug interactions. London: Pharmaceutical Press;2006.

Information sources Articles

-Dickerson RN, Melnik G. Osmolality of oral drug solutions and suspensions. American Journal of health-system pharmacy 1988;45:832-4.

-Gámez M, Clopés A, Cardona D, Farré R, Castro I, Bonal J. Importancia de las características fisico-químicas de los fármacos para su administración por sonda nasoentérica o enterostomía. Farm Hosp 1998;22:137-43.

-Schmidt LE, Dalhoff K.Food-drug interactions.Drugs 2002;62:1481-502

-Beckwith MC, Feddema SS, Barton RG, Graves C. A guide to drug therapy in patients with enteral feeding tubes:dosage form selection and administration methods.Hosp Pharm 2004;3:225-37.

-Magnuson BL, Clifford TM, Hoskins LA, Bernard AC. Enteral nutrition and drug administration, interactions, and complications. Nutr Clin Pract 2005;20:618-24..

Information from manufacturers

Interventions

According to the obtained results, pharmacists introduced information about drug administration

drug administration paper chart

drug administration computerized chart

MEDICACIO DOSI Hora Dill. Dima. Dime. Dijo. Dive. Diss. Dium.

-----------------------------------------------------------

INDAPAMIDA RETARD 1.5 MG COMP 1 COR/CADA 24 HORES/OR No triturar els comprimits. Administrar sense tenir en

compte els àpats.

PANTOPRAZOL 40 MG COMP 1 COM/CADA 24 HORES/OR No triturar els comprimits. Administrar sense tenir en

compte els àpats i amb un got d'aigua.

PARACETAMOL 1G IV VIAL 1 VIA/CADA 8 HORES/IV Administrar en 15min

Useful information for drug administration

Urgent information for drug administration

Conclusions

• A different knowledge profile in drug administration has been detected between nurses from different hospitals

• Different clinical characteristics of patients assisted in every center

• The introduction of strategies to improve security in drug administration is essential