Rate of IV infusion: Errors in IV Administration


Editors:

Elham Reshid and Hailemariam Shimelis : Click for the PDF version


An appropriate dosing interval for most drugs depends on the therapeutic range. Hence, patients sometimes must receive medication very rapidly and other times they should be given slowly but constantly. In both of these circumstances, intravenous (IV) medication administration may be required. Here, one should take note that shorter dosing intervals increase the risk of drug-induced toxicity, whereas prolonged dosing intervals may diminish the drug’s efficacy because of decreased blood levels.

Infusion therapy through IV access is a therapeutic option used in the treatment of many hospitalized patients. As inpatient healthcare becomes more complicated, in terms of investigation and treatment, and as inpatient care becomes busier with rapid through put of patients, there are numerous opportunities for error in administration of prescribed treatments.

Medication administration errors occur frequently and are more likely to result in serious harm and death than other types of medication errors. IV administrations have a higher risk and severity of error than other medication administrations.

A systematic review and meta-analysis of nine published studies indicated the overall probability of making at least one error in IV therapy was 73%. The probability of an error in preparation was 43% with reconstitution of drug and diluent the single highest step introducing error (31%). The probability of an administration error was 61%.

A study conducted on 107nurses preparing and administering 568 IV medications in two teaching hospitals revealed that 69.7% had at least one clinical error and 25.5% of these were serious. Four error types (wrong IV rate, mixture, volume, and drug incompatibility) accounted for 91.7% of errors.

Wrong rate was the most frequent accounting for 95 of 101 serious errors. In another study the periods over which IV crystalloid fluid bags were administered were compared with the time prescribed. Of a total of 207 bags, 53 (26%) were correctly administered at the prescribed rate, 138 bags (67%) were infused too slowly and 16 bags (8%) were infused too fast.

These studies demonstrate that IV therapy is complex, potentially dangerous and error prone. Since the consequences of inaccurate IV infusion rates may be more serious in patients at risk of dehydration or fluid overload, increased awareness of such errors and more training about IV administration rates could prevent such havoc.

References:

http://www.merckmanuals.com/vet/pharmacology/pharmacology_introduction/pharmacokinetics.html

Intravenous Medication Administration. http://www.healthline.com/health/intravenous-medication. . .

Errors in the administration of intravenous medications in hospital and the role of correct procedures and nurse experience. BMJ QualSaf 2011;20:1027.e1034.

Vijayakumar A, Sharon EV, Teena J, Nobil S, Nazeer I.A clinical study on drug-related prob-lems associated with intravenous drugadmin-istration. J Basic ClinPharma 2014;5:49-53.

Rooker JC and Gerard DA.2007. Errors of intravenous fluid infusion rates in medical Inpatients. Clinical medicine 7: 482-485.

McDowell et al. Qual Saf Health Care 2010;19:341-345.

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