ECLIPSE (Exploring the Current Landscape of Intravenous Infusion Practices & Errors) is a research project funded by NIHR (2014-2017) studying medication practices with infusion devices, to document the variety of existing practices and deliver recommendations for best practice in different situations.
There are various studies of the intravenous administration of drugs in hospitals; these suggest that errors often occur in the preparation and administration of these drugs. Depending on the methods used and what is counted as an “error”, published error rates vary from 18% of doses to 173% of doses (error rates of more than 100% are sometimes quoted where studies count more than one error per dose). Many of these errors are very minor and unlikely to affect the patient. However, others can lead to patient harm.
Within the USA, “smart” infusion pumps are used in most hospitals with the aim of preventing such errors. These pumps need more information from hospital staff (such as details of the medication and its concentration, the patient’s weight, etc.); they then alert the user to unusual infusion rates based on those values. Some US research suggests that smart pumps can prevent a significant proportion of errors; other research suggests they have little effect. Smart pump use is much less common in England – only a handful of hospitals use them. There are no UK studies of their likely effects on medication errors, and practices in relation to prescribing and administering intravenous medication are different to those in the USA. There is therefore little information available to guide UK hospital staff in deciding how best to prevent errors involving the administration of intravenous medication, and whether or not the costs of smart pumps would be justified by any impact on error reduction.
Our study aims to fill these gaps in knowledge. We will explore how often errors involving administration of intravenous medication occur in UK hospitals, the reasons for these errors, and how they may be linked to, or prevented by, the infusion pumps used. We will compare our results with a similar study of the types and frequency of intravenous medication administration errors ongoing in the US, and explore reasons for any differences identified.
First, we will conduct a study across English hospitals to find out how often errors occur in the administration of intravenous medication. In each hospital, we will study four wards (representing critical care, general medicine, general surgery and paediatrics). We will train a small team of staff in each hospital to collect details of the intravenous medication being administered on a particular day and compare this to the medication prescribed, to identify any errors. We will include errors involving administration of the wrong drug, wrong concentration, wrong infusion rate, wrong method of administration, wrong time of administration, and so on. We will also assess the importance of any errors identified using standard methods. We will then analyse the data to explore whether there might be differences in error rates or types across different wards or hospitals, or for different types of infusion pump. The ten hospitals will be selected based on a survey of English hospitals that we are conducting as part of another study to find out what kinds of infusion pumps are currently used, how, and for what purposes, and how they are managed and maintained. From the results of this survey, we will choose ten hospitals to represent a range of different practices in relation to the administration of intravenous medication.
Second, we will focus in more detail on a smaller number of selected wards and hospitals, to explore the reasons why errors in intravenous medication do or do not occur. The wards and hospitals will be selected based on the first phase of our study, as described above, to include wards with different rates and types of errors. Our researchers will observe staff administering intravenous medication and setting up infusion pumps in the study wards, supplemented by interviews with staff at all levels and with a variety of roles (managers, those responsible for training and device maintenance, as well as nurses and other staff who use infusion pumps and administer intravenous medication).
Finally, together with findings from the ongoing parallel US study, we will use our results to develop recommendations for best practice for intravenous drug medication administration in English hospitals. We will be able to provide information on types of error which currently occur, how many could be prevented using smart pumps, and how many would not. We will make recommendations for interventions (such as changes in protocols, pump design or healthcare professionals’ training) to reduce the likelihood of harm from errors in intravenous medication. We anticipate our work leading to a reduction in medication errors and thus patient harm, as well as providing useful information to hospitals in making decisions about the use of infusion pumps and whether or not to purchase smart pumps.
We are obtaining NHS ethics approval to do this research. Our research team will not be recording patient names or any other confidential information, and we will request informed consent from hospital staff before observing or interviewing them. Data will be anonymised so that staff, wards and hospitals cannot be identified. We have experience of conducting similar studies.
We are a team of experienced researchers, bringing together many years’ experience in studying medication errors, the interface between people and technology, and how technology is used in healthcare. We will also establish a clinical engagement group to encourage the input of nurses, doctors, pharmacists and patients into the research on an ongoing basis.
The success of the research will be assessed on the basis of data collection and analysis proceeding to schedule, and on generating findings and recommendations that are useful to the NHS.