An observational study of prescribing and administration of intravenous drugs in a general hospital

Abstract

The prescribing and administration of intravenous drugs on two surgical and one medical ward were studied to determine the number, type and causes of errors occurring. The errors were classified for potential to harm the patient and for implications for the system of supply, preparation and administration. Of the 154 patients, 46.7 per cent were prescribed intravenous drugs. Of the 178 prescriptions for intravenous drugs, 14 per cent failed to conform to the local policy on prescribing and 11.2 per cent were considered to be clinically inappropriate. Preparation and administration were observed for 41.5 per cent of all scheduled intravenous doses during the 39-day study period. Excluding wrong time errors, the intravenous error rate was 26.9 per cent. Most errors were omissions (12.5 per cent of all observations), of which 45 per cent were due to lack of venous access and 22.5 per cent due to improper use of the drug chart. The latter also caused two errors of extra dosing. Fifty-two per cent of doses were given at the wrong time. Of the 254 errors, 4.7 per cent were classed as of major consequence for the patient, 17.3 per cent classed as moderate and 77.9 per cent as minor. Although the majority of errors observed were of minor consequence for the patient, the intravenous medication error rate could be reduced by using knowledge of the causes observed to change or reinforce the existing system of intravenous drug supply, preparation and administration