Minimizing IV Risk Factors for ICU Patients; Jacobi J.
August 25, 2011
Pharmacy Purchasing & Products, 2011;16-20.
Key Points
- An ICU patient may receive an average of 13 medications per day; seven through the intravenous route, according to a study reported in 2008.1
- These patients are at greater risk than others for IV medication errors due to the high number of meds administered, frequent titration/dose changes, narrow therapeutic index of the drugs (the ratio between the toxic dose and the therapeutic dose of a drug) and challenges that the ICU work environment presents to the staff.
- Sedatives, antimicrobial agents, vasopressors and anticoagulants are commonly used in ICU and are associated with a greater error rate than other drugs. These drugs also cause greater harm to patients if not carefully managed.
- Safety measures have improved with USP <797> standards, but further methods to reduce medication preparation errors are the following:
- Decrease nurse prepared solutions*
- Standardize concentrations*
-Use of detailed mixing instructions
-Standardize labeling methods to increase clarity*
-Use of premixed IV products to diminish product variability*
-If the drug volume adds 20% more fluid or greater, a corresponding volume should be removed from the bag prior to adding the drug
-For weight-based dosing, use the patient’s admission weight but if the weight decreases by 20% or more, a new standard weight should be used to calculate dosing
-Link pre-defined, standardized IV medication parameters with a smart pump library; for example bolus dose, infusion dose and rate, and concentration
-Some hospitals have established a nurse double-check procedure to verify the order, pump programming and patient connection prior to starting an infusion
-New technology should be implemented with staff education, policies and documentation requirements.
-In the hospital, a collaborative team of nurses, pharmacists and physicians should define the parameters to be used for medication delivery with smart pumps.
Key Take Aways from this article:
Safe medication delivery practices cannot be mandated by regulations alone. In hospitals, there are many possible sources of error and this issue is compounded in busy ICU environments where patients are seriously ill. The author describes a “culture of safety” where clinicians point out concerns, work together to seek solutions to problems and design new ways to minimize risks to prevent medication errors.
1Moss J. et.al. Intravenous Medication Administration in Intensive Care: Opportunities for Technological Solutions. AMIA Annu Symp Proc. 2008;495-499
Order from PharMEDium
Inquire online
Or call 1(800) 523-7749 for more information on sterile admixture services.