Medication errors have become very common in the medical field. Consider the case of intravenous drugs. Hospitals widely use intravenous drugs, but the preparation of drugs for intravenous use on the wards by nursing or medical staff is found to be linked with various problems. Some of the risks associated with the usage of intravenous drugs are • Poor aseptic technique causes microbiological or particulate contamination of the dose and this result in further problems • Lack of time, restricted working and frequent interruptions lead to crucial mistakes in the administration and dose preparation• Low quality aseptic techniques cause microbiological or particulate contamination of the dose (finally resulting in problems like septicaemia) According to the recent reports, during the preparation of intravenous drugs there happens error at a rate of 26.
9 per cent. There were numerous cases that intravenous drug errors causes morbidity and mortality. This particular system also brings possible hazards to nursing staff; for example as a result of needle stick injury, risks associated with HIV (human immunodeficiency virus) and hepatitis virus transmission (transmitted from contaminated needles).Moreover, aerosolized antibiotics that result in irritation and hypersensitivity may also cause problems like antibiotic resistance.
Apart from this, the preparation of a single intravenous dose also results in problems related to time. Improper drug handling also causes intravenous medication errors. Nurses are required to be extra vigilant and alert during IV drug rounds. Mistakes usually happen during the drug preparation; while preparing small volumes or the usage of unusual drug vial presentations.The complex structure and design of equipment and the lack of expertise in the preparation are the underlying problems of errors.
Lack of perceived risk, unavailability of good technology and poor role models are also among the reasons for these frequently occurring intravenous medication errors. Intravenous medication errors are common events. They cause considerable harms most of them quite serious. Drug preparation and administration involves numerous drug errors.An example of such error is the violation of guidelines is the regarding of the crucial guidelines during the injection of bolus doses (when the injection is done faster than the recommended rate of 3-5 minutes. Even the concept of human error theory is not found to be that successful in finding out the real causes of intravenous errors. An Intravenous medication error can be explained as any deviation in the preparation or administration of the Intravenous medication from the doctor’s prescription, the hospital’s Intravenous policy, or the manufacturer’s instructions.
A simple carelessness from the nursing staff or a small medication error or misunderstanding can cause serious problems. Even though it is sure that the common causes of medication errors are communication problems, equipment problems, lack of experience and knowledge, lack of training, faults in the system, and personal problems, it is still unknown to what extent such factors contribute to intravenous medication errors. Let us use the Betty Neuman Systems Model for analyzing the problem of medication error in hospitals. The system is found to be very much adaptable to interdisciplinary usage.The systems approach and broadness are proved to be useful in the dynamic health care delivery system that exists in hospitals. The application of the Neuman’s System Model to interdisciplinary use is found to be useful. The systems model can be implemented in the hospital environment to eliminate issues like medication errors.
The system would eliminate disorders in the structural framework and would also provide more safety and support for patients as well as the health care professionals. The system is applicable in administrative, community, nursing and client levels.It would also furnish an experienced interdisciplinary health care team that can approach the problem at different angles. The works of John Walker and Patricia Hinton-Walker explain the interdisciplinary work at different levels of the system, typically the administrative (management) level.
The recommended framework and discipline of the work at nurse, client, and community level is explained in the works of Patricia Davies. The system is perfectly applicable to the interdisciplinary health care team and would eliminate several major problems like medication errors.The application of Betty Neuman Systems Model approach and further investigations has suggested a solution to the medication errors, particularly the intravenous drug errors. The application of Betty Neuman Systems Model in the practice setting of the hospital introduced a new approach of hospital setting that would avoid majority of the medication errors.
A thorough study of the details of the errors caused by intravenous medication errors reveal that the one and only solution to these problems (particularly from the nurse’s part) is the Centralized Intravenous Additive System (CIVAS).There are numerous advantages in using Centralized Intravenous Additive System (CIVAS) in nursing. It is found to be eliminating majority of errors in the traditional system of medication and nursing. The best solution to these problems in hospitals (that associated with the usage of intravenous drugs) is the usage of centralized intravenous additive (CIVA) services. Even though it is true that the usage of centralized intravenous additive (CIVA) services is expensive the numerous advantages of this system justify the expense.The introduction of the CIVAS (Centralized Intravenous Additive System) has moved a difficult and risk prone aspect of drug administration away from the nurse and into the hands of those best suited for the role, a simple and cost effective, but valuable solution. The number of intravenous drugs supplied by the CIVAS service is currently limited and further study is required to investigate the implications of broadening the service to include all intravenous medications, thereby presumably further lowering the risk of error.
Although providing pre-mixed drugs does remove some of the risk, it is still the responsibility of the nurse to consult the specific guidance for administering the drug, as they need to be aware of its actions as well as any possible side effects relevant to the individual patient and their current condition. No amount of pre-prepared drugs can absolve the nurse of the responsibility of correctly following guidelines and protocols for safe drug administration. Training needs and design issues must be seriously considered to reduce the rate of IV drug preparation and administration errors.All this require a coordinated approach from the staff, practitioners, regulators, doctors, nurses and the whole hospital administration.
The intravenous (IV) administration of drugs is extremely complex and tough to execute without error. A study conducted on ten wards in two hospitals in UK revealed that errors happen in nearly half of the intravenous drug preparations and administrations, out of which one percent is found to be severe and fifty-eight percent is of moderate nature. However it is true that CIVAS is a highly useful technique for hospital to make their service error free.CIVAS was less vulnerable to unanticipated interruptions in work flow than ward-based preparation. Moreover there are other benefits to a CIVAS service in addition to financial ones.
The most important benefit is increased patient safety. Errors in preparing and administering intravenous drugs can cause considerable harm to patients. Error always crept in during drug preparation and administration. The most common errors were giving bolus doses too quickly and mistakes in preparing drugs that required multiple steps.Other errors are errors happening during, preparation of wrong drug, preparation of an unauthorized drug.
Errors in solvent/diluent (use of wrong solvent/diluent or wrong volume), preparation of wrong dose and omission of prescribed drug are also common. There are also administration errors including administration to wrong patient, fast administration of bolus dose through a peripheral line, fast administration of bolus dose through a central line and Incompatibility errors.Centralized Intravenous Additive System (CIVAS) is found to be eliminating maximum number of medication errors and is found to be indispensable for hospitals even though it is bit expensive. Investigations of large scale accidents and big medication error problems (in high risk areas) revealed that the design of systems, pre-existing organizational factors and the conditions, conventions and procedures for the use of sophisticated technology (operations) keep human operators in a position in which human errors mostly lead to nothing but disasters.A proper study about such active failures and accidents reveals that the working conditions (error and violation producing conditions) and the lack of time (and proper coordination) at the time of the accident and the organizational processes and management decisions are the reason behind the accident.
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