Insights from the sharp end of intravenous medication errors: implications for infusion pump technology.

BACKGROUND: Intravenous (IV) medication errors are a common type of error identified in hospitals and can lead to considerable harm. Over the past 20 years there have been several hundred FDA reported incidents involving IV pumps, many of which have led to patient deaths. OBJECTIVE: To determine the actual types, frequency, and severity of medication errors associated with IV pumps. To evaluate the likelihood that smart pump technology without an interface to other systems could have prevented errors. METHODS: Using a point prevalence approach, investigators prospectively compared the medication, dose, and infusion rate on the IV pump with the prescribed medication, doses, and rate in the medical record. Preventability with smart pump technology was retrospectively determined based on a rigorous definition of currently available technology. RESULTS: A total of 426 medications were observed infusing through an IV pump. Of these, 285 (66.9%) had one or more errors associated with their administration. There were 389 documented errors overall; 37 were "rate deviation" errors and three of these were judged to be due to a programming mistake. Most of the documented events would not have caused patient harm (NCC MERP category C). Only one error would have been prevented by smart pump technology without additional interface and software capabilities. CONCLUSION: Medication errors associated with IV pumps occur frequently, have the potential to cause harm, and are epidemiologically diverse. Smart pumps are a necessary component of a comprehensive safe medication system. However, currently available smart pumps will fail to generate meaningful improvements in patient safety until they can be interfaced with other systems such as the electronic medical record, computerized prescriber order entry, bar coded medication administration systems, and pharmacy information systems. Future research should focus on the effectiveness of new technology in preventing latent and active errors, and on new types of error that any technology can introduce.

[Positioning of central venous catheters using ECG]. / Plassering av sentralvenøst kateter ved hjelp av EKG.

The position of a central venous catheter has to be controlled. As a supplement to radiography of the chest the position of the catheter tip can be documented by means of ECG. The ECG is recorded with the catheter tip functioning as one of the electrodes. If the catheter tip is situated in the right atrium the ECG will record an elevated P-wave. When the catheter is pulled back into the vena cava superior the atrial-P will assume a normal shape. The position of the catheter tip correlates with the morphology of the P-wave. An ECG recording performed during insertion of the catheter can be used to achieve correct positioning of the catheter to start with and thereby reduce the frequency of having to replace wrongly positioned catheters. Intraoperatively the ECG recording is a practical method of achieving correct and extracardial placement of the catheter tip.

[Effectiveness of cimetidine in the prevention of aspiration pneumonia in obstetrics]. / Wirksamkeit von Cimetidin zur Prophylaxe der Aspirationspneumonie in der Geburtshilfe.

In a prospective controlled study 30 parturients provided for elective cesarean section were premedicated either with no specific medication for prophylaxis of aspiration pneumonia or 400 mg cimetidine orally at the evening and 400 mg intramuscularly two hours prior to induction of anesthesia. In the cimetidine treated group only one patient had a gastric pH below 2.5, while in the control group 11 patients had a pH below this limit. The gastric volume in the cimetidine treated group also was significantly reduced. No side effects could be observed in mothers and children. Application of intramuscularly cimetidine seems to be an effective method for prophylaxis of aspiration pneumonia in obstetric anesthesia.

[Epidural morphine analgesia (PMA). III. Cancer pain (author's transl)]. / Peridurale Morphin-Analgesie. III. Karzinomschmerzen.

The effect of PMA in pain therapy was investigated over a period of one year on 52 patients suffering from terminal cancer. These patients, 22 being outpatients, received a total number of 85 peridural catheters. 75 of these catheters were evaluated according to morphine dosage and effect. The onset of PMA resulted in a drastic reduction in the need for high dose systemically applied analgesics. PMA was also successfully applied in cases with rapidly spreading metastases. Our catheters have remained in place up to 170 days. Side effects were rarely observed. Tachyphylaxis did not develop and almost all patients were satisfied with the therapy. Due to special care of the catheter we observed only 7 cases of infected puncture sites. Our clinical studies have proven that peridural morphine analgesia can be successfully applied as pain therapy in patients suffering from terminal cancer.

[Epidural morphine analgesia (author's transl)]. / Peridurale Morphin-Analgesie.

We report our experience with epidural morphine analgesia. Morphine 2-3 mg in 10-15 ml 0.9% saline was given to patients after abdominal surgery, patients with terminal carcinoma and patients with multiple fractured ribs. Mean duration of analgesia was 14 hours and was not accompanied by severe complications.

Treatment of dopamine-dependent shock with triiodothyronine.

At the present time dopamine is the most frequently used treatment in patients with septic shock. The effects of dopamine are mediated by alpha-, beta- and dopaminergic receptors. It has been suggested that these receptors are controlled by triiodothyronine (T3). In acute septic shock circulating T3-concentrations are decreased. We have, therefore, treated in a preliminary study 11 such patients with T2-replacement by continuous infusion of T3 (100-200 micrograms/24h). Dopamine dependence was terminated. In all patients there was an increase of arterial blood pressure (BP) within 24 hrs (systolic BP rose by 34 +/- 4.2 mmHg, diastolic BP by 14.0 +/- 8.2 mmHg, resulting in an increase of the mean BP by 25 +/- 6.1 (SEM mmHg). The pulse rate was not influenced suggesting an effect on minute volume. A hypothesis is offered which explains the T3-effects as a result of its decarboxylation to a dopaminergic iodothyronine which is disturbed during the "low T3-syndrome".

Interacoes medicamentosas: nossa realidade. / Drug interaction: our reality

Com o proposito de verificar as interacoes medicamentosas mais frequentes em nosso meio, realizou-se o estudo de 1.200 prescricoes de pacientes internados em diversas clinicas de Curitiba no ano de 1981.Observou-se um total de 455 interacoes medicamentosas, sendo 156 (34,3%) de importancia clinica menor, 262 (57,6%) de importancia clinica relativa e 37 (8,1%) de importancia clinica maior. Existe, portanto, elevado indice de interacoes medicamentosas, grande parte das quais potencialmente prejudiciais aos pacientes

[Treatment of dopamine-dependent shock with triiodothyronine: prelimary results (author's transl)]. / Behandlung des dopaminabhängigen Schocks mit Trijodthyronin. Vorläufige Mitteilung.

Triiodothyronine (T3) was administered to 11 patients in septic shock. In all there occurred an increase in arterial blood pressure within 24 hours, the rise in systolic pressure being 34 +/- 4.2 mm Hg, of diastolic 14 +/- 8.2 mm Hg, corresponding to a rise in mean arterial pressure of 25 +/- 6.1 mm Hg. Haemodynamic studies in four patients suggest that the action of T3 is mediated via beta-sympathomimetic channels.