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Preventing errors in administration of parenteral drugs: the results of a four-year national patient safety program.

Blok, C. de, Schilp, J., Wagner, C. Preventing errors in administration of parenteral drugs: the results of a four-year national patient safety program.: , 2013. 1988 p. Abstract. In: Abstractbook 5 Minute presentations. International Society for Quality in Health Care (ISQUA) 30th International Conference 'Quality and safety in population health and healthcare'. Edinburgh: ISQUA, 2013.
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Objectives: To evaluate the implementation of a four-year national patient safety program concerning the parenteral drug administration process in the Netherlands. Methods: Structuring the preparation and administration process of parenteral drugs reduces the number of medication errors. A nationwide hospital patient safety program was started in 2008 to improve patient safety in Dutch hospitals. The theme “high risk medication: preparation and administration of parenteral drugs” was assigned as one of the improvement themes. The goal is to reduce medication errors by following a checklist which describes the steps a nurse has to take in the preparation and administration of parenteral drugs. The goal was to implement this process in all Dutch hospitals before December 2012. To evaluate this goal, an observational, prospective study was started in 19 Dutch hospitals. Since most errors occur in the administration of drugs, we only focussed on the parenteral drug administration process. Data was collected during the period December 2011 – December 2012. During 10 monthly visits, a trained research assistant observed the process of intravenous drug administration at three departments (intensive care unit, internal medicine department, and surgery department) by using a checklist containing 9 items representing the steps nurses had to take in the administration process, such as patient identification, hand hygiene, and checking the injection rate. Multilevel analysis was used to determine if the percentage of administration processes in which all required steps were performed changed during the study. Results: In total 2154 observations of administration processes were included, the number of observations ranged from 178 to 247 per moment of measurement. On average, 7 items were performed in 28% of the administration processes observed, 8 items were performed in 29% and all 9 items were performed in 19% of the observations. These percentages remained stable over the study period. However, the number of processes where less than 5 items were performed decreased over the period of our study. surgical and intensive care units), or for different hospital types (teaching versus non-teaching). Slight differences were determined in items scores for different hospital wards and different hospital types. Conclusion: Despite a four year program in which a lot of attention was paid in all Dutch hospitals to the importance and required contents of a high-quality parenteral drugs administration process, the quality of the administration process varies between hospitals. None of the hospitals in our sample already fulfilled the goal of complete and correct implementation of the parenteral drug administration process (to score 100% in December 2012). Further improvements are especially required on hand hygiene, patient identification and check of the process by a second person.