Introduction Most paediatric intensive care units (PICU) currently use a traditional bespoke weight-based method for calculating the concentration of intravenous infusion using complex and highly variable approaches. There are big variation in preparation methods across PICUs in the UK with over 150 methods identified,¹ which can potentially increase the risk of error and subsequently impact patients’ safety. Approximately 46% of the errors that occur in PICUs are related to administration errors,² and IV medication errors represent about 54–56% of all administration errors.³ Standard concentrations of Infusions (SCI) is part of a global strategy to improve intravenous medication safety since it has been shown to potentially eliminate up to 27% of medication errors.⁴

Aim We aimed to explore and investigate the current approach and extent of the impact on the patients‘ safety. The objectives were to identify the numbers and types of errors reported in PICU specifically with regards to the weight based infusions. Furthermore, to assess the adherence of nurses to the local infusions policy and the time it takes for nurses to prepare infusions.

Method A secondary analysis was carried out for all medication errors gathered retrospectively from 1 September 2012 to 30 May 2022 in a PICU using the conventional weight based infusions method. Additionally, nine nurses were observed during the preparation of continuous infusions and observational data gathered using a data collection tool. A total of ten infusions were observed.

Results A total of 378 errors were identified during the study period, and 16 errors were directly attributed to weight based infusions, including four types of errors. Calculation and wrong setting of pumps were the highest number of errors (n=5 each; 31.3%), followed by preparation errors involving inaccuracy of withdrawn volume (n=4; 25%). Most of these errors (n=14, 87%) were considered no harm and two (13%) were considered low harm. These two errors required observation, monitoring and minor treatment of patients. Half of the errors identified (8 errors) were as a result of higher concentrations and the other half, lower concentrations. Furthermore, 19% (n=3) of errors were prescription related errors. The mean time to prepare infusions as directly observed in preparation of ten infusions was 12 minutes ranging between 7 and 29 minutes.

Conclusions The risk of medication errors due to the complex and highly variable weight based concentrations of infusions has demonstrated to have a negative impact on patient safety. Furthermore, the nature of errors that weight based concentrations is associated with, such as ten-fold higher or lower than the prescribed concentration, can lead to significant undesirable consequences. Implementation of the standard concentrations of infusions could be a potential solution to complement continuous education in reducing medication errors.

References

1. Oskarsdottir T, Harris D, Sutherland A, et al. A national scoping survey of standard infusions in paediatric and neonatal intensive care units in the United Kingdom. J Pharm Pharmacol 2018;70:1324–1331.

2. Santesteban E, Arenas S, Campino A. Medication errors in neonatal care: a systematic review of types of errors and effectiveness of preventive strategies. Journal of Neonatal Nursing 2015;21:200–208.

3. Ross LM, Wallace J, Paton JY. Medication errors in a paediatric teaching hospital in the uk: five years operational experience. Archives of Disease in Childhood 2000;83:492–497.

4. Howlett M, Butler E, Lavelle KM, et al. The impact of technology on prescribing errors in paediatric intensive care: a before and after study. Appl Clin Inform 2020;11:323–335.