Pinkney Sonia, Fan Mark, Chan Katherine, Koczmara Christine, Colvin Christopher, Sasangohar Farzan, Masino Caterina, Easty Anthony, Trbovich Patricia
HumanEra, University Health Network, Toronto, Ontario, Canada.
HumanEra, University Health Network, Toronto, Ontario, Canada ; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.
Ont Health Technol Assess Ser. 2014 May 1;14(5):1-163. eCollection 2014.
Administering multiple intravenous (IV) infusions to a single patient via infusion pump occurs routinely in health care, but there has been little empirical research examining the risks associated with this practice or ways to mitigate those risks.
To identify the risks associated with multiple IV infusions and assess the impact of interventions on nurses' ability to safely administer them.
Forty nurses completed infusion-related tasks in a simulated adult intensive care unit, with and without interventions (i.e., repeated-measures design).
Errors were observed in completing common tasks associated with the administration of multiple IV infusions, including the following (all values from baseline, which was current practice): setting up and programming multiple primary continuous IV infusions (e.g., 11.7% programming errors)identifying IV infusions (e.g., 7.7% line-tracing errors)managing dead volume (e.g., 96.0% flush rate errors following IV syringe dose administration)setting up a secondary intermittent IV infusion (e.g., 11.3% secondary clamp errors)administering an IV pump bolus (e.g., 11.5% programming errors)Of 10 interventions tested, 6 (1 practice, 3 technology, and 2 educational) significantly decreased or even eliminated errors compared to baseline.
The simulation of an adult intensive care unit at 1 hospital limited the ability to generalize results. The study results were representative of nurses who received training in the interventions but had little experience using them. The longitudinal effects of the interventions were not studied.
Administering and managing multiple IV infusions is a complex and risk-prone activity. However, when a patient requires multiple IV infusions, targeted interventions can reduce identified risks. A combination of standardized practice, technology improvements, and targeted education is required.
在医疗保健中，通过输液泵为单个患者进行多次静脉输液是常规操作，但很少有实证研究探讨这种做法相关的风险或降低这些风险的方法。
识别与多次静脉输液相关的风险，并评估干预措施对护士安全进行多次静脉输液能力的影响。
40名护士在模拟的成人重症监护病房中完成与输液相关的任务，有干预和无干预（即重复测量设计）。
在完成与多次静脉输液给药相关的常见任务时观察到错误，包括以下方面（所有值均来自基线，即当前做法）：设置和编程多个主要连续静脉输液（例如，11.7%的编程错误）；识别静脉输液（例如，7.7%的线路追踪错误）；处理死腔量（例如，静脉注射器给药后96.0%的冲洗速率错误）；设置二级间歇静脉输液（例如，11.3%的二级夹闭错误）；给予静脉泵推注（例如，11.5%的编程错误）。在测试的10种干预措施中，与基线相比，6种（1种实践、3种技术和2种教育）显著减少甚至消除了错误。
1家医院对成人重症监护病房的模拟限制了结果的推广能力。研究结果代表了接受干预培训但使用经验很少的护士。未研究干预措施的纵向影响。
进行和管理多次静脉输液是一项复杂且容易出错的活动。然而，当患者需要多次静脉输液时，有针对性的干预措施可以降低已识别的风险。需要标准化实践、技术改进和针对性教育相结合。
