Table 2 Errors related to rate control of intravenous (IV) medications (n = 22)

Short (1993) [20]

▪ Anesthetic critical events due to syringe pump failure (n = 2, 1.6%)

NA

Singleton (1993) [21]

▪ Incidents with vascular system access related to the administration of drugs at an unintended rate (n = 2, 3%)

- Prompt collapse of the veins

- Rapid onset of anesthesia

- Retrograde flow of blood from the patient

Goldspiel (2000) [22]

▪ Among the 23 modifications suggested by the task force, 2 modifications were related to the infusion pump; standardize portable pumps used throughout hospital, develop policy and procedure for standardizing overfill for infusion pump preparations

NA

Taxis (2003) [23]

▪ Giving bolus doses too quickly (n = 168, 63.4%)

- Additional midazolam and bolus dose of adrenaline administration due to delay of continuous adrenaline infusion

Wetterneck (2006) [24]

▪ There were 18 problems after implementing the smart IV pump

▪ Two weeks after implementation, a 475-infusion audit found the drug library was used in 99.6% of medication infusions, channel labels in 80%, and the correct profile in 97%

▪ Six weeks later, in a 485-infusion audit, 99.6% of medication infusions used the drug library, 76% used channel labels, and 96% had the correct profile

▪ Approximately, 3 dosing alerts per day resulted in reprogrammed doses, which prevented potential pump programming errors from reaching patients

Temporary harm or no harm

Rinke (2007) [25]

▪ Errors in equipment and medication delivery devices (n = 68 of 547 possible error causes, 12.4%)

▪ Two medications were hung at the same time for the same patient, and their infusion rates were reversed (n = 1 of 310 error reports, 0.3%)

NCC MERP severity ratings: E (the case of reversed infusion rates)

Nuckols (2008) [26]

▪ Wrong rate (n = 1, 1.0%)

▪ Wrong duration (n = 4, 4.0%)

No injuries were observed

Evans (2010) [27]

▪ Of the 970 alerts, 137 prevented potential harm to the patient (14%)

NA

Ligi (2010) [28]

▪ Tenfold infusion rate errors per 100 admissions decreased from 2.3 to 0.6 (p = 0.022)

NA

Westbrook (2011) [40]

▪ Wrong rate (n = 266, 73.3% of four types of error; wrong mixture, wrong volume, wrong rate, or drug incompatibility)

- Number of errors rated as serious of IV error type “wrong rate” (n = 95, 35.7%)

▪ IV administrations performed via bolus had higher error rates than infusions (p < 0.0001) and also higher serious error rates (p < 0.0001)

▪ All 72 serious errors with bolus IV infusions involved an incorrect rate

▪ 23 of 28 serious errors with IV infusions involved an incorrect rate

Serious errors mean errors that classified 3 (medium risk) and 4 (low risk) in potential Severity Assessment Code by New South Wales Health Department

Kandil (2012) [2]

▪ Wrong rate (n = 756, 38.3%)

- Oxytocin: 926 (wrong rate, time and dose)

- Misoprostol + oxytocin: 49 (wrong rate)

- IV tocolytics: 41 (wrong rate)

- Magnesium sulfate: 24 (wrong rate)

▪ Rates of infusion were usually set up faster than the rate prescribed or the bolus dose of medications was not administered as slowly as recommended

- Uterine hyper-contractility (oxytocin)

- Monitoring for toxicity (tocolytics)

- Cesarean section due to persistent fetal distress in 3 cases (oxytocin + misoprostol)

Rodriguez-Gonzalez (2012) [29]

▪ Wrong infusion speed (n = 27, 1.2% of all medication administration)

- No damage, but monitoring required

Ohashi (2013) [30]

▪ Clamp closed (n = 2, 1.1%)

▪ Incorrect rate setting in pump (n = 1, 0.6%)

▪ Rate deviations (n = 1, 0.6%)

▪ Redcap, a web-based data collection tool, was easy to use and capture IV medication errors

NCC MERP severity ratings: C (due to the errors with rate deviation)

Nguyen (2014) [37]

▪ Administration errors were approximately similar in both pre-intervention and intervention periods (based on 95% CI)

- Baseline: 44.9% (CI: 38.6, 51.2)

- Follow-up: 46.9% (CI: 42.1, 51.7)

▪ The prevalence of wrong administration techniques which included rate errors in the intervention ward

- Baseline: 44.9% (CI: 38.6, 51.2)

- Follow-up: 46.9% (CI: 42.1, 51.7)

▪ The prevalence of wrong administration techniques which included rate errors in the control ward

- Baseline: 61.4% (CI: 55.7, 67.1)

- Follow-up: 46.9% (CI: 48.3, 59.9)

NA

Prakash (2014) [31]

▪ Intervention utilization

- For interventions that required active use by participants, the rate of utilization is as follows:

- Visual timers for IV pushes: 100%

- Speaking aloud during pump programming: 53%

- Speaking aloud during patient identification verification: 74%

▪ Errors in IV push were significantly decreased (p = 0.001)

▪ Errors in pump programming and infusion initiation were significantly decreased (p = 0.017)

NA

Bagheri-Nesami (2015) [38]

▪ Wrong infusion rate (n = 45, 17.2%)

NA

Schnock (2017) [32]

▪ Smart pump use errors (n = 120, 10.3%): bypassing the smart pump (n = 16), bypassing the available drug library (n = 104)

▪ Wrong rate (n = 54, 4.6%): medications of fluids were infused slower or faster than the ordered rate (n = 47), the rate was set outside the titration parameter range specified in the order (n = 7)

NCC MERP severity rating:

- Smart pump use errors: A (n = 4), B (n = 4), C (n = 112)

- Wrong rate: A (n = 3), C (n = 49), D (n = 2)

Tsang (2017) [39]

▪ HAM incident related to device setting

- Before the point and calling implementation (24 months): 20%

- During the point and calling implementation (6 months): 17%

- After the point and calling implementation (8 months): 13%

NA

Lyons (2018) [33]

▪ Rate deviation (n = 152, 7.6% of all infusions)

▪ Drug library not used or incorrectly used (in the case of smart pumps) (n = 67, 3.3% of all infusions)

▪ No significant difference in error rates between doses given via a drug library and those given without

▪ Infusions delivered with smart pumps had higher discrepancy rates than infusions delivered with conventional pumps (p < 0.001)

NCC MERP severity rating:

▪ Rate deviation: A (n = 75), C (n = 65), D (n = 12)

▪ Drug library not used or incorrectly used (in the case of smart pumps): A (n = 67)

Schnock (2018) [34]

▪ Smart pump/drug library not used

- Pre-intervention (n = 114, 11.7%), post-intervention (n = 121, 11.4%)

▪ Wrong rate

- Pre-intervention (n = 50, 5.1%), post-intervention (n = 23, 2.2%)

▪ Pump setting error

- Pre-intervention (n = 5, 0.5%), post-intervention (n = 6, 0.6%)

▪ Most of the sites showed a reduction in wrong rate error, but it was not statistically significant (p = 0.10)

▪ Compliance rates of using the smart pump were almost 100% in all sites

▪ In terms of compliance rates of using the smart pump and drug library, results were not significant, and smart pumps and drug library use error rates at the intervention sites slightly increased

NCC MERP severity rating:

▪ Smart pump/drug library not used

- Pre-intervention: A (n = 4), B (n = 4), C (n = 109)

- Post-intervention: A (n = 10), B (n = 2), C (n = 109)

▪ Wrong rate

- Pre-intervention: A (n = 3), C (n = 45), D (n = 2)

- Post-intervention: A (n = 1), C (n = 5)

▪ Pump setting error

- Pre-intervention: C (n = 5)

- Post-intervention: A (n = 1), C (n = 5)

Taylor (2019) [35]

▪ Medication errors with infusion pumps (n = 187, 91%)

▪ Factors contributing to rate error

- Device maintenance (n = 4)

- Malfunction (n = 4)

- Patient behavior (n = 4)

- Insufficient information (n = 16)

- Pre-administration process problem (n = 18)

- Tubing/connection (n = 19)

- Programming (n = 122)

NA

Schilling (2022) [36]

▪ Among the 20 HAM selected in the first phase survey, 10 drugs had DRPs related to rate control of IV medications

▪ 9 DRPs were related to the rate control of IV medications

▪ 9 potential interventions for the DRP related to rate control of IV drugs

NA