Table 3 Facilitators and barriers related to rate control of intravenous (IV) medication
Categories by NCC MERPa | Sub-categories | Facilitators | Barriers |
|---|---|---|---|
Human factors | Knowledge deficit | Â | - Lack of knowledge about vascular access related to patient posture [20] - Lack of knowledge about medication equipment [23] - Lack of drug knowledge about medications [24] |
Performance deficit | Â | - Failure to check equipment properly [21] - Tubing misplacement [24, 35] - Monitoring inadequate [25] - Non-compliance with protocols and guidelines [2, 25] - Human handling errors with smart pumps [30] | |
Miscalculation of dosage or infusion rate | Â | - Error in infusion speed calculation [29] | |
Stress (high-volume workload) | Â | - High workload and distractions [23] - Error-prone ICU environment due to the heavy workload and complex critical care [37] | |
Design | Devices | - Expanding smart IV pump capabilities [26] - Monitoring pump programming at the system level [27] - Standardization of infusion pumps [22] - Using patient-controlled analgesia pumps and syringe drivers [28] | - Unexpected equipment faults [2, 20, 25, 35, 38] - Misassembly of an unfamiliar infusion pump [21] - Complex design of the equipment [23, 24] - Smart pumps that were not connected to electronic systems [30] - Incomplete drug libraries in smart pumps [33] |
Contributing factors (system related) | Frequent interruptions and distractions | Â | - A distracting environment in which nurses prepare medications [23] - Running multiple infusions at once [24, 27] - Air-in-line alarms or clearing air [24] - Error-prone ICU environment due to the heavy workload and complex critical care [37] |
Training | - Education on chemotherapy errors [22] - Mandatory end-user of smart IV pump training [24] - Education/training [36] | - Lack of appropriate training [23] | |
Assignment or placement of a health care provider or inexperienced personnel | - Ward-based pharmacist [36] | - Nurses with < 6 years of experience [40] | |
Policies and procedures | - Development of protocols for administering cytotoxic agents to nurses [22] - Providing information access [22] - Developing policy and procedure for standardizing overfill for infusion pump preparations and error follow-up [22] - Applying the FMEA method when introducing a smart IV pump [24] - Double-checks throughout the process [22, 24, 28, 36] - Using preprinted drug labels to identify tubing above and below the IV pump when running multiple infusions at once [24] - Continuous incidence reporting and subsequent prevention strategies [28] - Limiting the use of handwritten orders to emergency cases only [28] - Visual timers for IV pushes, no interruption zone with motion-activated indicators, speaking aloud, and reminder signage [31] - Use of point and calling method [39] - Use of infusion safety intervention bundle [34] - Standardized concentration and pre-printed label [36] - Standardized plan for dose tapering and infusion scheme [36] | - Absence of hospital policy that specifies a standard for KVO rate [30, 32] - Absence of a culture that promotes the use of smart pumps for all IV administrations [32, 33] - Medication orders that specified a duration rather than a rate [33] - Administering fluids for KVO at a low rate in anticipation of another infusion being needed [33] - Lack of automated infusion pumps [2] | |
Communication systems between healthcare practitioners | - Communication with physicians in instances of doubt [28] | Â |