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document
Errors during the preparation of drug infusions : a randomized controlled trial . BACKGROUND We investigated the extent and frequency of dose errors and treatment delays made as a consequence of preparing drug infusions at the bedside , rather than using pre-filled syringes . METHODS Forty-eight nurses with critical care experience volunteered to take part in this randomized , blinded , controlled study conducted in the simulation centre of an urban hospital . They assisted in the management of a simulated patient with septic shock . Vasopressor infusions were prepared either by diluting concentrated drugs from ampoules or were provided in syringes pre-filled beforehand by an intensive care unit resident . RESULTS The time taken for the infusion to be started and the final concentration of the drugs were measured . We also measured the concentration of infusions prepared by a pharmacist and a pharmaceutical company . Nurses took 156 s to start infusions when using pre-filled syringes compared with 276 s when preparing them de novo , a mean delay of 106 s [ 95 % confidence interval ( CI ) 73-140 s , P < 0.0001 ] . One infusion prepared from ampoules contained one-fifth of the expected concentration of epinephrine ; another contained none at all . Medication errors were 17.0 times less likely when pre-filled syringes were used ( 95 % CI 5.2-55.5 ) , and infusions prepared by pharmacy and industry were significantly more likely to contain the expected concentration ( P < 0.001 for norepinephrine and P=0.001 for epinephrine ) . CONCLUSIONS Providing drug infusions in syringes pre-filled by pharmacists or pharmaceutical companies would reduce medication errors and treatment delays , and improve patient safety . However , this approach would have substantial financial implications for healthcare providers , especially in less developed countries .
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Intervention_Physical
drug infusions at the bedside
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Intervention_Physical
pre-filled syringes
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Intervention_Pharmacological
Vasopressor infusions
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Intervention_Pharmacological
diluting concentrated drugs from ampoules
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Intervention_Physical
syringes pre-filled
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Intervention_Physical
pre-filled syringes
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Intervention_Pharmacological
epinephrine
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Intervention_Physical
pre-filled syringes
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Intervention_Pharmacological
infusions
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Intervention_Pharmacological
norepinephrine
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Intervention_Pharmacological
epinephrine
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Intervention_Pharmacological
drug infusions
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Intervention_Physical
pre-filled
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Outcome_Other
final concentration of the drugs
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Outcome_Other
concentration of infusions
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Outcome_Mental
Medication errors
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Outcome_Mental
medication errors
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Outcome_Mental
treatment delays
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Outcome_Other
patient safety
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Participant_Sample-size
Forty-eight
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Participant_Condition
septic shock