Safety is in the details
Safety in the ICU

Efforts to Reduce Risk of Error in Anesthesia Drug Administration

October 10, 2017

 

Just the thought triggers a sense of unease for any anesthetist, CRNA and medical practitioner responsible for any aspect of drug administration in a hospital environment. Errors in drug administration are no doubt a contributing factor in morbidity as well as mortality rates. The Institute of Medicine estimates that anywhere between 40,000 and 100,000 patients die annually as a result of medical errors, many of which are related to mistakes in drug administration or medications. [1]


Drug administration errors in anesthesia care settings can range from misreading a drug label, administering incorrect doses and errors made during syringe drug swaps. [2]


Patient safety is vital in all medical care scenarios, but pre-operative, anesthesia delivery, and post-op scenarios are among those that pose the greatest and most significant risks to patients. No one involved in drug administration wants to experience an adverse drug event. 


The efforts in reducing errors in drug administration during anesthesia and throughout post-op care and recovery environments can be divided into three components:

  • Enhanced communication goals among staff members
  • Improved drug administration management processes
  • Innovative, easy to use medical devices

 

Dealing with the Aspect of Human Error Caused by Overwork


CNRAs and anesthesia teams are among the most overburdened in many care environments and scenarios. Unfortunately, fatigue caused by overwork continues to be one of the primary contributors to human errors in medication administration. Reducing risk factors and errors in drug administration is vital – for the safety of both the healthcare provider and the patient.
 

A study recording fatigue events for anesthesiologists determined that following nine hours of consecutive work, risk for unintentional errors/accidents increased exponentially with every subsequent hour. [3]


A first-year resident is five times more likely to make a prescribing drug error, most likely due to extreme overwork and fatigue and clinical inexperience.[4]


Concerns of fatigue are not limited to the anesthesiologists. CNRAs participate in over 34 million anesthesia procedures in the US alone, with a continued increase of complexity and the number of procedures requiring their support 24/7. This high demand on the CNRA has contributed to sleep deprivation and fatigue, which can have a negative influence on not only performance, but outcomes for the patient. A nurse working longer than a 12.5-hour shift is three times more likely to make some type of error. [5]


Coaching for better communication


Better communication on patient status and any changes in drug administration can be facilitated by efficient updates to charts and databases. Increased collaboration between surgeons, anesthesiologists, and CNRA staff not only influences the ability to enhance anesthesia plan management, but also effects how surgical procedures are managed. The same applies to the anesthesiologists and CNRA’s comprehension of the surgical plan.


Suggestions for enhanced communication: [6]

  • Brief "huddles" that aid all-around understanding of both surgical and anesthesia plans with regards to patient care.
  • Increased transparency between anesthesia teams and ICU staff.
  • Benchmarking CRNA performance (not only regarding patient satisfaction, but also referring to communication with surgeons, OR staff, Post-Op and ICU care teams).
  • Attention to detail during an anesthesia hand off. Detailed information in a handoff report should include patient name, surgical procedure, medications given, fluid status, as well as past medical history and allergies. This applies to peri-operative as well as post-operative handoffs. [7]

 

Improved Procedures for Reducing Risk


A number of protocols and technologies have also aided in the reduction of risks in the field of anesthesia. Among them:

  • Color-coded labels - easier identification of drugs. [8] 
  • Drug bar code scanning systems - confirmation the right drug is being given.[8] [9]
  • Electronic dispensing carts - automated functions and tracking of medications.
  • Eliminating the removal of medications from packaging, as well as the discarding of inserts prior to use, and improved protocols in regard to the storage, preparation, documentation, and administration of medications.[9]
  • Utilization of controlled "smart" devices - infusions facilitating use of electronic devices that also display a medication library. [9]
  • Development of ready-to-use infusions and syringes - along with RFID codes, can be used with automated dispensing cabinets, clear expiration dates, and easier identification. [10]
  • Automated information systems - providing up-to-date status and updates to charting. [11]

 

Some mistakes can be prevented by simply anticipating what can go wrong and then taking steps to prevent those things from happening. Processes and check lists help here.


Attention to detail, enhanced communication, knowledge, and careful planning reduces risks, adverse effects, and enhances patient safety.

 

Newer Devices Reduce Risk of Error in Drug Administration


One of the major contributors utilized today in reducing drug administration errors is the development of modern devices that provide enhanced usability and comfort for medical stuff already under pressure when conducting IV procedures. For example, more user-friendly designs in manifolds and stopcocks can contribute in efforts to reduce risks in this field, as formerly confusing equipment and devices are exchanges for easy to use options.

Reducing risks and errors in fluid regulation has been the focus of developers, resulting in increasingly advanced devices including Elcam’s SafePort™ manifold, designed specifically for use in ICU and OR environments, that will be demonstrated at Anesthesiology 2017.

 

The SafePort manifold is specifically designed for ease of use, offering safe and convenient facilitation in anesthesia and ICU scenarios. The device makes the job of the anesthetists and CRNA easier and safer, with benefits such as:

  • Single-handed, simple and comfortable use.
  • Dual flow option side port valves, controlled by a simplified 90° turn of the handle.
  • Access to multiple IV lines and syringes, as well as delivery by pump. 
  • Minimizing risk of inadvertent injections or drug mixtures.
  • Assuring zero backflow.
  • Eliminating risk of blood loss or gas embolism during disconnection of syringes.
  • Facilitating visible control over flow direction and fluid path.

 

Reducing Complications in Drug Administration


Among the most prevalent hazards in drug administration in pre-operative, operative, post-operative and ICU environments include regulation of intravenous fluids and anesthetic residues found in IV lines. Anesthesia teams are aware that accuracy of flow rates and fluid regulation are essential for patient safety.


Reducing the risk of unintentional administration of residual anesthetics by continuous flushing of the internal valve volume is one of the several benefits of Elcam’s MarvelousTM stopcock . 


The elimination of post-medication flushing with a syringe also reduces risk of medication interactions and errors.


Reducing the risk of fluid overloads is another risk that can be facilitated by using the Marvelous, via reduction of stopcock manipulations.


CNRAs, anesthetists, ICU staff, and nursing support staff are dedicated to reducing the risk of drug administration errors in dose aspects of patient care. Newer developments in IV, stopcocks, and manifold design are providing positive direction in the reduction of such errors.


Elcam invites you to learn more about SafePort™ and MarvelousTM at Anesthsiology 2017. Meeting participants are also welcome to join the raffle  for a pair of SPECTACLES by SNAP Inc. at our booth #3729.

 

Resources:
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2933474
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3824420/
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2447555/
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3713658/
5. www.aana.com/newsandjournal/20102019/04call-shift-fatigue-15.pdf
6. https://www.beckersasc.com/anesthesia/5-strategies-to-improve-surgeon-or-communication-with-anesthesiologists.html
7. The Effectiveness of an Anesthesia Handoff Tool: An Electronic Health Record Application to Enhance Patient Safety: Anesthesia eJournal. Vol 4- Issue 1 2016 
8. http://monitor.pubs.asahq.org/article.aspx?articleid=2431681&_ga=2.265776591.1168637975.1507133795-497424936.1507133795
9.  https://www.ppmrrg.com/risk-management/anesthesia-law
10. https://www.pharmedium.com/compounded-services/operating-room-anesthesia/
11. http://drugtopics.modernmedicine.com/drug-topics/news/clinical/hospitalhealth-system-pharmacy/new-technology-enhances-safety-anesthesia-p

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