الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Intravenous (IV) therapy is considered an essential component of current healthcare delivery, with over 90% of hospitalized patients receiving some form of infusion therapy, intravenous (IV) therapy is complex, potentially dangerous and error prone. IV doses are five times more likely to be associated with a MAE than non-intravenous doses. An intravenous medication error defined as a deviation in the preparation or administration of a medicine from a doctor‘s prescription, hospital intravenous procedures, or the manufacturer‘s instructions. Patient harm associated with intravenous MEs is known to be much greater than for other errors.
Patients hospitalized at Intensive Care Units usually receive a higher number of drugs when compared to those hospitalized at other units. Critically ill patients are at higher risk for adverse drug events for many reasons including illness severity, complexity of care, the frequent use of complex drug regimens incorporating high-alert medications, and the need for frequent drug dosing.
Intravenous medications in ICU pose particular risks because of their greater complexity and the multiple steps required in their preparation, administration and monitoring. High-alert medications (HAM), also known as high-risk or potentially dangerous medications, are those with higher potential to cause severe or even fatal damage when an error occurs during their utilization, the consequences to the user can be more devastating.
ICU nurses are presented with several workflow challenges as they balance medication-related and non medication-related tasks frequent use of continuous infusions and high-risk medications, poor communication, complex orders, and repeated interruptions are among the factors associated with occurrence of errors in this setting. Adopted medication safety technologies such as bar code medication administration systems, and smart pump technology are showing significant impact in decreasing risks associated with medication use. However most of them are not available in most Egyptian hospitals.
The study aim to:
1. Identify the availability of policies and procedures concerning with medication safety in Rashid general hospital.
2. Quantify the incidence and specify the types of IV medication administration errors in ICU during drug transcription, preparation and administration.
3. Assess relationship between medication errors and some study variables as nurse experience, qualification and work shift.
The study was conducted at adult critical care unit at Rasheed hospital, which is a general ICU, with 8 beds, with an occupancy rate 95.7% in 2016. Rasheed general hospital is affiliated to the Ministry of Health with 85 beds, with an occupancy rate 79.6% in 2016. Adult Intensive care unit was selected in the study because of frequent administration of intravenous medications including high alert medications.
The study sample consists of 330 doses of IV medication administrated to adult ICU patients by 15 staff nurses who are responsible for administrating medications. Each nurse was observed for 7 weekdays on the three work shifts and a simple random sampling technique was used to select IV doses which were observed. A structured check list was designed based on previous studies which include patient and intensive care unit related factors, details for each drug administered procedure of drug preparation and administration. Observed data was compared with doctor order and nurse’s medication sheet to identify any discrepancies between drug given and the drug prescribed. A structured interview questionnaire was designed to collect data about demographic and work related data such as: age, sex, qualification and years of experience in nursing practices and in ICU, and data related to awareness about policies and procedures concerned with safe medication practices.
The study reveals the following findings:
The finding revealed nearly 50% (167/330) of all intravenous medications administered had at least one clinical error, and a one third of the administrations had a wrong intravenous rate (35.8%), antimicrobials reported a high rate drug category with at least one clinical error (32.8%). Highest percentage of administrations with at least one intravenous error was encountered for cerebrovascular stroke patients. We found a significant relationship between years of experience in nursing profession and committing at least one parenteral drug administration error. The most frequently encountered transcription errors were; transcription of two incompatible drugs and omission of drug dose (18.1% and 15.2%, respectively).
Accordingly, the following recommendations were suggested:
1. Conducting training program about safe IV medication administration practice, and raising nurses‘ awareness of the high intravenous administration error rate is likely to be helpful in reinforcing compliance with correct procedure.
2. The importance of implementing the effective error prevention strategies such as involvement of full-time, ward-based clinical pharmacists, increasing the nurse to patient ratio and participation of pharmacy department in drug preparation.
3. Use of modern systems and technology like electronic delivery of medication, infusion and syringe pump must be utilized.
4. Further studies should be identifying local barriers and causes hindering nurses from application of safety measures during preparation and administration IV medication .
5. Further studies should be completed to determine the potential for patient harm associated with these errors and improve clinical practice.
6. Replication of study on large probability samples and in all units of hospital is very important.