Injection device-related risk management toward safe administration of medications: experience in a university teaching hospital in The People's Republic of China

Abstract

The use of injection devices to administer intravenous or subcutaneous medications is common practice throughout a variety of health care settings. Studies suggest that one-half of all harmful medication errors originate during drug administration; of those errors, about two-thirds involve injectables. Therefore, injection device management is pivotal to safe administration of medications. In this article, the authors summarize the relevant experiences by retrospective analysis of injection device-related near misses and adverse events in the Second Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang University, People's Republic of China. Injection device-related near misses and adverse events comprised the following: 1) improper selection of needle diameter for subcutaneous injection, material of infusion sets, and pore size of in-line filter; 2) complications associated with vascular access; 3) incidents induced by absence of efficient electronic pump management and infusion tube management; and 4) liquid leakage of chemotherapeutic infusion around the syringe needle. Safe injection drug use was enhanced by multidisciplinary collaboration, especially among pharmacists and nurses; drafting of clinical pathways in selection of vascular access; application of approaches such as root cause analysis using a fishbone diagram; plan-do-check-act and quality control circle; and construction of a culture of spontaneous reporting of near misses and adverse events. Pharmacists must be professional in regards to medication management and use. The depth, breadth, and efficiency of cooperation between nurses and pharmacists are pivotal to injection safety.

Keywords: electronic infusion pump; infusion therapy; intravenous; medication errors; subcutaneous injection; vascular access.

Figure 1

Relative percentages of infusion devices used before (A) and after (B) the intravenous team’s intervention (2009 versus 2012). Abbreviations: CVC, central venous catheter; PICC, peripherally inserted central catheter.

Figure 2

Number of PICC procedures before and after the intravenous team’s intervention. Abbreviation: PICC, peripherally inserted central catheter.

Figure 3

Cases of complications in infusion therapy in 2011 and 2012.

Figure 4

Driver (A) and drug container (B) of ambulatory infusion pumps for fluorouracil infusion. Note: Apon®; Nantong Aipu Medical Instrument Co., Ltd., Nantong, People’s Republic of China.

Figure 5

An illustration of a packaging method to overcome liquid leakage of chemotherapeutic infusion around the syringe needle. Notes: A disposable infusion pipe is connected to a 50 mL syringe, making a slipknot on the connecting pipe. The combined devices are packaged into an aseptic sealed plastic bag.