title: Errors during the preparation of drug infusions: a randomized controlled trial.
abstract: 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.
authors: Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
authors: R M
authors: RM
authors: Adapa
authors: V
authors: V
authors: Mani
authors: L J
authors: LJ
authors: Murray
authors: B A
authors: BA
authors: Degnan
authors: A
authors: A
authors: Ercole
authors: B
authors: B
authors: Cadman
authors: C E
authors: CE
authors: Williams
authors: A K
authors: AK
authors: Gupta
authors: D W
authors: DW
authors: Wheeler
mesh_terms: D003422:Critical Care / Q000379:methods; D004339:Drug Compounding / Q000379:methods* / Q000706:statistics & numerical data; D004349:Drug Packaging; D004837:Epinephrine / Q000008:administration & dosage; D006786:Hospitals, Urban; D006801:Humans; D007262:Infusions, Intravenous; D008508:Medication Errors / Q000706:statistics & numerical data*; D016544:Patient Simulation; D012772:Shock, Septic / Q000188:drug therapy; D016037:Single-Blind Method; D013594:Syringes
chemical_list: D004837:Epinephrine