title: Protocol compliance of administering parenteral medication in Dutch hospitals: an evaluation and cost estimation of the implementation.
abstract: OBJECTIVE
  Preventable adverse drug events (ADEs) are closely related to administration processes of parenteral medication. The Dutch Patient Safety Program provided a protocol for administering parenteral medication to reduce the amount of ADEs. The execution of the protocol was evaluated and a cost estimation was performed to provide insight in the associated costs of protocol compliance.
  
  
  METHODS
  A longitudinal evaluation study was performed in secondary care. A total of 2154 observations of the administration process of parenteral medication were carried out within 10 measurements in 19 hospitals between November 2011 and December 2012. The total time needed for the process was measured in a sample of five hospitals. Multilevel linear and logistic regression analyses were used to analyse the trend over time of the implementation and to assess the association between hospital and administration characteristics, and compliance of the protocol. A cost estimation provided insight into the costs of performing a complete administration process and the costs at department level for 1 year.
  
  
  RESULTS
  The complete protocol was performed in 19% of the observations. The proceeding 'check by a second nurse' was least performed. Large differences were found between individual hospitals in performing the administration protocol. The compliance of the protocol was negatively influenced in case of disturbance of the administrator. The overall trend over time of completion of the protocol fluctuated during the study period. On average, 3 min 26 s were needed to perform the complete protocol, which costs €2.42. Extrapolating the costs to department level, including cost for clinical lessons, the difference in costs in performing the complete protocol and an incomplete protocol was €7.891 for 1 year.
  
  
  CONCLUSIONS
  The protocol for administering parenteral medication is still not implemented completely, therefore an investment in time and Euros is needed.
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
authors.forename: Janneke
authors.initials: J
authors.lastname: Schilp
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
authors.forename: Sanne
authors.initials: S
authors.lastname: Boot
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
authors.forename: Carolien
authors.initials: C
authors.lastname: de Blok
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Spreeuwenberg
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands Department of Public and Occupation Health, EMGO+Institute for Health and Care Research, VU University Medical Center (VUmc), Amsterdam, The Netherlands.
authors.forename: Cordula
authors.initials: C
authors.lastname: Wagner
mesh_terms: D000328:Adult; D002985:Clinical Protocols; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D019983:Guideline Adherence / Q000191:economics / Q000592:standards; D017721:Hospital Costs; D006761:Hospitals; D006801:Humans; D007267:Injections; D008137:Longitudinal Studies; D008508:Medication Errors / Q000517:prevention & control*; D009426:Netherlands; D017410:Practice Guidelines as Topic
keywords: Health & safety < HEALTH SERVICES ADMINISTRATION & MANAGEMENT