title: Dosing errors in preterm neonates due to flow rate variability in multi-infusion syringe pump setups: An in vitro spectrophotometry study.
abstract: BACKGROUND
  Drug administration on the neonatal intensive care unit is often associated with adverse events. This may be due to dosing errors caused by multi-infusion setups. We aim to investigate these dosing errors.
  
  
  METHODS
  N=3 experiment using a medication schedule, multi-infusion setup (three pumps) and disposables as applied on the NICU. In-line and real-time absorption spectrophotometry was used with dyes as substitutes for pharmaceuticals. Three flow rate changes lasting 1h were initiated. Subsequently, the possible dosing errors were estimated in the parallel pumps. In addition, startup durations, the times the flow rates required to reach steady state after significant dosing errors, as well as the total dosing error were measured.
  
  
  RESULTS
  Contribution of the start-up delays to the cumulative dosing errors was the largest. However, initiated flow rate changes resulted in significant dosing errors in the parallel pumps as well. The total dosing error was not significant. The significant peak errors were between 48.2% and -32.5% at flow rate increase and decrease, respectively. Startup delays of up to 42.6min were measured.
  
  
  CONCLUSIONS
  Applying multi-infusion while following a neonatal medication schedule may temporarily result in dosing errors, which can be relevant for fast-acting medications. Awareness may mitigate the risks.
authors: Dept. Medical Technology and Clinical Physics, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: r.a.snijder-2@umcutrecht.nl.
authors: Roland A
authors: RA
authors: Snijder
authors: Dept. Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Toine C G
authors: TC
authors: Egberts
authors: VSL Dutch Metrology Institute, Delft, The Netherlands.
authors: Peter
authors: P
authors: Lucas
authors: Dept. Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Petra M A
authors: PM
authors: Lemmers
authors: Dept. Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Frank
authors: F
authors: van Bel
authors: Dept. Medical Technology and Clinical Physics, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Annemoon M D E
authors: AM
authors: Timmerman
mesh_terms: D006801:Humans; D066298:In Vitro Techniques; D007231:Infant, Newborn; D007234:Infant, Premature; D007260:Infusion Pumps; D013057:Spectrum Analysis / Q000379:methods*; D013594:Syringes
keywords: Adverse event; Dosing error; High-risk medication; Multi-infusion; Neonatology; Photo spectrometric measurement