PREVALENCE AND DETERMINANTS OF INTRAVENOUS ADMIXTURE PREPARATION ERRORS. A PROSPECTIVE OBSERVATIONAL STUDY IN HOSPITAL

Abstract

Background: Intravenous admixture preparation errors (IAPEs) are critical issues in healthcare, involving incompatible diluents, incorrect mixing techniques, and wrong volumes of diluents and IV fluids. These errors compromise patient safety, with significant risks of adverse effects due to the rapid bioavailability of intravenous drugs. Despite the known dangers, insight into the prevalence, determinants, and severity of these errors in hospital settings is limited, underscoring the need for targeted preventive measures to enhance IV therapy safety.

Objective: This study aimed to determine the prevalence, types, and severity of IAPEs, identify the major determinants causing these errors, and propose strategies for minimizing their occurrence in hospital settings.

Methods: A prospective observational study was conducted across three private hospitals in Islamabad. Data were collected from various wards, including inpatient, emergency, general, infectious, gastroenterology, and respiratory wards. Observations of IV admixture preparation were performed covertly to avoid altering staff behavior. A structured data collection sheet was used to record errors related to diluent selection, volume, labeling, and mixing techniques. Demographic and professional information of staff, as well as ward-specific conditions, were documented. Statistical analysis was performed using descriptive statistics to evaluate the prevalence, types, and severity of errors.

Results: Of the observed IV admixtures, 60% were prepared by nurses, while 24.6% were prepared by pharmacists. The most common errors included incorrect diluent volume (58%), incomplete mixing (44.8%), and improper labeling (65.9%). Normal saline was used in 55.2% of preparations, while 53.6% of admixtures contained powdered antibiotics. Only 41.8% of staff adhered to sterile area protocols, and 71.5% had received IV admixture preparation training. Major determinants included insufficient knowledge, lack of training, poor working conditions, and excessive patient load.

Conclusion: IAPEs are prevalent in hospital settings, largely driven by insufficient training, knowledge gaps, and suboptimal working conditions. Comprehensive training, adherence to standardized guidelines, and implementing centralized IV admixture preparation programs can significantly reduce these errors and enhance patient safety.