A continuous quality improvement project to reduce medication error in the emergency department

doi:10.5847/wjem.j.issn.1920-8642.2013.03.004

Abstract

Abstract:

BACKGROUND: Medication errors are a common source of adverse healthcare incidents particularly in the emergency department (ED) that has a number of factors that make it prone to medication errors. This project aims to reduce medication errors and improve the health and economic outcomes of clinical care in Hong Kong ED.
METHODS: In 2009, a task group was formed to identify problems that potentially endanger medication safety and developed strategies to eliminate these problems.
RESULTS: Responsible officers were assigned to look after seven error-prone areas. Strategies were proposed, discussed, endorsed and promulgated to eliminate the problems identified. A reduction of medication incidents (MI) from 16 to 6 was achieved before and after the improvement work.
CONCLUSION: This project successfully established a concrete organizational structure to safeguard error-prone areas of medication safety in a sustainable manner.

Key words: Medication error, Medication safety, Continuous Quality Improvement (CQI)

Sara BC Lee, Larry LY Lee, Richard SD Yeung, Jimmy TS Chan. A continuous quality improvement project to reduce medication error in the emergency department[J]. World Journal of Emergency Medicine, 2013, 4(3): 179-182.

Figures/Tables 2

Table 1

Table 2

Standardized chart for IVI dilution regimen

Medication	Strength (may vary)	Dose to be added	Type of diluent/ to a total volume	Conc	Description /Rate	Dose	Dose	Dose	Dose	Dose	Formula	Dosage Remarks
Adrenaline 1:1 000 (Epinephrine)	1 mg /mL	3 mg	+ NS or D5 to total vol.50 mL	60 mg/mL	N mg/min	5	10	15	20	25	N	5-50 mg/min
Adrenaline 1:1 000 (Epinephrine)	1 mg /mL	3 mg	+ NS or D5 to total vol.50 mL	60 mg/mL	(mL/h)	5 mL	10 mL	15 mL	20 mL	25 mL	(1.0 N) mL	5-50 mg/min
Aminophylline	250 mg /10 mL	250 mg	+ NS or D5 to total vol.50 mL	5 mg/mL	N mg/h	15	30	40	50	60	N	15-60 mg/h
Aminophylline	250 mg /10 mL	250 mg	+ NS or D5 to total vol.50 mL	5 mg/mL	(mL/h)	3 mL	6 mL	8 mL	10 mL	12 mL	(N÷5) mL	15-60 mg/h
Amiodarone (Cordarone)					Refer to infusion pump chart
Diltiazem (Herbesser)	50 mg (powder) +5 mL NS or D5	50 mg	+NS or D5 to total vol.50 mL	1mg/mL	N mg/kg/min	5	7.5	10	12.5	15	N	5-15 mg/kg/min
					kg^*	mL/hr^*	mL/hr^*	mL/hr^*	mL/hr^*	mL/hr^*	mL/hr
					41-50 kg	14 mL	20 mL	27 mL	34 mL	41 mL	(2.7 N) mL
					51-60 kg	17 mL	25 mL	33 mL	41 mL	50 mL	(3.3 N) mL
					61-70 kg	20 mL	29 mL	39 mL	49 mL	59 mL	(3.9 N) mL
					71-80 kg	23 mL	34 mL	45 mL	56 mL	68 mL	(4.5 N) mL
					81-90 kg	26 mL	38 mL	51 mL	64 mL	77 mL	(5.1 N) mL
Dobutamine (Dobutrex)	250 mg /20 mL	250 mg	+NS or D5 to total vol.50 mL	5mg/mL	N mg/kg/min	1.25	2.5	5	7.5	10	N	1-10 mg/kg/min Starting dose 2.5-5 mg/kg/min (Infusion rate is rounded up to integer)
					kg^*	mL/hr^*	mL/hr^*	mL/hr^*	mL/hr^*	mL/hr^*	mL/hr
					31-40 kg	1 mL	1 mL	2 mL	3 mL	4 mL	(0.42 N) mL
					41-50 kg	1 mL	1 mL	3 mL	4 mL	5 mL	(0.54 N) mL
					51-60 kg	1 mL	2 mL	3 mL	5 mL	7 mL	(0.66 N) mL
					61-70 kg	1 mL	2 mL	4 mL	6 mL	8 mL	(0.78 N) mL
					71-80 kg	1 mL	2 mL	5 mL	7 mL	9 mL	(0.90 N) mL
					81-90 kg	1 mL	3 mL	5 mL	8 mL	10 mL	(1.02 N) mL
					91-100 kg	1 mL	3 mL	6 mL	9 mL	11 mL	(1.14 N) mL
Dopamine (Dopaminex)	200 mg /5 mL	200 mg	+NS or D5 to total vol.50 mL	4mg/mL	N mg/kg/min	1.25	2.5	5	7.5	10	N	1-10 mg/kg/min Starting dose 2.5-5 mg/kg/min (Infusion rate is rounded up to integer)
					kg^*	mL/hr^*	mL/hr^*	mL/hr^*	mL/hr^*	mL/hr^*	mL/hr
					31-40 kg	1 mL	1 mL	3 mL	4 mL	5 mL	(0.53 N) mL
					41-50 kg	1 mL	2 mL	3 mL	5 mL	7 mL	(0.68 N) mL
					51-60 kg	1 mL	2 mL	4 mL	6 mL	8 mL	(0.83 N) mL
					61-70 kg	1 mL	2 mL	5 mL	7 mL	10 mL	(0.98 N) mL
					71-80 kg	1 mL	3 mL	6 mL	8 mL	11 mL	(1.13 N) mL
					81-90 kg	2 mL	3 mL	6 mL	10 mL	13 mL	(1.28 N) mL
					91-100 kg	2 mL	4 mL	7 mL	11 mL	14 mL	(1.43 N) mL

Table 2

References 7

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	Drug items	DDA cabinet	Cub.10 fridge	NS1 fridge	R1fridge	E-Trolleys	Top-up cupboard	Observation room	RX room
1.	Muscle relaxants Rocuronium/Cisatracurium/Suxamethonium		√	√ (E kit)	√
2.	Actrapid HIV		√
3.	Adrenaline 1:1 000		√		√
4.	Vasopressors Adrenaline 1:10 000/Vasopressin					√
5.	Inotropes Dopamine/Dobutamine					√
6.	Digoxin					√
7.	MgSO₄					√
8.	Thrombolytics Streptokinase/Metalyes	√
9.	Lignocaine 1%						√		√
10.	Penicillin group antibiotics						√	√
11.	Warfarin						√	√
12.	Aspirin & NSAID						√	√
13.	Oral Hypoglycaemics						√	√

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[2]	Christian Hohenstein, Thomas Fleischmann, Peter Rupp, Dorothea Hempel, Sophia Wilk, Johannes Winning. German critical incident reporting system database of prehospital emergency medicine: Analysis of reported communication and medication errors between 2005-2015 [J]. World Journal of Emergency Medicine, 2016, 7(2): 90-96.
[3]	Kathryn Eastwood, Malcolm J Boyle, Brett Williams. Undergraduate paramedic students cannot do drug calculations [J]. World Journal of Emergency Medicine, 2012, 3(3): 221-226.