Risk factors for i.v. compounding errors when using an automated workflow management system

• Published in: American journal of health-system pharmacy Vol. 73; no. 12; pp. 887 - 893
• Main Authors: Deng, Yihong, Lin, Alex C, Hingl, John, Huang, Guixia, Altaye, Mekibib, Maynard, Heather, Mayhaus, Dave, Penm, Jonathan
• Format: Journal Article
• Language: English
• Published: England Copyright American Society of Health-System Pharmacists, Inc. All rights reserved 15.06.2016; Oxford University Press
• Subjects: Drug Compounding - methods; Drug Compounding - standards; Hospitals, Pediatric - standards; Humans; Infusions, Intravenous; Medication Errors - prevention & control; Medication Systems, Hospital - standards; Pharmacists; Pharmacy Service, Hospital - methods; Pharmacy Service, Hospital - standards; Practice; Risk Factors; Technology application; Workflow; Workflow software; Ohio
• ISSN: 1079-2082; 1535-2900
• DOI: 10.2146/ajhp150278

PURPOSE.Results of a study to determine the frequency of and risk factors for errors in automated compounding of i.v. medication doses at a pediatric hospital are presented. METHODS.Data compiled by the hospital’s automated i.v. compounding workflow management system over a 12-month period were analyzed. A descriptive analysis was conducted to characterize intercepted errors by frequency and type. Multivariate regression analysis via a backward stepwise procedure was performed to identify notable risk factors for i.v. compounding errors. RESULTS.Among the 421,730 i.v. doses evaluated, there were 3,101 documented errors (an overall error rate of 0.74%). The automated system intercepted 72.27% of the errors, mainly those containing an incorrect drug or diluent. The remaining 27.73% of i.v. compounding errors, primarily dose preparation in the wrong volume (21.51%) or damage to the final product (0.93%), were identified during final inspection by a pharmacist. The logistic regression model showed that four factors were significantly (p < 0.05) associated with an increased risk of compounding errorsdose preparation during the morning shift (relative risk [RR], 1.84; 95% CI, 1.68–2.02) or on a Sunday (RR, 1.28; 95% CI, 1.11–1.47), preparation of doses for use in critical care units (RR, 1.17; 95% CI, 1.07–1.28), and technician versus pharmacist compounding (RR, 1.17; 95% CI, 1.04–1.32). CONCLUSION.Analysis of error reports generated by an i.v. compounding workflow management system at a large pediatric hospital over one year found an overall rate of detected errors of 0.74%. Four factors were identified as significant predictors of increased error risk.