Evaluation of risks associated with the preparation of intravenous injections and infusions on the wards of hospitals in Tayside.

The intravenous route for administering medicines is commonly used in Tayside. Many of these intravenous medicines do not come in ready to use forms and have to be prepared at ward level before use. This can predispose the product to many risks eg. microbial and particulate contamination and compatibility and stability problems. Because of the high usage of these medicines in Tayside concern was noted that this may be putting patients at risk. Therefore this study was performed to evaluate risks associated with the preparation of intravenous medicines, and determine if current practice in Tayside was acceptable. Risk management is becoming more important in the NHS, especially since the removal of Crown Immunity in 1990. This study uses a method described by Dickson (1991) called a fault tree to evaluate risks associated with intravenous medicine preparation. An audit was performed to assess current procedures involved in the preparation of intravenous medicines, and monitor their quality. The aim of the audit being to identify risk areas, and through recommendations make improvements to the quality of care which patients receive. Initial validation work using sterile broth transfers suggested that if intravenous medicines were prepared in a ward environment using poor technique (no handwashing, no gloves, no swabbing and touch technique) the probability of contamination was as high as 15%. During the audit of actual preparation, 257 preparations were observed over a 7 month period, on 19 wards in hospitals throughout Tayside. Information relating to preparation was collected, and the preparation environment, hygiene of the operators, and techniques employed were monitored. A potential microbial contamination rate of 5.3% was identified when doctors and nurses were asked to use broth transfer kits. When further work was performed to establish the importance of the preparation environment, it was found that using "good" technique it was possible to achieve less than a 0.1% contamination rate, equivalent to the standard at which aseptic pharmacy-based services operate (Davison, 1990). When collating results from the main audit, it became apparent that information on the storage of intravenous medicines could not be readily determined. Therefore a small labelling/storage study was performed to elucidate this information. As many of the intravenous medicines prepared at ward level consisted of antibiotics, a small additional study attempted to qualify any risk to staff from residual beta-lactam contamination. The assessment of risks using a fault tree was found to be a valuable method for recognising risks, but in the case of intravenous medicine preparation further work needs to be performed before probability values can be assigned and quantification of the overall risk determined.

Grantor dc:publisher.institution

Robert Gordon University

Year dc:date.issued

1993

Author dc:creator

• McDonald, Alison

Advisor dc:contributor.advisor

• B. Millar and K. Kendle

• Intravenous medicine preparation
• Risk management
• Microbial contamination
• Fault tree analysis
• Aseptic technique
• Ward-level compounding
• National Health Service (NHS) Tayside

Language dc:language

en

Identifier

oai:rgu-repository.worktribe.com:2807483
https://doi.org/10.48526/rgu-wt-2807483

OAI identifier oai:identifier

oai:rgu-repository.worktribe.com:2807483