Prevalence and determinants of intravenous admixture preparation errors: A prospective observational study in a university hospital

Background Intravenous admixture preparation errors (IAPEs) may lead to patient harm. Insight into the prevalence as well as the determinants associated with these IAPEs is needed to elicit preventive measures. Aim The primary aim of this study was to assess the prevalence of IAPEs. Secondary aims were to identify the type, severity, and determinants of IAPEs. Method A prospective observational study was performed in a Dutch university hospital. IAPE data were collected by disguised observation. The primary outcome was the proportion of admixtures with one or more IAPEs. Descriptive statistics were used for the prevalence, type, and severity of IAPEs. Mixed-effects logistic regression analyses were used to estimate the determinants of IAPEs. Results A total of 533 IAPEs occurred in 367 of 614 admixtures (59.8%) prepared by nursing staff. The most prevalent errors were wrong preparation technique (n = 257) and wrong volume of infusion fluid (n = 107). Fifty-nine IAPEs (11.1%) were potentially harmful. The following variables were associated with IAPEs: multistep versus single-step preparations (adjusted odds ratio [ORadj] 4.08, 95% confidence interval [CI] 2.27–7.35); interruption versus no interruption (ORadj 2.32, CI 1.13–4.74); weekend versus weekdays (ORadj 2.12, CI 1.14–3.95); time window 2 p.m.-6 p.m. versus 7 a.m.-10 a.m. (ORadj 3.38, CI 1.60–7.15); and paediatric versus adult wards (ORadj 0.14, CI 0.06–0.37). Conclusion IAPEs, including harmful IAPEs, occurred frequently. The determinants associated with IAPEs point to factors associated with preparation complexity and working conditions. Strategies to reduce the occurrence of IAPEs and therefore patient harm should target the identified determinants.

Shaping Ability and Debris Extrusion of New Rotary Nickel-Titanium Root Canal Instruments

The aim was to evaluate the canal straightening and the amount of apically extruded debris associated with five rotary nickel-titanium when preparing curved root canals. A total of 100 root canals in extracted human teeth (angles of curvatures 20°–30°; radii 5.9–13.5 mm) were divided into five groups (n = 20/group). The groups were balanced with respect to the angle and the radius of canal curvature. The root canals were prepared using conventional austenite 55-NiTi alloy instruments F360, F6 SkyTaper (both Komet, Lemgo, Germany), and the heat-treated NiTi Jizai, Silk-Complex and Silk-Standard instruments (all Mani, Tochigi, Japan) to an apical size 25. The amount of extruded debris was assessed with a micro balance. Statistical analysis was performed using Kruskal–Wallis test with Bonferroni correction at a significance level of p < 0.05. During canal preparation, neither instrument fractures nor procedural preparation errors were noticed. Regarding canal straightening, the use of Jizai instruments resulted in the significantly lowest straightening (p < 0.05), while no significant differences were obtained between all other groups (p > 0.05). Regarding the amount of apically extruded debris, no significant differences between all groups were obtained (p > 0.05). Within the limitations of this study, all instruments performed well, and especially the Jizai instruments showed an excellent shaping ability.

Effect of barcode technology on medication preparation safety: a quasi-experimental study

Background Medication errors are a common problem in hospitals and a major driver of adverse patient outcomes. Barcode verification technology is a promising strategy to help ensure safe medication preparation practices. Objectives The objectives of this study were (i) to assess the effects of a barcode-assisted medication preparation and administration system regarding the rate of medication preparation errors and (ii) to compare the time spent on medication preparation tasks by medical staff. Methods A quasi-experimental study with a pre–post design was conducted, from August 2017 to July 2018, in two mixed medical/surgical units of a tertiary teaching hospital. The primary aim was to assess the effects of a barcode-based electronically assisted medication preparation and administration system linked to the hospital’s electronic medication administration record regarding the rate of medication preparation errors and time-based staff performance. Data were collected using direct observation. Adjusted and unadjusted logistic models were used for error frequencies and linear regression models for time performance. Results 5932 instances of medication selection and dosing during 79 medication preparation procedures were observed. The overall medication preparation error incidence decreased from 9.9% at baseline to 4.5% at post-intervention, corresponding to a relative risk reduction of 54.5% (P &lt; 0.001). However, the adjusted effect by registered nurses (RNs) and nurses’ work experience of total medication preparation errors showed only borderline significance (odds ratio [OR] 0.64, P = 0.051). For adjusted error-specific analyses, significant error reductions were found in wrong medication errors (OR 0.38, P &lt; 0.010) and wrong dosage errors (OR 0.12, P = 0.004). Wrong patient, wrong form and ambiguous dispenser errors did not occur at post-intervention. Errors of omission (OR 1.53, P = 0.17), additional doses (OR 0.63, P = 0.64) and wrong dispenser boxes (OR 0.51, P = 0.11) did not change significantly. The time necessary to prepare medications for a 24-h period also decreased significantly—from 30.2 min to 17.2 min (beta = −6.5, P = 0.047), while mean preparation time per individual medication dose fell from 24.3 s to 15.1 s (beta = −5.0, P = 0.002). Conclusion Use of the new barcode technology significantly reduced the rate of some medication preparation errors in our sample. Moreover, the time necessary for medication preparation, both per 24-h period and per single-medication dose, was significantly reduced.

Effects of a Novel NiTi Thermomechanical Treatment on the Geometric Features of the Prepared Root Canal System

Objectives: This study aimed to compare the ex vivo performance of two rotary nickel–titanium (NiTi) systems with similar designs but manufactured from martensitic and austenitic alloys, the One Curve (OC) and One Shape (OS) rotary endodontic files, respectively. Methods: Forty separate mesial canals of 20 extracted mandibular molars were scanned using micro-computed tomography (CT), which were divided into 2 groups and instrumented with OC and OS, respectively. Post-instrumentation micro-CT scans were evaluated using validated computer algorithms to compare changes in canal thickness, surface area, structure model index (SMI) scores, volume of removed dentin, percentage of untreated canal surface, percentage of curvature straightening, and the amount of canal transportation. Results: Both files led to significant changes in the basic root canal geometry, with no preparation errors and no statistically significant differences. However, OC treatment resulted in significantly less curvature straightening (17.30%; 10.77%) (independent samples t test, p < 0.05) and less apical transportation (55.11 µm; 33.15 µm) (Mann–Whitney U, test p < 0.05) compared to OS treatment. Transportation values in the middle and coronal thirds were statistically similar (independent sample t-test, p > 0.05). OC treatment produced significantly less straightening and less apical transportation than OS.

Use of Computer Vision to Identify the Frequency and Magnitude of Insulin Syringe Preparation Errors

Background: No current technology exists to ensure the dose of insulin administered in hospitals matches the physician order. Objective: Assess the feasibility of using computer vision to identify insulin syringe preparation errors. Methods: Twenty-two nurses prepared 50 insulin doses (n=1100) each. A computer vision device (CVD) measured the volume drawn up and identified air present. Syringes identified as inaccurate by the CVD were confirmed by two observers, and a random sample of 100 syringes identified as accurate was validated by two independent observers. Results: Ten syringes (1.0%) had the wrong volume prepared, and 68 syringes (6.5%) contained air sufficient to meet the definition of inaccuracy. All errors were confirmed by two independent observers. Conclusion: CVDs could reduce insulin administration errors in hospitalized patients.

Stability of calcium levofolinate reconstituted in syringes and diluted in NaCl 0.9% and glucose 5% polyolefin/polyamide infusion bags

Purpose Calcium levofolinate (CaLev) for intravenous administration is commercially available as a powder that must be reconstituted for injection or reconstituted and then diluted before administration. The lack of stability data on CaLev solutions renders necessary extemporaneous manual preparation, preventing the use of automated/semi-automated systems, with a consequent loss in terms of quality and safety. Methods The present work assessed the chemical–physical and microbiological stability of CaLev prepared in sodium chloride 0.9%, glucose 5% and water for injections and stored in polyolefin/polyamide bags and polypropylene syringes at 2–8°C protected from light. For this purpose, we developed and validated a new rapid High Performance Liquid Chromatography with Ultra Violet Diode-Array Detection (HPLC-UV-DAD) method. Results The samples tested were stable for 14 days, retaining >95% of their initial concentration and showing no change in colour, turbidity or pH. Microbiological tests performed on the samples were negative. Conclusions Our results confirmed the analytical stability of CaLev in NaCl 0.9%, glucose 5% and water for injection at concentrations used in clinical practice at our institute. This enables our centralized laboratory to organize the preparation of this drug in advance and the use of robots rather than manual preparation reduces the workload and the risk of preparation errors.

Work overload is related to increased risk of error during chemotherapy preparation

Purpose Chemotherapy preparation units face peaks in activity leading to high workloads and increased stress. The present study evaluated the impact of work overloads on the safety and accuracy of manual preparations. Method Simulating overwork, operators were asked to produce increasing numbers of syringes (8, 16, and 24), with markers (phenylephrine or lidocaine), within 1 h, in an isolator, under aseptic conditions. Results were analyzed using qualitative and quantitative criteria. Concentration deviations of < 5%, 5%–10%, 10%–30%, and >30% from the expected concentration were considered as accurate, weakly accurate, inaccurate, and wrong concentrations, respectively. Results Twenty-one pharmacy technicians and pharmacists carried out 63 preparation sessions (n = 1007 syringes). A statistically significant decrease in the manufacturing time for one syringe was observed when workload increased (p < 0.0001). Thirty-nine preparation errors were recorded: 30 wrong concentrations (deviation > 30%), 6 mislabeling, 2 wrong diluents, and 1 wrong drug. There was no statistically significant difference in the mean concentration accuracy of final preparations across the three workloads. The overall error rate increased with the number of preparations made in 1 h: 1.8% for 8 preparations, 2.7% for 16 preparations, and 5.4% for 24 preparations (p < 0.05). Conclusion Although pharmacy technicians and pharmacists were able to increase production speeds with no effect on mean concentration accuracy under stressful conditions, there were greater probability errors being made. These results should encourage actions to spread workloads out over the day to avoid peaks in activity.

The Effect of Gates-Glidden Drills on the Quality of Root Canal Treatment by Pre-Clinical Dental Students

AIM: This study was conducted to investigate the effect of applying Gates-Glidden (GG) drill by pre-clinical dental students on root canal treatment quality. METHOD: A total of 56 first molars consisting of 168 canals were selected in this study. For this purpose, 56 students who had been formerly trained by two methods of root canal preparation were randomly divided into two groups (n = 28). Group 1: the step-down method by GG and Group 2: step-back technique without GG. The prepared teeth were filled with gutta-percha/ZOE sealer using lateral condensation. Periapical radiographs were taken before and the following treatment to survey occurrence of preparation errors and CBCT images to determine residual dentine at furcation region. RESULTS: The findings showed that among 10 error types in specimens prepared by students, the occurrence of underfilling, overfilling, inappropriate, ledge formation, and single cone was more common without GG. There were no significant differences in residual dentine amount at furcation region between preparation with and without using GG (P > 0.05). CONCLUSION: Using GG for root canal preparation by dental students resulted in low errors and not an increased dentine removal risk.