Journal
BRITISH JOURNAL OF CLINICAL PHARMACOLOGY
Volume 87, Issue 11, Pages 4273-4282Publisher
WILEY
DOI: 10.1111/bcp.14844
Keywords
medication administration error; medication documentation; precision dosing; smart pump; therapeutic drug monitoring
Categories
Funding
- Australian Government through Medical Research Future Fund
- Cancer Council's Beat Cancer Project
- State Government through Department of Health
- St Vincent's Clinical School, University of New South Wales, Sydney
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The study found discrepancies between actual and documented administration times for antimicrobial infusions, with no significant impact from day of the week, time of day, or nurse-to-patient ratio. Night administrations had smaller discrepancies, and antimicrobials with shorter half-lives showed less variation in documented times.
Aims Accurate documentation of medication administration time is imperative for many therapeutic decisions, including dosing of intravenous antimicrobials. The objectives were to determine (1) the discrepancy between actual and documented administration times for antimicrobial infusions and (2) whether day of the week, time of day, nurse-to-patient ratio and drug impacted accuracy of documented administration times. Methods Patient and dosing data were collected (June-August 2019) for 55 in-patients receiving antimicrobial infusions. Documented and actual administration times (n = 660) extracted from electronic medication management systems and smart infusion pumps, respectively, were compared. Influence of the day (weekday/weekend), time of day (day/evening/night), nurse-to-patient ratio (high 1:1/low 1:5) and drug were examined. Monte Carlo simulation was used to predict the impact on dose adjustments for vancomycin using the observed administration time discrepancies compared to the actual administration time. Results The median discrepancy between actual and documented administration times was 16 min (range, 2-293 min), with discrepancies greater than 60 minutes in 7.7% of administrations. Overall, discrepancies (median [range]) were similar on weekends (17 [2-293] min) and weekdays (16 [2-188] min), and for high (16 [2-157] min) and low nurse-to-patient ratio wards (16 [2-293] min). Discrepancies were smallest for night administrations (P < .05), and antimicrobials with shorter half-lives (P < .0001). The observed discrepancies in vancomycin administration time resulted in a different dose recommendation in 58% of cases (30% higher, 28% lower). Conclusions Overall, there were discrepancies between actual and documented antimicrobial infusion administration times. For vancomycin, these discrepancies in administration time were predicted to result in inappropriate dose recommendations.
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