Local hospitals throughout San Diego County, along with San Diego Patient Safety Consortium and the Cardinal Health Center for Safety and Clinical Excellence, today announced the results of a first-of-its-kind regional task force to improve patient safety by eliminating variation in intravenous (IV) medication practices among county hospitals.
The task force has created county-wide standards for safe administration of IV medicines by using a common drug identifier and standardizing the concentration and dosage units for each drug. The task force aimed to make San Diego the first metropolitan area in the United States to develop and implement this new approach to significantly reduce the variation in IV therapy, resulting in safer and more consistent practices in administering high-risk IV medications to patients.
“The San Diego campaign for Safe Administration of High-Risk IV Medications has brought together virtually every hospital in our region to agree on IV standards that will reduce unnecessary variation among hospitals that can lead to harmful medication errors,” said Nancy Pratt, Senior Vice President of Clinical Effectiveness for Sharp HealthCare and key participant in the Task Force. “We hope our efforts in San Diego can serve as a model for other regions and begin to create a common standard for IV practices in hospitals across the country.”
The 2006 Institute of Medicine (IOM) report, “Preventing Medication Errors,” found that medication errors cause harm to more than 1.5 million people annually and cost hospitals more than $3.5 billion each year. The task force chose to concentrate on IV practices because 61 percent of the most serious and life-threatening potential adverse drug events are related to IV medications[1], and the IV route of administration often results in the most serious outcomes of medication errors.[2] The report urged hospitals to take action to reduce the potential for errors, which reinforced the efforts being made by the medication safety task force in San Diego that began more than a year ago.
The IOM report further points out that the most common cause of IV medication errors is the incorrect programming of infusion devices.A key problem related to drug administration is incorrect dosing due to confusion among medications and the complexity of the medication use process. The San Diego initiative focused on standardizing high-risk IV drug concentrations and dosage units within and across San Diego hospitals to reduce complexity and improve compliance with best practices. These standards improve medication safety for patients and clinicians by ensuring the safest medication process is in place regardless of the caregiver or health-care facility.
When infusion practices differ from one patient care area or hospital to another, the use of agency nurses, new graduates, traveling nurses and nurses who change hospitals or care areas can further increase the likelihood of errors. For example, if one hospital or patient care area uses an infusion rate of milligrams per minute and another uses milligrams per hour, choosing the wrong dosage unit could result in a 60-fold overdose.
San Diego County is the first region in the nation to standardize practices for safe administration of IV medications. When the task force began their work, the 15 hospitals in the San Diego task force used a combined total of more than 85 different concentrations and 57 different dosage units for 34 IV medications. Today those totals have been reduced to 34 standard, single-strength concentrations and 34 standard dosage units, effectively eliminating 100 percent of unnecessary variability in administering continuous IV infusions. Having met their goal of standardizing IV concentrations and dosage units, the task force is now working to standardize dosage ranges and drug libraries involved in the use of computerized ‘smart’ pumps.
“While clinical practice will always involve some degree of variability, it is important to identify and reduce both unnecessary variability that increases opportunities for errors and costs, and undesirable variability that reflects deviations from clinical guidelines and best practices,” said Tim Vanderveen, Vice President of Cardinal Health’s Center for Safety and Clinical Excellence. “The challenge is to identify the variability, implement changes to reduce it, monitor the impact of those changes and use clinical data to continually improve patient safety and care.”
The IV Safety Task Force also created a ?toolkit? that contains the final list of standard concentrations and dosage units, and is intended to help other regions implement similar measures to standardize IV medication practices. The toolkit also includes practical advice on forming a regional task force, identifying variations in practice across different hospitals, developing standards and overcoming barriers that may arise during the process. In addition to patient safety benefits, the implementation of consistent IV practices is expected to help hospitals comply with measures set by the Joint Commission of Accreditation of Healthcare Organizations (JCAHO), which has identified standardization of IV concentrations as one of its National Patient Safety Goals.
Local hospitals involved in this initiative include Alvarado Hospital Medical Center, Palomar Pomerado Health, Scripps Health, Sharp HealthCare, Tri-City Medical Center, University of California San Diego Medical Center and VA San Diego Medical Center.