Give Intravenous Bolus Overdose a Brake: User Experience and Perception of Safety Device.
| Autor: | Ng YYY; From the Department of Pharmacy, Changi General Hospital., Wan PW; Department of Emergency Medicine, Singapore General Hospital., Chan KP; Department of Emergency Medicine, Sengkang General Hospital., Sim GG; Department of Accident and Emergency, Changi General Hospital, Singapore. |
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| Jazyk: | angličtina |
| Zdroj: | Journal of patient safety [J Patient Saf] 2021 Mar 01; Vol. 17 (2), pp. 108-113. |
| DOI: | 10.1097/PTS.0000000000000770 |
| Abstrakt: | Objectives: Drugs can come in concentrated solutions that require dilution before intravenous bolus administration. Upon dilution, the syringe can contain more than the required amount of drug. The user may mistakenly administer the full contents of the syringe, resulting in an overdose. In this cross-sectional study, we evaluated user experience and perception of Syringe Brake, a dosage flow restrictor device, as part of the intravenous morphine bolus administration workflow. Methods: From December 2018 to January 2019, doctors and nurses working in the emergency department of 3 public tertiary hospitals in Singapore were invited to complete a paper-based 11-item 5-point Likert scale survey questionnaire after 3 months of Syringe Brake implementation. Results: Overall, 77.5% (290/374; 4.11 ± 0.83) of participants were satisfied with the use of Syringe Brake to prevent medication error. Our survey results showed that the top features of Syringe Brake were ease of setting the desired volume to be administered (86.1%; 4.21 ± 0.72), allowing the drug to be titrated safely (84.8%; 4.26 ± 0.77), and giving users the confidence to avoid overdosing the patient (82.1%; 4.21 ± 0.78). Those with hands-on experience with Syringe Brake rated significantly higher for all survey statements except on the perceived ability to prevent error arising from miscommunication (adjusted odds ratio, 1.58 [0.98-2.57]; P = 0.062). Conclusions: Syringe Brake shows promising potential for adoption to prevent medication errors. The device serves as a constraint to prevent accidental overdose, caused by user unfamiliarity or autopilot administration. Competing Interests: This work was supported by Changi General Hospital FY2018 Innovation Grant (COCHFINN1801). The funding source was not involved in the study design, manuscript preparation, data management, or writing of the report. A full regular patent application has been filed for Syringe Brake, and the intellectual property is managed by Changi General Hospital. Y.Y.Y.N. is one of the coinventors of Syringe Brake and will receive net royalties outside the submitted manuscript. However, she will not hold any patent rights to Syringe Brake. The remaining authors disclose no conflict of interest. (Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc.) |
| Databáze: | MEDLINE |
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