A administração de catecolaminas por via intravenosa é uma prática comum no ambiente hospitalar, principalmente em Unidade de Terapia Intensiva (UTI), Hemodiálise e Pronto Socorro (PS). Apesar de se tratar de um procedimento que demanda cuidados de enfermagem bastante específicos, este pode ser realizado por qualquer membro da equipe de enfermagem, até mesmo sem supervisão direta de um enfermeiro. Para prestar cuidados de enfermagem adequados aos pacientes que recebem catecolaminas por via intravenosa é necessário que o profissional que realiza o procedimento disponha de conhecimento específico acerca da prática realizada. Em unidades como UTI, PS e Hemodiálise, espera-se que o enfermeiro exerça supervisão direta desses cuidados, já que são unidades em que os pacientes apresentam condições mais críticas e geralmente instáveis. Desta forma, é esperado que o enfermeiro detenha todo o conhecimento necessário para administrar as catecolaminas com segurança, minimizando assim os riscos para o paciente. Estes conhecimentos devem ser aprofundados englobando desde ciências básicas como anatomia e fisiologia, até aspectos mais específicos como a escolha do cateter, recomendações de uso dos materiais disponíveis, conhecimentos farmacológicos direcionados e recomendações e cuidados durante a infusão desse tipo de medicamento. Este estudo avaliou o grau de conhecimento dos enfermeiros do Hospital Universitário (HU) da Universidade de São Paulo (USP) quanto à administração de catecolaminas de infusão contínua por via intravenosa. Foram sujeitos deste estudo somente os enfermeiros que atuam em unidades onde a administração de catecolaminas é prática comum. A pesquisa limitou-se aos enfermeiros que atuam em unidades de cuidados de adultos por considerar que há peculiaridades existentes no cuidado do paciente adulto e pediátrico no que diz respeito à administração de drogas vasoativas e à necessidade de atualização e vivência prática da situação. Assim, através de questionário estruturado, procedeu-se a avaliação do conhecimento dos enfermeiros atuantes nas unidades de Hemodiálise, PS de adultos e UTI de adultos com relação à administração de catecolaminas por via intravenosa. Os dados obtidos com a aplicação dos questionários foram submetidos a análises estatísticas para definir se o conhecimento apresentado pelos enfermeiros avaliados é condizente com o preconizado pela literatura para realização segura de tal procedimento / Catecholamine management through intravenous route is a common practice in the hospital setting, mainly at the Intensive Care Unit (ICU), Hemodialysis and Emergency Room (ER). Although it\'s a procedure that demands very specific nursing care, this can be made by any member of the nursing staff, even without direct supervision of a nurse. For delivering optimal nursing care to patients who receive catecholamine through intravenous route, it\'s necessary the provider who makes the procedure to have specific knowledge on this practice. In settings like ICU, ER and Hemodialysis, the nurse is expected to have direct supervision in these procedures, once they are units where patients present more critical and generally unstable conditions. This way, the nurse is supposed to have all the knowledge necessary to manage catecholamine safely, thus minimizing the risks for the patient. This knowledge must be deepen involving from basic sciences such as anatomy and physiology, to more specific aspects, such as the catheter chosen, recommendations for use of available material, specified pharmacological knowledge and recommendations and care during infusion of this type of medication. This study evaluated the knowledge level of nurses from University Hospital (HU) of University of Sao Paulo (USP) regarding to catecholamine management of continuous infusion through intravenous route. Subjects of the study were only the nurses who work in setting where catecholamine management is a common practice. The research limited to nurses who work in adult care, considering that there are peculiarities in adult and pediatric care related to vasoactive medication management and the need of upgrade and practical experience of the situation. Thus, through a structured questionnaire, it was made an evaluation of knowledge of nurses who work in Hemodialysis units, adult ER and adult ICU regarding to catecholamine management through intravenous route. The data obtained through the questionnaires were submitted to statistic analyses to define if the knowledge presented by the evaluated nurses is according to what is advised by literature to make safely such procedure

The purpose of this research was to compare the design of Dose Error Reduction Software (DERS) between smart pumps to determine which features affect the ability of nurses to safely and efficiently program intravenous medications. A high-fidelity usability experiment was conducted. Twenty-four Registered Nurses completed a series of infusion tasks, in a simulated clinical environment, using three smart pumps (Cardinal Alaris System, BBraun Infusomat, and Hospira Symbiq). Results found significant differences in nursing performance across the smart pumps. Nurses were more likely to override clinically inappropriate soft limit alerts when using BBraun Infusomat, than when using Hospira Symbiq or Cardinal Alaris System. Furthermore, when asked to program an infusion over a specific duration, nurses were found to make significantly more parameter entry errors when using Hospira Symbiq than when using Cardinal Alaris System. Results from this study will help set DERS design principles, and assist hospitals during their procurement processes.

The purpose of this research was to compare the design of Dose Error Reduction Software (DERS) between smart pumps to determine which features affect the ability of nurses to safely and efficiently program intravenous medications. A high-fidelity usability experiment was conducted. Twenty-four Registered Nurses completed a series of infusion tasks, in a simulated clinical environment, using three smart pumps (Cardinal Alaris System, BBraun Infusomat, and Hospira Symbiq). Results found significant differences in nursing performance across the smart pumps. Nurses were more likely to override clinically inappropriate soft limit alerts when using BBraun Infusomat, than when using Hospira Symbiq or Cardinal Alaris System. Furthermore, when asked to program an infusion over a specific duration, nurses were found to make significantly more parameter entry errors when using Hospira Symbiq than when using Cardinal Alaris System. Results from this study will help set DERS design principles, and assist hospitals during their procurement processes.

A administração de catecolaminas por via intravenosa é uma prática comum no ambiente hospitalar, principalmente em Unidade de Terapia Intensiva (UTI), Hemodiálise e Pronto Socorro (PS). Apesar de se tratar de um procedimento que demanda cuidados de enfermagem bastante específicos, este pode ser realizado por qualquer membro da equipe de enfermagem, até mesmo sem supervisão direta de um enfermeiro. Para prestar cuidados de enfermagem adequados aos pacientes que recebem catecolaminas por via intravenosa é necessário que o profissional que realiza o procedimento disponha de conhecimento específico acerca da prática realizada. Em unidades como UTI, PS e Hemodiálise, espera-se que o enfermeiro exerça supervisão direta desses cuidados, já que são unidades em que os pacientes apresentam condições mais críticas e geralmente instáveis. Desta forma, é esperado que o enfermeiro detenha todo o conhecimento necessário para administrar as catecolaminas com segurança, minimizando assim os riscos para o paciente. Estes conhecimentos devem ser aprofundados englobando desde ciências básicas como anatomia e fisiologia, até aspectos mais específicos como a escolha do cateter, recomendações de uso dos materiais disponíveis, conhecimentos farmacológicos direcionados e recomendações e cuidados durante a infusão desse tipo de medicamento. Este estudo avaliou o grau de conhecimento dos enfermeiros do Hospital Universitário (HU) da Universidade de São Paulo (USP) quanto à administração de catecolaminas de infusão contínua por via intravenosa. Foram sujeitos deste estudo somente os enfermeiros que atuam em unidades onde a administração de catecolaminas é prática comum. A pesquisa limitou-se aos enfermeiros que atuam em unidades de cuidados de adultos por considerar que há peculiaridades existentes no cuidado do paciente adulto e pediátrico no que diz respeito à administração de drogas vasoativas e à necessidade de atualização e vivência prática da situação. Assim, através de questionário estruturado, procedeu-se a avaliação do conhecimento dos enfermeiros atuantes nas unidades de Hemodiálise, PS de adultos e UTI de adultos com relação à administração de catecolaminas por via intravenosa. Os dados obtidos com a aplicação dos questionários foram submetidos a análises estatísticas para definir se o conhecimento apresentado pelos enfermeiros avaliados é condizente com o preconizado pela literatura para realização segura de tal procedimento / Catecholamine management through intravenous route is a common practice in the hospital setting, mainly at the Intensive Care Unit (ICU), Hemodialysis and Emergency Room (ER). Although it\'s a procedure that demands very specific nursing care, this can be made by any member of the nursing staff, even without direct supervision of a nurse. For delivering optimal nursing care to patients who receive catecholamine through intravenous route, it\'s necessary the provider who makes the procedure to have specific knowledge on this practice. In settings like ICU, ER and Hemodialysis, the nurse is expected to have direct supervision in these procedures, once they are units where patients present more critical and generally unstable conditions. This way, the nurse is supposed to have all the knowledge necessary to manage catecholamine safely, thus minimizing the risks for the patient. This knowledge must be deepen involving from basic sciences such as anatomy and physiology, to more specific aspects, such as the catheter chosen, recommendations for use of available material, specified pharmacological knowledge and recommendations and care during infusion of this type of medication. This study evaluated the knowledge level of nurses from University Hospital (HU) of University of Sao Paulo (USP) regarding to catecholamine management of continuous infusion through intravenous route. Subjects of the study were only the nurses who work in setting where catecholamine management is a common practice. The research limited to nurses who work in adult care, considering that there are peculiarities in adult and pediatric care related to vasoactive medication management and the need of upgrade and practical experience of the situation. Thus, through a structured questionnaire, it was made an evaluation of knowledge of nurses who work in Hemodialysis units, adult ER and adult ICU regarding to catecholamine management through intravenous route. The data obtained through the questionnaires were submitted to statistic analyses to define if the knowledge presented by the evaluated nurses is according to what is advised by literature to make safely such procedure

Thesis (Mcur)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: A literature study showed that the topics of medication safety and medication error prevention have been studied in depth. Findings from the literature revealed that medication errors are reported to be common in neonatal and paediatric ICUs, that more than half of these errors are preventable and that risk reduction measures protect patients against untoward outcomes or adverse events (Clifton-Koeppel, 2008:72). If and when there is a failure in the process of safe medication administration, it results in a medication error, which is defined as a breach of one or more of the five rights of medication administration (Institute for Safe Medication Practices Alert, 2007:1). Medication administration, which is predominantly a nursing task, is of high risk and high volume in the intensive care unit (ICU). The accuracy of intravenous medication administration is critical for a neonatal and paediatric ICU patient since it can potentially heighten the patient’s vulnerability if further harm is caused. In view of the complexity of medication administration for neonatal and paediatric ICU patients, researchers confirm the diverse role of the registered nurse in safe medication administration practices. The purpose of the study was to describe the perceptions of registered nurses (RNs) regarding the factors that influence IV medication safety practice in the neonatal intensive care unit (NICU); paediatric intensive care unit (PICU); and paediatric cardiac intensive care unit (CSICU) in Saudi Arabia. The study objectives were set to describe the actual factors that have an influence on IV medication safety practices of RNs working in these ICUs; to determine the knowledge of registered nurses in the selected ICUs with regard to safe intravenous medication administration practices and to describe nursing medication administration strategies that are focused on medication error prevention. A quantitative research approach was selected for this study which had a descriptive, survey design. An 85% non-probability purposive sampling method was used to draw a sample (n=103) of the target population of NICU-, PICU- and CSICU-registered nurses (N=121) who were responsible for administering intravenous medication at King Faisal Specialist Hospital and Research Centre in Jeddah (KFSHRC-J). A self-administered questionnaire with closed-ended Likert and open-ended question was designed to describe the objectives under study. A pilot study was conducted to pre-test the questionnaire. A quantitative method was used to analyse the study data. MS Excel was used to capture the quantitative data after which it was analysed using descriptive statistics by means of STATISTICA 9 software. The open–ended questions (indicating “other” and Question 70) were also interpreted quantitatively after exploring the main aspects in the responses. The main findings were that multiple perceived factors influence the intravenous medication safety practices of RN’s working with neonatal and paediatric ICU patients in a particular Saudi Arabian tertiary hospital. It was found that these nurses’ had knowledge regarding safe medication administration practice that constitutes that all five medication rights have to be checked through nursing ‘double-checks’ in the steps of medication administration, as the method of checking as per hospital policy. However, from the findings, it is reflected that RNs perceptions of completely and correctly checking medication rights through complete and independent nursing ‘double-checks’, do not match the steps required by policy and that their knowledge is inadequate. It is evident from the perceptions of RNs that they are aware of the multiple factors influencing IV medication safety practice in this vulnerable patient setting. As perceived by RNs, it is possible to implement more safety strategies. Key recommendations on conclusion of the study include that there are more nursing medication administration strategies that could still be implemented for medication error prevention. These strategies relate to medication safety awareness, the role of the nurse and nursing managers, mandatory staff education, and review of knowledge and skills. / AFRIKAANSE OPSOMMING: Gebaseer op ʼn literatuurstudie blyk dit dat medikasieveiligheid en voorkoming van medikasiefoute reeds in diepte bestudeer are. Bevindings dui daarop dat medikasiefoute algemeen voorkom in neonatale en pediatriese intensiewesorgeenhede, dat meer as die helfte daarvan voorkombaar is, en dat maatreëls om risiko te vermindering pasiënte teen voorkombare uitkomste beskerm (Clifton-Koeppel, 2008:72). Indien en wanneer die proses vir veilige medikasietoediening faal, kom ʼn medikasiefout voor, wat gedefinieer word as die verbreking van een of meer van die vyf medikasieregte (Institute for Safe Medication Practices Alert, 2007:1). Medikasietoediening is hoofsaaklik ʼn verpleegtaak, wat ʼn hoërisiko- en hoëvolume-taak behels. Die akkuraatheid van intraveneuse medikasietoediening is kritiek vir neonatale en pediatriese intensiewesorgpasiënte, aangesien hul weerloosheid verhoog word indien verdere skade veroorsaak word. Omrede medikasietoediening vir neonatale en pediatriese intensiewesorgpasiënte kompleks is, bevestig navorsers dat geregistreerde verpleegkundiges se rol ten opsigte van veilige medikasietoediening veelsoortig is. Die doel van die studie was om die persepsies van geregistreerde verpleegkundiges aangaande die faktore wat medikasieveiligheid in die neonatale en paediatriese intensiewe eenhede in Saoedi-Arabië beinvloed, te beskryf. Studiedoelwitte is gestel om die spesifieke faktore te beskryf wat aanleiding gee tot medikasietoedieningsfoute in die genoemde intensiewesorgeenhede; om geregistreerde verpleegkundiges in die geselekteerde intensiewesorgeenhede se kennis van veilige medikasietoediening te bepaal; en die medikasietoedieningstrategieë wat op die voorkoming van medikasietoedieningsfoute fokus, te beskryf. ʼn Kwantitatiewe navorsingsbenadering is geselekteer vir die studie wat ʼn beskrywende navorsingsontwerp gehad het. ʼn 85% nie-waarskynlike gerieflikheidsteekproef is gebruik om ʼn steekproef (n=103) te selekteer vanuit die teikenpopulasie geregistreerde verpleegkundiges (N=121) wat verantwoordelik was vir medikasietoediening in die geselekteerde intensiewesorgeenhede by King Faisal Specialist Hospital and Research Centre, Jeddah (KFSHRC-J). ʼn Self-geadministreerde vraelys met geslote Likert- en oop-eindevrae is opgestel om die gestelde studiedoelwitte te ondersoek. ʼn Vooraf-toetsing van die vraelys is tydens die loodsstudie uitgevoer. ʼn Kombinasie van kwantitatiewe en kwalitatiewe metodes is gebruik vir die ontleding van die studie-data. Die kwantitatiewe data is op MS Excel ingevoer, waarna beskrywende statistiek deur middel van Statistica 9-sagteware gebruik is om dit te ontleed. Die studie het hoofsaaklik bevind dat veelvuldige faktore die veiligheidspraktyk ten opsigte van intraveneuse medikasie van geregistreerde verpleegkundiges wat met neonatal en pediatriese intensiewesorgpasiënte in ʼn spesifieke tersiêre hospitaal in Saoedi-Arabië werk, beïnvloed. Dit blyk dat hierdie verpleegkundiges se kennis voldoende is aangaande ‘n veilige medikasie toedieningspraktyk wat bestaan uit die kontrolering van al vyf medikasieregte deur verpleegkundige dubbel-kontrolering, soos beskryf is in die hospitaalbeleid. Volgens die bevindinge blyk dit egter dat die verpleegkundiges se persepsie van volledige and korrekte verpleegkundige dubbel-kontrolering, nie met die stappe volgens die hospitaalbeleid ooreenstem nie en dat hulle kennis onvoldoende is. Dit is duidelik dat die verpleegkundiges bewus is van die veelvuldige faktore wat intraveneuse medikasieveiligheidpraktyk vir weerlose pasiënte beïnvloed. Die verpleegkundiges se persepsie is dat daar meer verpleegkundige medikasietoedieningstrategieë is wat geïmplementeer kan word om medikasiefoute te voorkom, insluitende veiligheidsbewustheid ten opsigte van medikasie, die rol van verpleegkundiges en verpleegbestuurders, verpligte personeelopleiding, en hersiening van kennis en vaardighede.

Secondary infusions are a common and convenient method to administer intermittent infusions unattended through a single IV access using infusion pump technology. Previous studies have indicated that clinicians have a high frequency of committing operation errors while administering secondary infusions, which can cause patient harm. The purpose of this study was to evaluate the safety of secondary infusion practice by identifying and analyzing potential failure modes when delivering secondary infusions on five different smart infusion pumps. Healthcare Failure Mode and Effect Analysis (HFMEA) was used to prioritize potential failure modes that are considered high-risk for each pump. Results showed that four of the five pumps were not able to mitigate physical set-up errors. As well, each pump contributed differently to programming errors due to difference in interface design. Recommendations from this study focused on outlining desired infusion pump features and mitigation strategies to help alleviate high-risk secondary infusion failure modes.

Secondary infusions are a common and convenient method to administer intermittent infusions unattended through a single IV access using infusion pump technology. Previous studies have indicated that clinicians have a high frequency of committing operation errors while administering secondary infusions, which can cause patient harm. The purpose of this study was to evaluate the safety of secondary infusion practice by identifying and analyzing potential failure modes when delivering secondary infusions on five different smart infusion pumps. Healthcare Failure Mode and Effect Analysis (HFMEA) was used to prioritize potential failure modes that are considered high-risk for each pump. Results showed that four of the five pumps were not able to mitigate physical set-up errors. As well, each pump contributed differently to programming errors due to difference in interface design. Recommendations from this study focused on outlining desired infusion pump features and mitigation strategies to help alleviate high-risk secondary infusion failure modes.

Secondary infusions is a common method to deliver short infusions of intravenous (IV) drugs and fluids. Errors associated with this infusion method have led to patient safety concerns. This study's objective was to empirically evaluate interventions to mitigate secondary infusion risks. Three interventions, including a technology-based intervention (clamp detector on a smart pump), a training-based intervention (educational module), and a practice-based intervention (use of a separate pump for short infusions), were tested in a simulated inpatient unit. The technology-based intervention significantly decreased secondary clamp errors whereas the training-based intervention reduced complex pressure differential errors. The practice-based intervention was the only intervention that significantly decreased both secondary clamp errors and pressure differential errors, but introduced new risks due to mismanagement of residual volume in IV tubing. Study results highlight the need for a combination of mitigation strategies and can help guide the selection of interventions to reduce secondary infusion errors.

Secondary infusions is a common method to deliver short infusions of intravenous (IV) drugs and fluids. Errors associated with this infusion method have led to patient safety concerns. This study's objective was to empirically evaluate interventions to mitigate secondary infusion risks. Three interventions, including a technology-based intervention (clamp detector on a smart pump), a training-based intervention (educational module), and a practice-based intervention (use of a separate pump for short infusions), were tested in a simulated inpatient unit. The technology-based intervention significantly decreased secondary clamp errors whereas the training-based intervention reduced complex pressure differential errors. The practice-based intervention was the only intervention that significantly decreased both secondary clamp errors and pressure differential errors, but introduced new risks due to mismanagement of residual volume in IV tubing. Study results highlight the need for a combination of mitigation strategies and can help guide the selection of interventions to reduce secondary infusion errors.