Aims Errors involving chemotherapy and vascular access management (VAM) may cause serious patient harm. Dose error reduction software (DERS) safety limits are installed on all intravenous infusion devices, however average DERS compliance within the haematology/oncology profile was 8.5% lower than other adult areas within the hospital. To improve DERS and VAM compliance, a clinical review was undertaken.
Methods A multidisciplinary working group of pharmacists, nurses and doctors with vendor representation was established to review medication entries in the DERS and coordinate an electronic survey assessing clinicians’ satisfaction with the current profiles. Survey Monkey was used to collect responses and tabulate data. DERS compliance was measured using vendor supplied Continuous Quality Improvement Software. A prospective observational audit was conducted to review VAM and compliance of running infusions with the corresponding prescription and organisational guidelines.
Results The working group made changes to 71 drugs, predominantly to realign with updated practice recommendations and reduce nuisance alerts. The group reviewed 150 patients with 59 infusions running via 57 infusion pumps during the audit. Most pumps (56, 98.2%) were in the correct profile with 44 of 46 DERS infusions (95.7%) reflecting the hanging bag. One hundred vascular access devices were observed with use of the preferred insertion site exceeding national benchmarking data, however 83% did not comply with local labelling requirements. Over the audit period, average compliance with DERS increased from 77.9% to 85.6%, p=0.157. Fifty eight staff responded across both surveys with the very satisfied rating increasing from 13.3% to 57.1%, P<0.005.
Conclusion A review group to improve the haematology/oncology DERS profile was successful in improving compliance. There was good compliance for vascular access insertion sites; however improvement in site and line labelling is required. Infusions running outside of DERS have been addressed by amendment of the DERS profile and feedback to clinical areas.