Preventing intravenous (IV) preparation errors will improve patient safety and reduce costs by an unknown amount.
Objective
To estimate the financial benefit of robotic preparation of sterile medication doses compared to traditional manual preparation techniques.
Methods
A probability pathway model based on published rates of errors in the preparation of sterile doses of medications was developed. Literature reports of adverse events were used to project the array of medical outcomes that might result from these errors. These parameters were used as inputs to a customized simulation model that generated a distribution of possible outcomes, their probability, and associated costs.
Results
By varying the important parameters across ranges found in published studies, the simulation model produced a range of outcomes for all likely possibilities. Thus it provided a reliable projection of the errors avoided and the cost savings of an automated sterile preparation technology. The average of 1,000 simulations resulted in the prevention of 5,420 medication errors and associated savings of $288,350 per year. The simulation results can be narrowed to specific scenarios by fixing model parameters that are known and allowing the unknown parameters to range across values found in previously published studies.
Conclusions
The use of a robotic device can reduce health care costs by preventing errors that can cause adverse drug events.
PattersonTR, NordstromKA.An analysis of intravenous additive procedures on nursing units, Am J Hosp Pharm. 1968;25:134–137.
8.
ThurMP, MillerWA, LatiolaisCJ.Medication errors in a nurse-controlled parenteral admixture program. Am J Hosp Pharm. 1972;29:298–304.
9.
TaxisK, BarberN.Ethnographic study of the incidence and severity of intravenous drug errors. Br Med J. 2003;326:684–687.
10.
McDowellSE, Mt-IsaS, AshbyD, Where errors occur in the preparation and administration of intravenous medications: A systematic review and Bayesian analysis. Qual Saf Health Care. 2010;19:341–345.
SchneiderPJ, GiftMG, LeeYP, Cost of medication-related problems at a university hospital. Am J Health Syst Pharm. 1995;52:2415–2418.
14.
KohnL, CorriganJ, DonaldsonM; Institute of Medicine. To Err Is Human: Building a Safer Health System. Bethesda, MD: National Academies Press; 2000.
15.
FeldsteinP.The future rule of hospitals. In:Health Policy Issues, an Economic Perspective. 5th ed. Chicago: Health Administration Press; 2011:207–223.
16.
ClassenDC, PestotnikSL, EvansS, Adverse drug events in hospitalized patients: Excess length of stay, extra costs, and attributable mortality. JAMA. 1997;277: 301–306.
HarringtonAR, ArmstrongEP, Cost effectiveness of apixaban, dabigatran, rivaroxaban, and warfarin for stroke prevention in atrial fibrillation. Stroke. 2013;44:1676–1681.
28.
ChanA, LeungH, HuangS.Cost effectiveness of Cetuximab concurrent with radiotherapy for patients with locally advanced head and neck cancer in Taiwan: A decision tree analysis. Clin Drug Investig. 2011;31(10):717–726.
29.
ReschB, SommerC, Cost effectiveness of Palivizumab for respiratory syncytial virus infection in high risk children, based on long term epidemiological data from Austria. Pediatr Infect Dis J. 2012;31(1):e1–e8.
30.
BlondonM, RighiniM, Fondaparinux for isolated superficial vein thrombosis of the legs: A cost effectiveness analysis. Chest. 2012;141(2):321–329.
31.
KosudaS, IchiharaK, Decision tree sensitivity analysis for cost effectiveness of whole body FDG PET in the management of patients with non small cell lung carcinoma in Japan. Ann Nucl Med. 2002;16(4):263–271.
32.
CatalanP, CallejoD, BlascoJ.Cost effectiveness analysis of 64 slice computed tomography vs cardiac catheterization to rule out coronary artery disease before non-coronary cardiovascular surgery. Eur Heart J Cardiovasc Imaging. 2013;14(2):149–157.
33.
DongD, SungC, Cost effectiveness of HLA-B*1502 genotyping in adult patients with newly diagnosed epilepsy in Singapore. Neurology. 2012;79(12):1259–1267.
34.
YieeJ, BaskinL.Use of internal stent, external transanastomotic stent or no stent during pediatric pyeloplasty: A decision tree cost effectiveness analysis. J Urol. 2011;185(2):6763–6781.
35.
FerradoA, PaganoE, A decision tree model to estimate the impact on cost effectiveness of a venous thromboembolism prophylaxis guideline. Qual Saf Health Care. 2009;18(4):309–313.
36.
MogasaleV, VosT.Cost effectiveness of asthma clinic approach in the management of chronic asthma in Australia. Health Econ. 2013;37(3):205–210.
37.
ErzebetB, DavidsonT, Cost effectiveness analysis of goal directed hemodynamic treatment of elderly hip fracture patients: Before clinical research starts. Anesthesiology. 2012;117(3):519–530.
38.
SegerA, ChurchillW, KeohaneC, Impact of robotic antineoplasic preparation on safety, workflow, and costs. J Oncol Pract. 2013;8(6):344–350.
39.
ValentinA, CapuzzoM, GuidetB, Errors in administration of parenteral drugs in intensive care units: Multinational prospective study. Br Med J. 2009;338:b814.
40.
HanP, CoombesI, GreenB.Factors predictive of intravenous fluid administration errors in Australian surgical care wards. Qual Saf Health Care. 2005;14:179–184.
41.
FlynnE, PearsonR, BarkerK.Observatinal study of accuracy in compounding i.v. admixtures at five hospitals. Am J Health Syst Pharm. 1997;54:904–912.
42.
BemtP, FijnR, VoortP, Frequency and determinants of drug administration errors in the intensive care unit. Crit Care Med. 2002;30(4):846–850.
43.
NiemiH, HupliM, KilpiH, PuukkaP.Medication calculation skills of nurses in Finland. J Clin Nurs2003;12: 519–528.
44.
MorimotoT, GandhiT, SegerA, Adverse drug events and medication errors: Detection and classification methods. Qual Saf Health Care2004;13:306–314.
45.
PottsA, BarrF, GregoryD, Computerized physician order entry and medication errors in a pediatric critical care unit. Pediatrics. 2004;113(1):59–63.
46.
BondC, RaehlC, FrankeT.Medication errors in United States hospitals. Pharmacotherapy. 2001;21(9):1023–1036.
47.
SeeleyE.A baseline study of medication error rates at Baylor university medical center in preparation for implementation of a computerized physician order entry system. Health Care Res Improve Proc. 2004;17:357–361.
48.
BatesD, TeichJ, LeeJ, The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc. 1999;6:313–321.
BatemanR, DonyaiP.Errors associated with the preparation of aseptic products in UK hospital pharmacies: Lessons from the national aseptic error reporting scheme. Qual Saf Health Care. 2010;19:1–6.
51.
AnselmiM, PeduzziM, SantosC.Errors in the administration of intravenous medications in Brazilian hospitals. J Clin Nurs. 2007;16(10):1839–1847.
52.
WirtzV, TaxisK, BarberN.An observational study of intravenous medication errors in the United Kingdom and in Germany. Pharm World Sci. 2003;25(3):104–111.
53.
TaxisK, BarberN.Incidence and severity of intravenous drug errors in a German hospital. Eur J Clin Pharmacol. 2004;59:815–817.
54.
ParshuramC, ToT, SetoW, Systematic evaluation of errors occurring during the preparation of intravenous medication. CMAJ. 2008;178(1):42–48.
55.
CousinsD, SabatierB, BegueD, Medication errors in intravenous drug preparation and administration: A multicentre audit in the UK, Germany, and France. Qual Saf Health Care. 2005;14:190–195.
56.
O'HareM, BradleyA, Errors in administration of intravenous drugs. Br Med J. 1995;310:1536–1537.
57.
AdapaR, ManiV, MurrayL, Errors during the preparation of drug infusions: A randomized controlled trial. Br J Anaesth. 2012;109(5):729–734.
58.
HartleyM, DhillonS.An observational study of the prescribing and administration of intravenous drugs in a general hospital. Int J Pharm Pract. 1998;6(1):38–45.
59.
BrierK, LatiolaisC, SchneiderP, Effect of laminar air flow and clean-room dress on contamination rates of intravenous admixtures. Am J Hosp Pharm. 1981;38: 1144–1147.
60.
GrafhorstJ, FoudraineN, NooteboomF, Unexpected high risk of contamination with staphylococci species attributable to standard preparation of syringes for continuous intravenous drug administration in a simulation model in intensive car units. Crit Care Med. 2002;30(4): 833–836.
61.
StuckiC, SautterA, FavetJ, BonnabryP.Microbial contamination of syringes during preparation: The direct influence of environmental cleanliness and risk manipulations on end-product quality. Am J Health Syst Pharm. 2009;66:2032–2036.
62.
TrisselL, GentempoJ, SaenzL, Effect of two work practice changes on the microbial contamination rates of pharmacy-compounded sterile preparations. Am J Health Syst Pharm. 2007;64:837–841.
63.
American Hospital Association. Hospital Statistics. 2011 edition; Table 1.
64.
ShaneR, PepperG, FlumaraK.Improving i.v. medication safety: Identifying the risk points. Presented at: ASHP Midyear Clinical Meeting, Las Vegas, 2009.
