MEDICATION ERROR IN INFUS THERAPY

CAUSES OF MEDICATION ERROR

To address the causes and prevention of medication errors throughout
the entire system of medication therapy is a daunting
• •
task. It has been
estimated that, from the “tip of the pen to the tip of the tongue,”
there are 65 steps in the process of medication administration.14
Errors may occur at any step in this process, including:

Prescribing errors
Compounding errors
Dispensing errors
Admininstration errors
Monitoring errors
Communication and management errors, including failures in
error reporting

• Although medication errors can occur through any route of administration, this online course will
focus on the prevention of medication errors in the dispensing and administration of intravenous
(IV) medications.
• The administration of IV medications carries a relatively greater risk for error than other routes of
medication administration, in part because of the complexity associated with their preparation and
administration. For example:

• IV medications are associated with 54% of potential ADEs.15

• 60 % of serious and life-threatening medication errors are associated with IV medications.16

• Infusion devices account for up to 35% of all medication errors that result in significant harm. The
most common error is incorrect manual programming of infusion parameters (eg, rate, drug, dose)
into infusion devices. (Other errors include administering the wrong drug, administering the right
drug to the wrong patient, and tampering with the recommended infusion parameters.)
Research
• In 1979, Falk et al reported an increased mutagenic
activity in the urine of nurses exposed to cytotoxics.
• In 1983
1983,, Sotaniemi et al reported that destruction in 3
nurse liver that work at oncology ward
ward..
• In two Hospital, In Italy, has carried cyclophosphamide
and iphosphamide in nurse urine and pharmacy staff that
not follow procedure of handling cytotoxic
cytotoxic..
• Taxis,K..,Barber,W
Taxis,K ,Barber,W..,2003
2003,, reported that occured 249
mistakes by nurses from 430 times preparation intra
vena drugs (dispencing and administration)
administration)..
• Lim..S., 1998
Lim 1998,, Princess Margareth Hospital, reported that
cost saving for drugs about $ 250 250..000
000/year
/year and
efficiency time of nurse is 330 hour/month
hour/month..
Microbiology Data In Oncology ward ’Dharmais’ Hospital
2000

Preparate Coloni amount

Ward third class 750 coloni
Ward first class 550 coloni
Ward VIP/VVIP class 225 coloni
Ward Isolate 40 coloni
Surgical Room 65 coloni
ICU Room 240 coloni
IV Preparation in third class room 50 coloni
IV Preparation in Second class room Sterile
IV Preparation in VIP class room Sterile
Why Does PIVAS Implement ?
1. For all intravena drug must sterile from
contamination (nosocomial infection)
2. Especially for cytotoxic/neoplastic drugs,
we must protect the operator from
exposure the cytotoxic drugs
(carcinogenic, mutagenic, oncogenic etc)
3. Pharmacists responsible to realisize both
of them. Because they have knowledge
and skill
• Tingginya tingkat infeksi nosokomial
• Data pertumbuhan mikroba pada sediaan iv
injection yang direkonstitusi di ruang
perawatan.
• Risiko infeksi pasien bertambah → biaya
pengobatan ↑

Tanggungjawab Farmasis akan pelayanan IV

Admixture secara aseptis
Standar Pelayanan Farmasi RS Tahun 2004
PHARMACY STRATEGY TO DO PIVAS
1. Make Presentation in front of nurse and doctor (PTC/
Pharmacy & Therapy Committee) that involve :
§ Effect of Cytotoxic
§ Condition area in oncology wards
2. Benchmark to another country had set up centralisation
of handling cytotoxic.
- National University Hospital Singapore
- Royal North Shore Hospital Australia .
3. Design and Set Up Clean Room
4. Make Standard Procedure
5. Training the Pharmacy staff
6. Running Programme PIVAS
7. Evaluation and Report
Facility Design

Clean room
Storage Area
Administrasi Area
Clean Area
Toilet Area
Ante Room
Pass Box
Biological Safety cabinet (BSC)
Biological Safety Cabinet (BSC) :
• BSC Class II for Cytotoxic drugs (Cytogard)
• Fungsi : Memberikan proteksi kepada
petugas, materi yang dikerjakan, dan
lingkungan.
• Prinsip kerja : Tekanan udara didalam
cytogard lebih negatif dari tekanan udara
luar, sehingga aliran udara bergerak dari luar
ke dalam BSC, Didalam BSC udara bergerak
vertical membentuk barrier, sehingga jika ada
percikan obat kanker didalam BSC tidak
kembali kearah petugas.
• Validasi alat : kalibrasi 6 bulan sekali
Personal Protective Equipment
1. Protective Gown
2. Head Cap
2
3. Chemotherapy Mask
3
4. Glove
5. Shoe and Boot 1

6. Emergency Kit :
4

- NaCl 0,9 % 500 ml

- Larutan Pencuci mata Steril
- Air Sabun 120 ml
- Lar. Chlorin 5 % 500 ml 5

- H2O2 3 % 500 ml

7. Formulir Laporan Kecelakaan

PERSONAL
• Persons should get training about aseptic
technique and handling cytotoxic before
placed in handling cytotoxic area
area..
• Staff who pregnant or plan to pregnan not
recommended to reconstitution
reconstitution..
• Women breastfeeding not recommended
too..
too
• Every staff must check laboratorium at least
per 6 month.
 Mutu :
Contoh :
•Produk steril
E
Obat Injeksi P •Operator
selamat F
I • Stabilitas ; E
Obat Kanker
V suhu, waktu
K
TPN A Efisien :
T
•Unit dose
S I
• Sisa obat utk
F
pasien tdk
mampu
Workflow of Centralization PIVAS Complete

Drug &
Chemotherapy DEPARTMENT OF PHARMACY
order form
Checklist Preparation :
- Data of Patient (MR, Name, Age, Weight, Doctor/
Height, Diagnose) Not Complete nurse
- Dosis & Exp.Date of Drugs
completed
Delivery
- Inpatient Ward Labeling Desinfection
outside
- One day care Ward

Pass box
Clean Room
rekonstitution

Syringe/infuse

Finished Labelling inside

CENTRALISATION HANDLING CYTOTOXIC
TRANSPORTATION & WASTE HANDLING

• Worker delivery the preparation with

closed trolley
trolley..
• Handling and disposing of Cytotoxic waste
in separate and signed container, for
sharpen waste likes spuit, vial and ampul
dispose in sharp container
container..
• All of waste burn in incenerator
Average :
• Amount of Patien 525/ month
• Amount of Preparation 1520 /month
• Average Preparation 52/day
EFFICIENCY OF PIVAS
“Handling Cytotoxic On The 2009”
No. BULAN PENDAPATAN PENGHEMATAN

1. Januari Rp. 2,247,038,484.00 Rp. 113,500,500.00

2. Februari Rp. 2,169,488,819.00 Rp. 90,800,400.00

3. Maret Rp. 3,024,856,762.00 Rp. 121,067,200.00

4. April Rp. 3,488,656,873.00 Rp. 116,022,733.33

5. Mei Rp. 3,205,318,364.00 Rp. 119,806,083.33

6. Juni Rp. 3,586,061,215.00 Rp. 123,589,433.33

7. Juli Rp. 2,584,730,465.00 Rp. 127,372,783.33

8. Agustus Rp.. 2,657,100,514.00

Rp Rp. 131,156,133.33

Rp.. 22,923,251,496.00
Rp Rp.. 943,315,266.67
Rp
Total