Intravenous-medication errors; vitamin [D.sub.3] supplementation; employee physical fitness; effects of anesthesia - Evidence For Practice

AORN Journal,  Nov, 2003  by George Allen

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Incidence and severity of IV medication errors

BMJ

March 29, 2003

The purpose of this prospective ethnographic study was to determine the incidence and clinical importance of errors resulting from the preparation and administration of IV medications and the stages of the process in which these errors occur. (1) trained observer accompanied nurses on 10 wards in two hospitals in the United Kingdom and observed them as they prepared and administered IV medication for six to 10 consecutive days on each ward. The incidence of IV medication errors was calculated by errors per dose and by errors per process stage (ie, preparation stage or administration stage). Four experienced health care professionals assessed the clinical importance of errors, using a visual analogue scale ranging from zero (ie, no harm) to 10 (ie, death). Standard statistical methods were used to analyze the findings.

Findings. One hundred thirteen nurses and one physician were observed. One or more errors occurred in the preparation and administration of 212 out of 430 IV medication doses (error rate 49%, 95% confidence interval 45% to 54%). Errors were potentially serious in three doses (1%), moderate in 126 doses (29%) and minor in 83 doses (19%). Most errors occurred during the administration of bolus doses or preparation of medications that required multiple steps.

Clinical implications. This study found a high incidence of errors in the preparation and administration of IV medications. Perioperative nurse managers should understand that errors are more likely to occur if multiple steps are required to prepare a medication before administration or if bolus administration of medication is being used. Consideration should be given to implementing a system of centralized preparation for all IV medications and affixing warning labels to all medications intended for bolus administration.

Effect of vitamin [D.sub.3] supplementation

BMJ

March 2003

The purpose of this randomized, double blind controlled study was to determine the effect of vitamin D supplementation on the rate of fractures in men and women age 65 and older. (2) Individuals between the ages of 65 to 85 (n = 2,686, 2,037 men and 649 women) were assigned randomly to a treatment group that received vitamin D supplements or a control group that received a placebo. A capsule containing 100,000 IU vitamin [D.sub.3] (ie, cholecalciferol) or a matching placebo was mailed to each participant every four months for five years--a total of 15 doses. Participants were instructed to ingest the capsule immediately and to complete a form indicating that they had done so. They also completed a checklist of events experienced, such as fractures or major illness. The forms were returned by mail. Incidence of fractures, cardiovascular disease, and cancer were identified. Relative risk for incidence of fractures between the two groups was determined.

Findings. Participants in the treatment group had a 22% lower rate for first fracture at any site (8.8 versus 11.1, age adjusted relative risk [RR] 95% confidence interval [CI] 0.78 [0.86-0.99], P = 0.04). Additionally, the treatment group had a 33% lower rate for fractures of the hip, wrist, forearm, and vertebrae (4.5 versus 6.5, RR 95% CI 0.67 [0.48-0.431 P = 0.02). Mortality from all causes was lower in the treatment group but not significantly lower than in the placebo group (16.7 versus 18.4, RR 95% CI 0.88 [0.74-1.06] P = 0.18).

Clinical implications. The study revealed that a single oral 100,000 IU dose of vitamin [D.sub.3] taken every four months is safe and effective in reducing the incidence of fractures in individuals older than age 65. Perioperative nurses should be prepared to use this information as a possible strategy in their preoperative and postoperative patient teaching programs.

Fitness levels and worker absenteeism

Journal of Exercise Physiology online

February 2003

Absenteeism is a major problem for employers. The purpose of this study was to determine individuals' level of fitness and relate it to their perceived productivity, job satisfaction, and absenteeism. (3) One hundred forty-three employees representing nine city departments, including fire, police, public works, and library, were assessed on three measures of job performance and four health-related components of fitness--body composition, cardiorespiratory endurance, flexibility, and muscular strength. Participants were asked to complete a fitness assessment that measured body fat percentage, cardiorespiratory endurance, flexibility, and muscular strength. Additionally, they were asked to complete a questionnaire using a five-point Likert-type scale, with answers ranging from "strongly agree" to "strongly disagree." The questionnaire determined the relationship between participants' fitness levels and perceived productivity and job satisfaction. Section A of the questionnaire measured the employees' current exercise level, section B measured the employees' perceived productivity, and section C measured the employees' job satisfaction. Absenteeism rates during a one-year period were compared to the fitness level of each participant. Stepwise regression analyses were used to analyze the findings.