Injection device-related risk management toward safe administration of medications: experience in a university teaching hospital in The People's Republic of China

Ling-ling Zhu,¹ Wei Li,² Ping Song,³ Quan Zhou<sup>3

1</sup>Geriatric VIP Ward, Division of Nursing, ²Division of Medical Administration, ³Department of Pharmacy, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China

Abstract: The use of injection devices to administer intravenous or subcutaneous medications is common practice throughout a variety of health care settings. Studies suggest that one-half of all harmful medication errors originate during drug administration; of those errors, about two-thirds involve injectables. Therefore, injection device management is pivotal to safe administration of medications. In this article, the authors summarize the relevant experiences by retrospective analysis of injection device-related near misses and adverse events in the Second Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang University, People's Republic of China. Injection device-related near misses and adverse events comprised the following: 1) improper selection of needle diameter for subcutaneous injection, material of infusion sets, and pore size of in-line filter; 2) complications associated with vascular access; 3) incidents induced by absence of efficient electronic pump management and infusion tube management; and 4) liquid leakage of chemotherapeutic infusion around the syringe needle. Safe injection drug use was enhanced by multidisciplinary collaboration, especially among pharmacists and nurses; drafting of clinical pathways in selection of vascular access; application of approaches such as root cause analysis using a fishbone diagram; plan–do–check–act and quality control circle; and construction of a culture of spontaneous reporting of near misses and adverse events. Pharmacists must be professional in regards to medication management and use. The depth, breadth, and efficiency of cooperation between nurses and pharmacists are pivotal to injection safety.

Keywords: electronic infusion pump, infusion therapy, intravenous, medication errors, subcutaneous injection, vascular access