Abstract
Background Intravenous fluid therapy remains an essential part of patients’ care during hospitalization. There are only few studies that focused on fluid therapy in the hospitalized patients, and there is not any consensus statement about fluid therapy in patients who are hospitalized in medical wards. Objective The aim of the present study was to assess intravenous fluid therapy status and related errors in the patients during the course of hospitalization in the infectious diseases wards of a referral teaching hospital. Setting This study was conducted in the infectious diseases wards of Imam Khomeini Complex Hospital, Tehran, Iran. Methods During a retrospective study, data related to intravenous fluid therapy were collected by two clinical pharmacists of infectious diseases from 2008 to 2010. Intravenous fluid therapy information including indication, type, volume and rate of fluid administration was recorded for each patient. An internal protocol for intravenous fluid therapy was designed based on literature review and available recommendations. The data related to patients’ fluid therapy were compared with this protocol. The fluid therapy was considered appropriate if it was compatible with the protocol regarding indication of intravenous fluid therapy, type, electrolyte content and rate of fluid administration. Main outcome measure: Any mistake in the selection of fluid type, content, volume and rate of administration was considered as intravenous fluid therapy errors. Results Five hundred and ninety-six of medication errors were detected during the study period in the patients. Overall rate of fluid therapy errors was 1.3 numbers per patient during hospitalization. Errors in the rate of fluid administration (29.8%), incorrect fluid volume calculation (26.5%) and incorrect type of fluid selection (24.6%) were the most common types of errors. The patients’ male sex, old age, baseline renal diseases, diabetes co-morbidity, and hospitalization due to endocarditis, HIV infection and sepsis are predisposing factors for the occurrence of fluid therapy errors in the patients. Conclusion Our result showed that intravenous fluid therapy errors occurred commonly in the hospitalized patients especially in the medical wards. Improvement in knowledge and attention of health-care workers about these errors are essential for preventing of medication errors in aspect of fluid therapy.
Similar content being viewed by others
References
Latta T. Affording a view of the rationale and results of his practice in the treatment of cholera by aqueous and saline injections. Lancet. 1831;32:274–7.
Woo A, Sutton H, Stephens R. An introduction to fluid therapy. Br J Hosp Med. 2007;2(68):M62–4.
Lobo DN, Allison SP. Fluid, electrolyte and nutrient replacement. In: Burnand KG, Young AE, Lucas J, Rowlands BJ, Scholefield J, editors. The New Aird’s companion in surgical studies. 3rd ed. London: Churchill LIVingstone; 2005. pp. 20–41. ISBN: 978-0-443-07211-6.
Steele A, Gowrishankar M, Abrahamson S, Mazer CD, Feldman RD, Halperin ML. Postoperative hyponatremia despite near-isotonic saline infusion: a phenomenon of desalination. Ann Intern Med. 1997;126:20–5.
Brady M, Kinn S, Stuart P. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev. 2003; 4:CD004423. doi:10.1002/14651858.CD004423.
Johnston RV, Boiteau P, Charlebois K, Long S. U D. Responding to tragic error: lessons from Foothills Medical Centre. CMAJ. 2004;170:1659–60.
Oster JR, Singer I. Hyponatremia, hypo-osmolality, and hypotonicity: tables and fables. Arch Intern Med. 1999;159:333–6.
Ayus JC, Wheeler JM, Arieff AI. Postoperative hyponatremic encephalopathy in menstruant women. Ann Intern Med. 1992;117:891–7.
Faber MD, Kupin WL, Heilig CW, Narins RG. Common fluid-electrolyte and acid-base problems in the intensive care unit: selected issues. Semin Nephrol. 1994;14:822.
Classen DC, Pestotnik SL, Evans RS, Lloyd JF, Burke JP. Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. JAMA. 1997;277:301–6.
Rose BD. Maintenance and replacement fluid therapy in adults. In: Rose BD, Post TW, editors. Clinical physiology of acid-base and electrolyte disorders. 5th ed. New York: McGraw-Hill; 2001. pp. 285–7. ISBN: 978-0071346825.
Shafiee MA, Bohn D, Hoorn EJ, Halperin ML. How to select optimal maintenance intravenous fluid therapy. QJM. 2003;96:601.
Sterns RH, Silver SM. Salt and water: read the package insert. QMJ. 2003;96:549.
Rose BD. Regulation of the effective circulating volume. In: Rose BD, Post TW, editors. Clinical physiology of acid-base and electrolyte disorders. 5th ed. New York: McGraw-Hill; 2001. pp. 17, 107. ISBN: 978-0071346825.
Han PY, Coombes ID, Green B. Factors predictive of intravenous fluid administration errors in Australian surgical care wards. Qual Saf Health Care. 2005;14:179–84.
Taxis K, Barber N. Ethnographic study of incidence and severity of intravenous drug errors. BMJ. 2003;326:684.
National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). What is a medication error? 1998-2001. Retrieved October 29, 2008, from http://www.nccmerp.org/aboutMedErrors.html.
Moghissi ES, Korytkowski MT, DiNardo M, Einhorn D, Hellman R, Hirsch IB, Inzucchi SE, Ismail-Beigi F, Kirkman MS, Umpierrez GE. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care. 2009;32:1119–31.
Rooker JC, Gorard DA. Errors of intravenous fluid infusion rates in medical inpatients. Clin Med. 2007;7:482–5.
Gladstone J. Drug administration errors: a study into the factors underlying the occurrence and reporting of drug errors in a district general hospital. J Adv Nurs. 1995;22:628–37.
Bruce J, Wong I. Parenteral drug administration errors by nursing staff on an acute medical admissions ward during day duty. Drug Saf. 2001;24:855–62.
Hartley GM, Dhillon S. An observational study of the prescribing and administration of intravenous drugs in a general hospital. Int J Pharm Pract. 1998;6:38–45.
Leier CV, Dei Cas L, Metra M. Clinical relevance and management of the major electrolyte abnormalities in congestive heart failure: hyponatremia, hypokalemia, and hypomagnesemia. Am Heart J. 1994;128:56474.
Moritz ML, Ayus JC. Hospital-acquired hyponatremia–why are hypotonic parenteral fluids still being used? Nat Clin Pract Nephrol. 2007;3:374–82.
Bagshaw SM, Townsend DR, McDermid RC. Disorders of sodium and water balance in hospitalized patients. Can J Anaesth. 2009;56:151–67.
Arieff AI. Hyponatremia, convulsions, respiratory arrest, and permanent brain damage after elective surgery in healthy women. N Engl J Med. 1986;314:1529–35.
Belba MK, Petrela EY, Belba GP. Comparison of hypertonic vs isotonic fluids during resuscitation of severely burned patients. Am J Emerg Med. 2009;27:1091–6.
Acknowledgments
We appreciate the nursing staff of Infectious Diseases Wards of Imam Khomeini Hospital Complex for their kind supports.
Funding
The authors have not received any financial support for this work.
Conflicts of interest
There is no conflict of interest to declare.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mousavi, M., Khalili, H. & Dashti-Khavidaki, S. Errors in fluid therapy in medical wards. Int J Clin Pharm 34, 374–381 (2012). https://doi.org/10.1007/s11096-012-9620-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11096-012-9620-8