Injections are two-and-a-half times safer when nurses use revamped guidelines

July 06, 2020

The UK's National Health Service (NHS) is changing the way it writes its guidelines for giving injections in hospitals, following groundbreaking research from the University of Bath.

The Bath study, funded by the National Institute for Health Research (NIHR), found that hospital nurses make far fewer mistakes when administering medicines intravenously if they follow instructions written with nurses in mind. Researchers used a process called 'user testing', which identifies where mistakes are being made and introduces changes so the instructions are easier to use.

Current NHS guidelines on intravenous injections are written by pharmacists with little input from their primary audience - nurses. These instructions can be confusing or overly complicated, which contributes to 30-50% of intravenous doses being incorrect in some way.

Injection-related mistakes form a major part of the 237 million medication errors that occur annually in England, and they can arise because nurses struggle to find relevant, unambiguous information in the NHS guidelines, explained Dr Matthew Jones, who led the research from the University's Department of Pharmacy and Pharmacology in collaboration with colleagues from the Universities of Leeds and Strathclyde, and UCL School of Pharmacy.

"When nurses follow modified guidelines that present the same information in a more user-friendly way, nearly two and half times more doses are given without mistakes," he said. "As a bonus, the injection procedure is also completed faster and nurses feel more confident about their decisions."

He added: "Current instructions are usually written by pharmacists using a format and language that makes immediate sense to other pharmacists, but not necessarily to nurses.

"Different professions think about things in different ways as a result of the different training they receive, and we need injection guidelines to be written in a way that is understood by nurses because they prepare and administer most injections."

In developing the Bath study, researchers collaborated with Luto Research, a University of Leeds spin-out company with expertise in user testing. The study involved 273 nurses and midwives who regularly administer injections from four NHS hospitals.

Participants were taken part way through a shift and asked to give an injection to a rubber dummy simulating a patient's arm. Around half of participants were given the current NHS guidelines and the other half the modified guidelines. A researcher watched to identify guideline-related errors.

"The results make it clear that busy, stressed staff need information to be presented in a way that is easy to understand and quick to find," said Dr Jones. "User testing allowed us to identify where the information needed improving and how we could do that."

The study's findings have triggered a review of how injection guidelines are produced for the NHS Injectable Medicines Guide. This website-based guide provides information on the correct procedures for preparing and administering over 350 intravenous medicines in over 120 hospitals. It is accessed approximately 3-million times per year, mostly by hospital nurses.

Dr Jones said: "To improve patient safety, most injectable medicines' guidelines should be user-tested. This is particularly important when high-risk and complex decisions are being made."

According to the World Health Organisation, unsafe medication practices and medication errors are a leading cause of injury and avoidable harm in health care systems across the world. Globally, the cost associated with medication errors is estimated at US$42 billion every year.
The Bath paper, User-testing guidelines to improve the safety of intravenous medicines administration: a randomised in-situ simulation study, is published in the BMJ Quality and Safety.

* Dr Matthew Jones talks about his research here:

University of Bath

Related Medication Errors Articles from Brightsurf:

Therapy plus medication better than medication alone in bipolar disorder
A review of 39 randomized clinical trials by scientists from UCLA and their colleagues from other institutions has found that combining the use medication with psychoeducational therapy is more effective at preventing a recurrence of illness in people with bipolar disorder than medication alone.

A new technique prevents errors in quantum computers
A paper recently published in Nature presents a protocol allowing for the error detection and the protection of quantum processors in case of qubit loss.

Electronic health records fail to detect up to 33% of medication errors
Despite improvements in their performance over the past decade, electronic health records (EHRs) commonly used in hospitals nationwide fail to detect up to one in three potentially harmful drug interactions and other medication errors, according to scientists at University of Utah Health, Harvard University, and Brigham and Women's Hospital in Boston.

Environmental enrichment corrects errors in brain development
Environmental enrichment can partially correct miswired neurons in the visual pathway, according to research in mice recently published in eNeuro.

Are healthcare providers 'second victims' of medical errors?
Four women with family members who died as a result of preventable medical error penned an editorial for The BMJ urging abandonment of the term 'second victims' to describe healthcare providers who commit errors.

Cell editors correct genetic errors
Almost all land plants employ an army of editors who correct errors in their genetic information.

Immunizing quantum computers against errors
Researchers at ETH Zurich have used trapped calcium ions to demonstrate a new method for making quantum computers immune to errors.

New study sheds light on medication administration errors leading to death -- omission is a common cause
Medication administration errors leading to death are common with anticoagulants and antibiotics in particular, according to a new study that analyzed incidents reported in England and Wales.

Coping with errors in the quantum age
Nowadays, quantum systems can be manipulated with extremely high, but not with perfect precision.

Medical errors in the emergency room: Understanding why
Medical errors are estimated to cause 250,000 deaths per year in the US.

Read More: Medication Errors News and Medication Errors Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to