(P-212) Determinants of Intravenous Admixture Preparation Errors: A Prospective Observational Study

Background: Intravenous admixture preparation errors (IAPEs) occur frequently and may lead to patient harm. Insight into determinants associated with the occurrence of IAPEs is needed to elicit effective preventive measures.

Objectives: The aim of this study was to identify determinants of IAPEs.

Methods: We performed a prospective observational study in five clinical wards (hematology, internal oncology, neurosurgery, and two pediatric wards) in a university hospital. IAPE data were collected by disguised observation. Univariable and multivariable mixed-effects logistic regression analyses were used to estimate the association between determinants and IAPEs with adjustments for clustering on nurse and patient level.

Results: One or more IAPEs occurred in 367 of 614 admixtures (59.8%). The following variables were significantly associated with an increased probability of IAPEs: multistep preparations (adjusted odds ratio [ORadj] 4.04, 95% confidence interval [CI] 2.24-7.26 versus single-step preparations); interruptions during preparation (ORadj 2.25, CI 1.10-4.59 versus no interruption); preparation during the weekend (ORadj 1.91, CI 1.02-3.59 versus weekdays); and preparation between 10 a.m.-2 p.m. (ORadj 2.21, CI 1.06-4.60 versus 7 a.m.-10 a.m.) and 2 p.m.-6 p.m. (ORadj 3.76, CI 1.75-8.09 versus 7 a.m.-10 a.m.). One pediatric ward was associated with a lower probability of IAPEs (ORadj 0.15, CI 0.02-0.90 versus neurosurgery).

Conclusions: This study identified several determinants associated with IAPEs. The determinants point to factors associated with working conditions and workload as well as the complexity of preparations. Preventive strategies to reduce the occurrence of IAPEs in clinical wards should target the identified determinants.