Accuracy of documented administration times for intravenous antimicrobial drugs and impact on dosing decisions

Stephanie A Roydhouse; Jane E Carland; Deborah S Debono; Melissa T Baysari; Stephanie E Reuter; Alice J Staciwa; Anmol P K Sandhu; Richard O Day; Sophie L Stocker

doi:10.1111/bcp.14844

Accuracy of documented administration times for intravenous antimicrobial drugs and impact on dosing decisions

Br J Clin Pharmacol. 2021 Nov;87(11):4273-4282. doi: 10.1111/bcp.14844. Epub 2021 Apr 15.

Authors

Stephanie A Roydhouse^{1

2}, Jane E Carland^{1

2}, Deborah S Debono³, Melissa T Baysari⁴, Stephanie E Reuter⁵, Alice J Staciwa⁶, Anmol P K Sandhu⁶, Richard O Day^{1

2}, Sophie L Stocker^{1

2

7}

Affiliations

¹ Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital Sydney, Sydney, Australia.
² St Vincent's Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, Australia.
³ Centre for Health Services Management, School of Public Health, The University of Technology Sydney, Sydney, Australia.
⁴ Sydney School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
⁵ UniSA Clinical and Health Sciences, University of South Australia, Adelaide, Australia.
⁶ Pharmacy Department, St Vincent's Hospital Sydney, Sydney, Australia.
⁷ Sydney Pharmacy School, The University of Sydney, Sydney, Australia.

PMID: 33792079
DOI: 10.1111/bcp.14844

Abstract

Aims: Accurate documentation of medication administration time is imperative for many therapeutic decisions, including dosing of intravenous antimicrobials. The objectives were to determine (1) the discrepancy between actual and documented administration times for antimicrobial infusions and (2) whether day of the week, time of day, nurse-to-patient ratio and drug impacted accuracy of documented administration times.

Methods: Patient and dosing data were collected (June-August 2019) for 55 in-patients receiving antimicrobial infusions. "Documented" and "actual" administration times (n = 660) extracted from electronic medication management systems and smart infusion pumps, respectively, were compared. Influence of the day (weekday/weekend), time of day (day/evening/night), nurse-to-patient ratio (high 1:1/low 1:5) and drug were examined. Monte Carlo simulation was used to predict the impact on dose adjustments for vancomycin using the observed administration time discrepancies compared to the actual administration time.

Results: The median discrepancy between actual and documented administration times was 16 min (range, 2-293 min), with discrepancies greater than 60 minutes in 7.7% of administrations. Overall, discrepancies (median [range]) were similar on weekends (17 [2-293] min) and weekdays (16 [2-188] min), and for high (16 [2-157] min) and low nurse-to-patient ratio wards (16 [2-293] min). Discrepancies were smallest for night administrations (P < .05), and antimicrobials with shorter half-lives (P < .0001). The observed discrepancies in vancomycin administration time resulted in a different dose recommendation in 58% of cases (30% higher, 28% lower).

Conclusions: Overall, there were discrepancies between actual and documented antimicrobial infusion administration times. For vancomycin, these discrepancies in administration time were predicted to result in inappropriate dose recommendations.

Keywords: medication administration error; medication documentation; precision dosing; smart pump; therapeutic drug monitoring.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anti-Bacterial Agents
Documentation
Humans
Infusion Pumps*
Infusions, Intravenous
Pharmaceutical Preparations*
Vancomycin

Substances

Anti-Bacterial Agents
Pharmaceutical Preparations
Vancomycin