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Reducing Underdosing

Underdosage 

a cause of medication errors

Medical Professional

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In small volume infusions up to 32.2% of active agent remain in IV line3

(last access June 2021)

 

[1] Toh, M. R., Teo, V., Kwan, Y. H., Raaj, S., Tan, S. Y., & Tan, J. Z. (2014). Association between number of doses per day, number of medications and patient’s non-compliance, and frequency of readmissions in a multi-ethnic Asian population. Preventive Medicine Reports, 1, 43-471. This study investigated whether the number of doses per day and the number of medications are significantly associated with the number of readmissions.

[2] Hughes, R. G. (Ed.). (2008). Patient safety and quality: An evidence-based handbook for nurses. Rockville, MD: Agency for Healthcare Research and Quality; U.S. Department of Health and Human Services.

[3] Plagge, H., Golmick, J., Bornand, D., & Deuster, S. (2010). Evaluation of the dead volume in intravenous short-term infusion. EJHP Science, 16, 31-37.

[4] NHS England. (2015). Are you under infusing IV antibiotic infusions? Sign up to Safety Webinar https://www.england.nhs.uk/signuptosafety/wp-content/uploads/sites/16/2015/11/su2s-infusing-iv-antibiotics-webinar.pdf

[5]. Cousins, D. (2018). Patients are being underdosed: we need new guidance on small-volume drug infusions. Clinical Pharmacist, 10(12), 356-357.

[6] J.K. Aronson, Medication errors: what they are, how they happen, and how to avoid them, QJM: An International Journal of Medicine, Volume 102, Issue 8, August 2009, Pages 513–521, https://doi.org/10.1093/qjmed/hcp052

[7] Cooper, D.M., Rassam, T., & Mellor, A. (2018). Non-flushing of IV administration sets: an under-recognised under-dosing risk. British Journal of Nursing, 27(14)

[8] Gregerson, B.G., Harrison, S.K., Garrett, J.S., Kohman, K.N., & Kline, J.A. (2018). Comparison of outcomes in patients with intracranial hemorrhage on factor Xa inhibitors versus vitamin K antagonists treated with 4-factor prothrombin complex concentrate. Proceedings (Baylor University Medical Center), 31(2), 153-156.

[9] Chan, Y. K., Chan, A. H., & Wong, A. K. (2013). A novel approach for the detection of atrial fibrillation in single lead ECG using statistical features and random forest. CMBES Proceedings, 36(1), 1–4. 1.

[10] Cousins, D. (2018). Patients are being underdosed: we need new guidance on small-volume drug infusions. Clinical Pharmacist, 10(12), 356–357.

[11] Hidden Medication Loss When Using a Primary Administration Set for Small-Volume Intermittent Infusions.” Institute For Safe Medication Practices. December 3, 2020 https://www.ismp.org/resources/hidden-medication-loss-when-using-primary-administration-set-small-volume-intermittent

[12] MacLachlan L et al, Antimicrobial Stewardship – Ensuring full prescribed Dose Delivery of IV Antibiotics in OPAT, Hull University Teaching Hospitals, NHS Trust

[13] Fish, D., & Ohlinger, M. (2006). Antibiotic resistance among bacteria: One of the world’s most serious health problems. In “Molecular characterization of multidrug-resistant avian pathogenic Escherichia coli isolated from poultry and poultry products” by Deshmukh, O., Suryawanshi, R., Kurkure, N., Kaore, M., Badar, S., Shinde, O., Awandkar, S., & Gaikwad, N. Indian Journal of Animal Sciences, 93(5), 431–436

[14] Centers for Disease Control and Prevention. (2019). Antibiotic Resistance Threats in the United States, 2019 retrived from CDC 2015, https://www.cdc.gov/drugresistance/biggest-threats.html

[15] Gurney, H. (2002). How to calculate the dose of chemotherapy. British Journal of Cancer, 86(8), 1297-1302.

[16] Bowman, S., Raghavan, K., & Walker, I.A. (2013). Residual anaesthesia drugs in intravenous lines—a silent threat? Anaesthesia, 68(6), 557-561.

[17] Cooper, D.M., Rassam, T., & Mellor, A. (2018). Non-flushing of IV administration sets: an under-recognised under-dosing risk. British Journal of Nursing, 27(14).

[18] Institute For Safe Medication Practices. (2021). Additional Strategies to Improve Complete Delivery of Small-Volume Intermittent Infusions. Retrieved from https://www.ismp.org/resources/additional-strategies-improve-complete-delivery-small-volume-intermittent-infusions

[19] Peyko, V., An unrecognized Problem in Optimizing Antimicrobial Therapy: Significant Residual Volume Remaining in Intravenous Tubing With Extended-Infusion Piperacillin-Tazobactam, 2021 Journal of Pharmacy Practice Vol. 0.0 1-4.

[20] National Infusion and Vascular Access Society (NIVAS). (2019). Intravenous Infusion Drug Administration: Flushing Guidance. Retrieved from NIVAS-Flushing-gudiance-2019-final.pdf