The BMJ features a study of a new patented multimodal system (SAFERSleep) designed to reduce errors in the recording and administration of drugs in anaesthesia.
The prospective randomised open label clinical trial conducted at 5 designated operating theatres in a major tertiary referral hospital in Auckland involved 89 consenting anaesthetists managing 1075 cases in which there were 10,764 drug administrations. The SAFERSleep system was compared with conventional practice in drug administration with a manually compiled anaesthetic record.
The SAFERSleep system consists of:
• Customised drug trays and purpose designed drug trolley drawers to promote a well organised anaesthetic workspace and aseptic technique
• Pre-filled syringes for commonly used anaesthetic drugs all prepared in the pharmacy or by the manufacturer
• Large legible colour coded drug labels
• Barcode reader linked to a computer
• Speakers, and touch screen to provide automatic auditory and visual verification of selected drugs immediately before each administration
• Automatic compilation of an anaesthetic record
• An on-screen and audible warning if an antibiotic has not been administered within 15 minutes of the start of anaesthesia
• Certain procedural rules—notably, scanning the label before each drug administration
The primary outcome measure was a composite of errors in the recording and administration of IV drugs detected by direct observation and by detailed reconciliation of the contents of used drug vials against recorded administrations; and lapses in responding to an intermittent visual stimulus (vigilance latency task).
The following findings were reported:
• The overall mean rate of drug errors per 100 administrations was 9.1 (95% CI, 6.9 to 11.4) with the new system (1 in 11 administrations) and 11.6 (9.3 to 13.9) with conventional methods (1 in 9 administrations) [p=0.045 for difference].
• Most of the errors were recording errors, and, though fewer drug administration errors occurred with the new system, this was not statistically significantly different compared to methods.
• Rates of errors in drug administration were lower when anaesthetists consistently applied two key principles of the new system (scanning drug barcode before administering each drug and keeping the voice prompt active) than when they did not: mean 6.0 (3.1 to 8.8) errors per 100 administrations vs. 9.7 (8.4 to 11.1) respectively (p=0.004).
• Lapses in the vigilance latency task occurred in 12% (58/471) of cases with the new system and 9% (40/473) with conventional methods (p=0.052).
• The records generated by the new system were more legible, and anaesthetists preferred the new system, particularly in relation to long, complex, and emergency cases.
• There were no differences between new and conventional systems in respect of outcomes in patients or anaesthetists’ workload.
The researchers conclude that this approach “reduces a composite end point of errors in the recording and administration of drugs, increases the legibility and reduces the time spent creating anaesthetic records, and increases time spent observing patients during anaesthesia. Conversely, it decreases time spent watching monitors and increases lapses in a vigilance latency task.” They note that compliance with the systems’ principles evaluated in this study was inversely related to error rates, but achieving high levels of compliance was difficult.
According to an accompanying editorial, these findings are consistent with previous studies showing that bar code scanning technology greatly reduces drug administration errors, which account for 38% of all drug errors occurring in hospitals.