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With the USPS, though it is much larger and will deliver farther than smaller services, your package will go through multiple people that you do not get to meet and evaluate. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. ABSTRACTPractitioners who work in labor and delivery units may administer an assortment of high-alert medications during the birthing process.
Medical error is clearly the Number One problem in healthcare, contributing to more deaths in the USA than motor vehicle accidents, falls, drowning and plane crashes combined—see Figure 1 below.
Most medical errors are related to system problems, not individual negligence or misconduct, and are preventable (see our other Summary Statistic on the preventability of adverse events).
Zegers M, Bruijne MC de, Wagner C, Hoonhout LHF, Waaijman R, Smits M, Hout FAG, Zwaan L, Christiaans-Dingelhoff I, Timmermans DRM, Groenewegen PP, Wal G van der. Certain couriers use technology that allow you to know who your driver will be at pick up so you can be certain to hand your precious cargo to the right individual. These medications, such as oxytocin (used to induce and augment labor) and magnesium sulfate (used to treat preeclampsia and to delay preterm birth), are often administered intravenously. For the sake of simplicity, I have summarised the study results to one figure—10% (or one in every ten hospital admissions).
Medical errors cause more accidental deaths in the USA than motor vehicle accidents, falls, drowning and plane crashes combined. The Canadian adverse events study: the incidence of adverse events among hospital patients in Canada. The incidence of adverse events in Swedish hospitals: a retrospective medical record review study. Adverse events and potentially preventable deaths in Dutch hospitals: results of a retrospective patient record review study. Also, more times than not small couriers are far more reliable than any other delivery service. There are many horror stories about checks being lost in the mail or mail going to the wrong house. Also courier services are very good at keeping you informed of where your package is and when it will arrive. As long as you make sure that the courier is with the company and they can answer the basic questions about what their company does, then your package will be perfectly safe in their hands. Medications used to manage pain, such as morphine and HYDROmorphone, may also be administered intravenously, while others, such as bupivacaine and fentanyl, may be administered via the epidural route. Though the post office has the tracking function as well, it is more likely to take at least one business day for it to activate and show you where your package is. Yes, your post man can deliver it to its destination, but they have a set route that they need to follow every day. When high-alert medications are used in error in labor and delivery units, the event can affect both the mother and the fetus.
The USPS is only open certain hours and forget about if you miss the 5 o’clock mail pick up; you have to wait a whole day before being able to have your package sent. Using a larger company where your package passes between multiple individuals allows more risks of human error.
With a local courier you can be sure that they will schedule their deliveries to suit everyone’s needs.
Between June 2004 and April 2009, Pennsylvania healthcare facilities submitted 2,611 event reports involving medication errors in labor and delivery units.
There is also no guarantee that a large delivery service such as UPS or FedEx will be able to pick it up in time. 32 of 2004 on Local Government 1982 Guideline for central government, local government and society in health development activity Decree of Minister of Health of The Republic of Indonesia.
Strategies to prevent medication errors and patient harm in this specialty setting include standardizing the dosing and administration protocols as well as standardizing the concentrations and dosing units of drug infusions and adopting a policy that all infusions be administered with an infusion pump. Practitioners who work in labor and delivery units may administer a variety of medications during the birthing process.


These medications, such as oxytocin (used to induce and augment labor) and magnesium sulfate (used to treat preeclampsia and delay preterm birth), are frequently administered intravenously. Medications to manage pain, including morphine and HYDROmorphone, may also be administered intravenously, while others, such as bupivacaine and fentanyl, may be administered via the epidural route. All these medications are high-alert medications and, when used in error, bear a heightened risk of causing significant patient harm. Most of these errors were the result of unfamiliarity with safe dosage ranges and signs of toxicity, inadequate patient monitoring, pump programming errors, and confusion between magnesium sulfate, oxytocin, and intravenous (IV) fluids used for hydration.1,2 Simpson and Knox accumulated a database of 52 cases involving accidental magnesium overdoses. The authors state that these events were not uncommon, were known to have happened in at least two institutions, and appear to have involved similar themes and causative factors.3Risks are associated with epidural injections and infusions as well. One of the most significant risks is associated with erroneous infusion of epidural medications—particularly epidural infusions containing bupivacaine—intravenously. A Look at the NumbersPennsylvania healthcare facilities submitted 2,611 event reports to the Pennsylvania Patient Safety Authority from June 2004 to April 10, 2009, that described medication errors that took place in labor and delivery units in Pennsylvania. Further breakdown by harm score, which is adapted from the National Coordinating Council for Medication Error Reporting and Prevention harm index,4 shows that 68.7% (n = 1,793) of the events reached the patient (harm index = C to I) and 1% (n = 27) of the events were indicated by the facility as resulting in harm to the patient. GBS is a type of bacteria that can cause life-threatening infections in neonates, occurring in approximately 1 in every 3,000 infants born in the United States.5 Infected infants usually contract GBS from their mothers during vaginal birth.
Infants with an early-onset infection suffer from one or more of the following conditions: pneumonia, sepsis, and less commonly, meningitis.
However, GBS can also cause complications in the mother, unrelated to neonatal infection, including uterine infection before or after delivery. Infection before delivery, or chorioamnionitis, causes fever, uterine tenderness, and increased heart rate in the fetus. In addition, 70 events (25%) involved high-alert medications, the majority of which were infusions. The anesthesiologist handed a vial of ephedrine to the RN [registered nurse] and told the nurse to mix it with normal saline and administer 1 mL of the prepared solution to the patient.
The RN did so, but then the patient became nauseated and dizzy and began to hyperventilate.
It was then realized that the RN had been handed a vial of epinephrine instead of ephedrine. The anesthesiologist was uncertain if he picked up that vial in error as opposed to the ephedrine vial, which is kept in the epidural cart.The patient was admitted for induction of labor. The patient delivered without incident.This last case is similar to a nationally known case in which, in 2006, a 16-year-old woman in labor died after an epidural analgesic including bupivacaine and fentanyl was inadvertently infused intravenously instead of penicillin.
A few minutes after the start of the infusion, the woman experienced seizures, a clenched jaw, and gasping respirations. The bupivacaine infusion did not contain fentanyl, and therefore, did not require locked storage. Since the nurse thought she was administering a bag of normal saline, she had no reason to require another nurse to double-check the product before giving it.
The authors of one study noted that errors involving oxytocin administration during labor are predominantly dose-related and often involve a lack of timely recognition and appropriate treatment of excessive uterine activity (tachysystole).12Additional analysis of these reports suggests frequent prescribing errors with misoprostol. The fetal heart rate dropped; the patient was given terbutaline and was taken for a stat cesarean section.
A new nurse on orientation confused the IV lines, connecting the IV fluids to the pump at the rate of infusion for the Pitocin drip and vice versa. The baby was delivered via a stat cesarean section with reasonable Apgar scores.The fetal heart tones were low. The nurse mistakenly opened the magnesium sulfate infusion wide open instead of lactated Ringer’s as ordered. The patient was monitored, and no further intervention was required.Wrong-Rate (IV) Errors in the Labor and Delivery UnitAnother medication error event type that often leads to overdoses is wrong-rate errors. A total of 58 (2.2%) medication error reports associated with the labor and delivery unit submitted to the Authority involved wrong-rate errors associated with IV infusions.
The following are examples of wrong-rate errors reported to the Authority.The RN increased the rate [of the oxytocin infusion] to 725 mu instead of 5 mu.


The infusion was begun, and 20 minutes later it was noted that the rate was 106 units per hour.
Establish dosing and administration protocols and standard order sets for magnesium sulfate, oxytocin, and other high-alert medication infusions.
Avoid the use of dual-channel pumps for simultaneous administration of IV and epidural drugs. In addition, use yellow-lined tubing without injection ports for epidural infusions in order to set its appearance apart from regular IV tubing, and never use it for anything other than epidural administration. Likewise, when drug infusions are discontinued, require the immediate removal of those drug infusions from the patient’s access site, pump, and IV pole to prevent later accidental infusion.11LabelingUse bold fonts to label IV infusion bags of oxytocin, magnesium sulfate, and other high-alert infusions to differentiate them from each other and from IV hydration infusions.
In addition, label infusion pumps with the name of the solution being infused as well as the IV tubing near the IV pump.
When infusions are started or the rate is adjusted, trace the tubing by hand from the IV bag, to the pump, and then to the patient for verification. For epidural medications, clearly label infusion bags and syringes that contain epidural medications as well as epidural infusion pumps with the designation “For Epidural Use Only” in large type.1,2,11StorageReduce the risk of mix-ups by separating the storage of high-alert IV drug infusions, epidural infusions, and regular fluids, such as lactated Ringer’s solution, used for hydration.
In addition, never store look-alike products, such as EPINEPHrine and ePHEDrine, side by side in anesthesia or epidural carts.
This form of differentiating look-alike products should be used on computer screens, pharmacy and nursing unit shelf labels and bins (including automated dispensing cabinets), pharmacy product labels, and medication administration records. Point-of-care bar-code systems can also assist in verification of the drug, strength, and the patient.
When the status of the mother and fetus changes suddenly, include as part of the assessment an immediate check of the infusing solution to ensure that it is the one prescribed.
Signs and symptoms of fetal distress often alert the staff that a medication error is in progress. Establish standard rescue procedures in the event of drug overdoses and toxicity, and ensure that required medications are readily accessible to staff on code carts or with other secured emergency supplies.1,11 NotesInstitute for Safe Medication Practices.
Perinatal Group B Streptococcal disease after universal screening recommendations—United States, 2003-2005. GBS is a type of bacteria that can cause life-threatening infections in newborns including pneumonia, sepsis, and meningitis. Among this error type, reports submitted indicated frequent dispensing errors with misoprostol. Analysis of Authority reports involving wrong dose errors associated with an overdose of a medication accounted for less than 10% of all labor and delivery errors.
Require an independent double check of the drug, concentration, infusion rate, pump settings, line attachments, and patient before administering high-alert medications. Use bold fonts to label IV infusion bags of oxytocin, magnesium sulfate, and other high-alert infusions to differentiate them from each other. Establish standardized concentrations and dosing regimens for oxytocin, magnesium sulfate, and other high-alert medication infusions)A patient admitted for induction of labor was ordered lactated Ringer’s solution. The patient was placed on her left side and given terbutaline with a return of fetal heart rate to the baseline. Select which of the following strategies would not help prevent this event from reoccurring. Label infusion pumps with the name of the solution being infused as well as the IV tubing near the IV pump. Separate the storage of the lactated Ringer’s solution from other high-alert IV drug infusions. Frequently monitor patients’ vital signs, oxygen saturation, and level of consciousness, as well as fetal heart tones, maternal uterine activity, and other necessary patient parameters. Use individualized concentrations of IV high-alert infusions like Pitocin, magnesium sulfate, and morphine sulfate solutions.



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