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Updated: Aug 13, 2026
A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
Published on: November 9, 2016
An overview of intravenous-related medication administration errors as reported to MEDMARX, a national medication
Rodney W Hicks1, Shawn C Becker
1United States Pharmacopeia, Center for the Advancement of Patient Safety, Rockville, MD 20852-1790, USA. RH@usp.org
Abstract:
Medication errors can be harmful, especially if they involve the intravenous (IV) route of administration. A mixed-methodology study using a 5-year review of 73,769 IV-related medication errors from a national medication error reporting program indicates that between 3% and 5% of these errors were harmful. The leading type of error was omission, and the leading cause of error involved clinician performance deficit. Using content analysis, three themes-product shortage, calculation errors, and tubing interconnectivity-emerge and appear to predispose patients to harm. Nurses often participate in IV therapy, and these findings have implications for practice and patient safety. Voluntary medication error-reporting programs afford an opportunity to improve patient care and to further understanding about the nature of IV-related medication errors.
Insights
Medication errors involving intravenous (IV) administration can harm patients. Omission errors and clinician performance deficits were leading issues, with product shortages and calculation errors also contributing to harm.
Area of Science:
- Patient Safety
- Medication Error Analysis
- Healthcare Quality Improvement
Background:
- Medication errors, particularly with intravenous (IV) administration, pose significant risks to patient well-being.
- Understanding the patterns and causes of these errors is crucial for developing effective safety interventions.
Purpose of the Study:
- To analyze a large dataset of IV-related medication errors to identify common types, causes, and contributing factors.
- To provide insights into specific themes that predispose patients to harm from IV medication errors.
Main Methods:
- A mixed-methodology approach was employed, combining a 5-year review of 73,769 IV-related medication errors from a national reporting program.
- Content analysis was used to identify recurring themes associated with harmful errors.
Main Results:
- 3% to 5% of reviewed IV medication errors resulted in patient harm.
- Omission errors were the most frequent type, with clinician performance deficits identified as the primary cause.
- Product shortages, calculation errors, and tubing interconnectivity emerged as significant themes predisposing patients to harm.
Conclusions:
- Findings highlight the critical need for enhanced safety protocols in IV therapy, particularly addressing clinician performance and system-level issues like product availability and medication calculation.
- Voluntary reporting programs are vital for ongoing surveillance and improvement of patient care related to IV medication administration.
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