Preparation/administration of push-dose versus continuous infusion epinephrine and phenylephrine: A simulation

Area of Science:

• Pharmacology
• Critical Care Medicine
• Patient Safety

Background:

• Hypotension is a frequent and serious complication in emergency departments (ED) and intensive care units (ICU).
• Epinephrine and phenylephrine are commonly used to manage hypotension, typically via continuous infusion (CI).
• Push-dose (PD) administration offers an alternative but lacks comparative data on preparation/administration efficiency and error rates.

Purpose of the Study:

• To compare the preparation and administration times of push-dose (PD) versus continuous infusion (CI) epinephrine and phenylephrine.
• To evaluate the incidence of preparation and administration errors associated with PD and CI methods.
• To assess these parameters when medications are prepared by ED/ICU pharmacists.

Main Methods:

• A crossover simulation study involving 16 ED/ICU pharmacists.
• Utilized a multi-venous intravenous training arm kit for realistic simulation.
• Measured primary outcome: total preparation and administration time (seconds).
• Measured secondary outcome: major preparation and administration errors (≥5-fold overdose).

Main Results:

• PD demonstrated significantly faster total preparation and administration times (approx. 70s reduction vs. CI).
• PD resulted in a higher rate of major preparation and administration errors (18.8% of PD preparations), with dilutional errors being the primary cause.
• Continuous infusion (CI) had no major preparation and administration errors.

Conclusions:

• While PD epinephrine and phenylephrine offer faster administration times for pharmacists, they are associated with an increased risk of significant preparation errors.
• Dilutional errors are a key factor contributing to overdoses in PD medication preparation.
• Further strategies are needed to mitigate error risks associated with PD medication administration in critical care settings.