Advantages and disadvantages of evidence-based intravenous medication administration in hospitals

Evidence-Based Medicine

Discuss advantages, disadvantages feasibility clinical practice evidence-based focusing errors administration intravenous medications hospitals role correct procedures and nurse experience.

Advantages, disadvantages and feasibility of evidence-based medicine in clinical practice: Errors in the administration of intravenous medications in hospitals

In 2000, the Institute of Medicine released a report with the shocking statistic that "up to 98,000 patients die in hospitals every year due to medical errors," a statistic supported by another study by the Chicago Tribune which "found that poorly trained or overworked nurses were responsible for the deaths of 1,700 patients and injuries up to 9,548 since 1995" (Your health: Medical errors linked to nurses, 2000, CNN). IV errors are one of the most frequent sources of unnecessary patient harm: "IV medications are associated with 54% of potential adverse drug events (ADEs) (Kaushal, et al. 2001), 56% of medication errors (Ross, et al., 2000), and 61% of the [most] serious and life-threatening errors" (Vanderveen 2005).

Under-staffing and over-working were cited as the primary causes of the errors in the Institute of Medicine Study. However, chronic nursing shortages have proved difficult to rectify. One proposed solution to reducing errors was that of evidence-based medicine. "Evidence-based medical practice has 5 components: defining a clinically relevant question, searching for the best evidence, appraising the quality of the evidence, applying the evidence to clinical practice, and evaluating the process" (Steves & Hootman 2004). It is research-based and scientific in nature, and prescribes treatment based upon evidence-based, scientifically justifiable best practices. It aims to integrate research with clinical experience in a seamless fashion.

One of the great strengths of evidence-based medicine is that it requires practitioners to remain constantly abreast of new developments. Medicine is always changing. "The research literature is constantly changing. What the evidence points to as the best method of practice today may change next year" (Steves & Hootman 2004). Evidence-based medicine requires clinicians to constantly be 'on their toes,' although this is sometimes leveled as a critique of evidence-based medicine as unrealistic in the modern healthcare environment.

Evidence-based medicine has been praised because it encourages thoroughness: it is "useful as a check-sheet that makes sure that nothing vital has been overlooked" and facilitates prioritization (Lowey 2012). It encourages healthcare systems to use research to give attention to specific areas which have the highest rates of fatalities and to determine which solutions can be useful. For example, in many instances technology has been used to reduce IV errors. "To meet the need for improved IV medication safety at the point of care, 'smart technology' was developed to standardize IV infusion administration, reduce IV programming errors, and streamline processes for IV administration" (Vanderveen 2005). "A point-of-care unit contains the computer 'brain' that programs the infusions and contains the safety software... The software performs a final 'test of reasonableness.' If programmed parameters are outside of pre-established limits, the software provides an alert that must be addressed before infusion can begin" (Vanderveen 2005). Concerns about the value of the machine can be addressed through tracking patient outcomes and documenting averted errors that can be traced solely to the implementation of new technology.