Evaluation of an intravenous preparation information system for improving the reconstitution and dilution process

Abstract

Background: There are very few studies reporting the impact of providing intravenous (IV) preparation information on quality use of antimicrobials, particularly regarding their reconstitution and dilution. Therefore, to improve these processes in IV antimicrobial administration, an IV preparation information system (IPIS) was implemented in a hospital. Objective: We aimed to evaluate the effect of improving reconstitution and dilution by implementing an IPIS in the electronic medical record (EMR) system. Methods: Prescriptions and activity records of nurses for injectable antimicrobials requiring reconstitution and dilution for IV preparation from January 2008 to December 2013 were retrieved from EMR, and assessed the accuracy of reconstitution or dilution solutions based on the instructions provided by the package insert. We defined proper reconstitution and dilution as occurring when the reconstitution and dilution solutions prescribed were consistent with the nurses' acting records. The types of intervention in the IPIS were as follows: a pop-up alert for proper reconstitution and passive guidance for proper dilution. We calculated the monthly proper reconstitution rate (PRR) and proper dilution rate (PDR) and evaluated the changes in these rates and trends using interrupted time series analyses. Results: Prior to the initiation of the reconstitution alert and dilution information, the PRR and PDR were 12.7% and 46.1%, respectively. The reconstitution alert of the IPIS rapidly increased the PRR by 41% (p < 0.001), after which the PRR decreased by 0.9% (p = 0.013) per month after several months. However, there was no significant change in the rate or trend of the PDR during the study period. Conclusions: This study demonstrated that the provision of reconstitution alerts by the IPIS contributed to improving the reconstitution process of IV antimicrobial injection administration. However, the sustainability of the impact was not evident. Furthermore, solutions to ensure the continuous effectiveness of alert systems are warranted and should be actively sought.