Multimodal system designed to reduce errors in recording and administration of drugs in anaesthesia: prospective randomised clinical evaluation

摘要: Objective To clinically evaluate a new patented multimodal system (SAFERSleep) designed to reduce errors in the recording and administration of drugs anaesthesia. Design Prospective randomised open label clinical trial. Setting Five designated operating theatres major tertiary referral hospital. Participants Eighty nine consenting anaesthetists managing 1075 cases which there were 10 764 drug administrations. Intervention Use (which includes customised trays purpose trolley drawers promote well organised anaesthetic workspace aseptic technique; pre-filled syringes for commonly used drugs; large legible colour coded labels; barcode reader linked computer, speakers, touch screen provide automatic auditory visual verification selected immediately before each administration; compilation an record; on-screen audible warning if antibiotic has not been administered within 15 minutes start anaesthesia; certain procedural rules—notably, scanning administration) versus conventional practice with manually compiled record. Main outcome measures Primary: composite intravenous detected by direct observation detailed reconciliation contents vials against recorded administrations; lapses responding intermittent stimulus (vigilance latency task). Secondary: outcomes patients; analyses anaesthetists’ tasks assessments workload; evaluation legibility records; compliance rules system; questionnaire based ratings respective systems participants. Results The overall mean rate per 100 administrations was 9.1 (95% confidence interval 6.9 11.4) (one 11 administrations) 11.6 (9.3 13.9) methods (P=0.045 difference). Most errors, and, though fewer occurred system, comparison did reach significance. Rates lower when consistently applied two key principles (scanning administering keeping voice prompt active) than they not: 6.0 (3.1 8.8) v 9.7 (8.4 11.1) respectively (P=0.004). Lapses vigilance task 12% (58/471) 9% (40/473) (P=0.052). records generated more legible, preferred particularly relation long, complex, emergency cases. There no differences between respect patients or workload. Conclusions associated reduction anaesthesia, attributable mainly errors. Automatic record increased but also decreased time spent watching monitors. Trial registration Australian New Zealand Clinical Trials Registry No 12608000068369.