Comparison of Healthcare Professionals’ Knowledge and Compliance with Intravenous Drug Dilution in ICU Settings in Indonesian and Malaysian Hospitals
Healthcare Professionals’ Knowledge and Compliance with Intravenous Drug Dilution
DOI:
https://doi.org/10.22146/ijp.19140Keywords:
standardized concentration, drug dilution knowledge, ICU, Indonesia, MalaysiaAbstract
Background. The occurrence of medication errors (MEs) associated with intravenous (IV) drugs can be reduced by diluting these drugs according to their recommended standardized concentrations, which minimizes variability in their concentrations.
Aim. The study aimed to assess healthcare professionals’ (HCPs) knowledge of IV drug dilution and evaluate their practice on whether the drug was diluted according to the standardized concentration.
Method. This cross-sectional study was conducted at a teaching hospital in Malaysia and Indonesia. The research was divided into two parts: a survey and a retrospective study. The survey using a questionnaire was utilized to assess HCP’s knowledge of IV drug dilution. The correlation between knowledge (dependent variable) and education (independent variable) was evaluated. Data for 9 topmost common IV drugs used in ICU were extracted from patient medical records to evaluate the practice of IV dilution in the retrospective study. The dilution practices were then compared with the three standardized concentration guidelines: American Society of Health-System Pharmacists (ASHP), Intensive Care Society (ICS), and hospital guidelines.
Result. A total of 32 nurses from Malaysia and 20 nurses from Indonesia were participated in the survey. The results showed that the average correct answers to all questions about knowledge of IV dilution among Malaysian and Indonesian HCPs were 75% and 84%, respectively. There was a significant relationship between the level of knowledge and the educational background (p= 0.082, CI= 90%). The result of the retrospective study showed that the majority of IV drugs were diluted according to standardized concentrations in both Malaysian and Indonesian hospitals. Among drugs that did not comply with the recommended concentrations included aminophylline, vancomycin, and noradrenaline in Malaysia and nicardipine, isosorbide dinitrate (ISDN), amiodarone, dobutamine, dopamine, insulin, and noradrenaline in Indonesia.
Conclusion. This study indicates that the majority of HCPs had good knowledge about drug dilution, which increases with higher education level. Most IV drugs were also diluted according to the recommended guidelines. Noncompliance issues only occurred due to variations in patient conditions such as dose-response, plasma drug concentrations, patient pathological conditions, and fluid restrictions.
References
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32. Jung B, Couldry R, Wilkinson S, Grauer D. Implementation of standardized dosing units for i.v. medications. Am J Health Syst Pharm [Internet] 2014;71(24):2153–8. Available from: https://doi.org/10.2146/ajhp140046
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39. Arenas-López S, Stanley IM, Tunstell P, Aguado-Lorenzo V, Philip J, Perkins J, et al. Safe implementation of standard concentration infusions in paediatric intensive care. J Pharm Pharmacol [Internet] 2017;69(5):529–36. Available from: https://doi.org/10.1111/jphp.12580
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3. Fahimi F, Ariapanah P, Faizi M, Shafaghi B, Namdar R, Ardakani MT. Errors in preparation and administration of intravenous medications in the intensive care unit of a teaching hospital: An observational study. Aust Crit Care [Internet] 2008;21(2):110–6. Available from: https://doi.org/10.1016/j.aucc.2007.10.004
4. Pharmacy–nursing shared vision for safe medication use in hospitals: Executive summary session. Am J Health Syst Pharm [Internet] 2003 [cited 2024 Aug 29];60(10):1046–52. Available from: https://academic.oup.com/ajhp/article/60/10/1046/5142990
5. McDowell SE, Mt-Isa S, Ashby D, Ferner RE. Where errors occur in the preparation and administration of intravenous medicines: a systematic review and Bayesian analysis. Qual Saf Health Care [Internet] 2010;19(4):341–5. Available from: https://doi.org/10.1136/qshc.2008.029785
6. Association for the Advancement of Medical Instrumentation. Infusing patients safely: priority issues from the AAMI/FDA infusion device summit. AAMIFDA Infus Device Summit Proc 2010;5–6.
7. Jessurun JG, Hunfeld NGM, Van Rosmalen J, Van Dijk M, Van Den Bemt PMLA. Prevalence and determinants of intravenous admixture preparation errors: A prospective observational study in a university hospital. Int J Clin Pharm [Internet] 2022;44(1):44–52. Available from: https://doi.org/10.1007/s11096-021-01310-6
8. Kane-Gill SL, Dasta JF, Buckley MS, Devabhakthuni S, Liu M, Cohen H, et al. Clinical Practice Guideline: Safe Medication Use in the ICU. Crit Care Med [Internet] 2017;45(9):e877–915. Available from: https://doi.org/10.1097/ccm.0000000000002533
9. American Society of Health-System Pharmacists. Standarize 4 Safety : IV Adult Continuous Infusion Guidelines [Internet]. 2016 [cited 2023 Sep 15];Available from: https://www.ashp.org/-/media/assets/pharmacy-practice/s4s/docs/s4s-iv-adult-continuous-infusion-guiding-principles.ashx
10. American Society of Health-System Pharmacists. Standarize 4 Safety : Pediatric Continuous Infusion [Internet]. 2019 [cited 2023 Sep 15];Available from: https://www.ashp.org/-/media/assets/pharmacy-practice/s4s/docs/Pediatric-IV-Continuous--Guidance-for-public-comment.ashx?la=en&hash=DA7BEAB25C2D9EA18B5E97BA5F69D604E074B2DB
11. American Society of Health-System Pharmacists. Standarize 4 Safety : Compounded Oral Liquid Standards [Internet]. 2020 [cited 2023 Sep 15];Available from: https://www.ashp.org/-/media/assets/pharmacy-practice/s4s/docs/Compound-Oral-Liquid.ashx
12. American Society of Health-System Pharmacists. Standarize 4 Safety : Patient Controlled Analgesia (PCA) and Epidural Standards [Internet]. 2020 [cited 2023 Sep 15];Available from: https://www.ashp.org/-/media/assets/pharmacy-practice/s4s/docs/ASHP-PCA-and-Epidural-Standards.pdf
13. Bullock J, Jordan D, Gawlinski A, Henneman EA. Standardizing IV Infusion Medication Concentrations to Reduce Variability in Medication Errors. Crit Care Nurs Clin North Am [Internet] 2006;18(4):515–21. Available from: https://doi.org/10.1016/j.ccell.2006.08.008
14. Irwin D, Vaillancourt R, Dalgleish D, Thomas M, Grenier S, Wong E, et al. Standard concentrations of high-alert drug infusions across paediatric acute care. Paediatr Child Health [Internet] 2008;13(5):371–6. Available from: https://doi.org/10.1093/pch/13.5.371
15. Pramesti AC. Evaluation of Knowledge and Compliance of Nurses on The Use Personal Protective Equipment (PPE) in Intensive Care Unit (ICU) RSUD Panembahan Senopati Bantul Yogyakarta. J Medicoeticolegal Dan Manaj Rumah Sakit [Internet] 2017;6(3). Available from: https://doi.org/10.18196/jmmr.6144
16. Kuitunen S, Niittynen I, Airaksinen M, Holmström AR. Systemic Causes of In-Hospital Intravenous Medication Errors: A Systematic Review. J Patient Saf [Internet] 2021;17(8):e1660–8. Available from: https://doi.org/10.1097/pts.0000000000000632 Actions
17. Sagita RW, Pangastuti HS, Alim S. FACTORS AFFECTING NURSES’ COMPLIANCE IN IMPLEMENTING STANDARD PRECAUTIONS IN GOVERNMENT HOSPITAL IN YOGYAKARTA. Indones Contemp Nurs J ICON J [Internet] 2019;3(2):1. Available from: https://doi.org/10.20956/icon.v3i2.4972
18. Sulistyowati AD, Rusminingsih E, Sari DP, Khayat FN, A YW. The Relationship Between Nurses’ Knowledge And Compliance In Performing Fall Risk Reassessment. J Vocat Nurs [Internet] 2022;3(1):65–9. Available from: https://doi.org/10.20473/jovin.v3i1.35112
19. Pierobon N, Batista J, Marcondes L, Parreira Da Silva D. Conocimiento de enfermeras en la administración y regulación de fármacos de alta vigilancia en oncología. Enferm Glob [Internet] 2022;21(3):82–108. Available from: 10.6018/eglobal.511881
20. Nasr Abd El Aziz A, Ahmed S, Abolwafa N. Nurses, Knowledge and Practice Regarding Medication Preparation and Administration Errors Occurrence at Neonatal Intensive Care Units. Minia Sci Nurs J [Internet] 2021;010(1):141–7. Available from: 10.21608/msnj.2021.105044.1011
21. Escrivá Gracia J, Brage Serrano R, Fernández Garrido J. Medication errors and drug knowledge gaps among critical-care nurses: a mixed multi-method study. BMC Health Serv Res [Internet] 2019;19(1):640. Available from: https://doi.org/10.1186/s12913-019-4481-7
22. Alzoubi MM, Al-Mahasneh A, Al-Mugheed K, Al Barmawi M, Alsenany SA, Farghaly Abdelaliem SM. Medication Administration Error Perceptions Among Critical Care Nurses: A Cross-Sectional, Descriptive Study. J Multidiscip Healthc [Internet] 2023;Volume 16:1503–12. Available from: https://doi.org/10.2147/jmdh.s411840
23. Anwar I, Sinala S, Nurisyah N, Adhayanti I, Dewi STR. Review: Medication Error in Prescribing and Dispensing Phases on Outpatient: Review: Medication error dalam fase peresepan dan dispensing pada Pasien Rawat Jalan. J Farm Galen Galen J Pharm E-J [Internet] 2022;8(1):52–64. Available from: https://doi.org/10.22487/j24428744.2022.v8.i1.15800
24. Campino A, Santesteban E, Pascual P, Sordo B, Arranz C, Unceta M, et al. Strategies implementation to reduce medicine preparation error rate in neonatal intensive care units. Eur J Pediatr [Internet] 2016;175(6):755–65. Available from: https://doi.org/10.1007/s00431-015-2679-1
25. Márquez-Hernández VV, Fuentes-Colmenero AL, Cañadas-Núñez F, Di Muzio M, Giannetta N, Gutiérrez-Puertas L. Factors related to medication errors in the preparation and administration of intravenous medication in the hospital environment. PLOS ONE [Internet] 2019;14(7):e0220001. Available from: https://doi.org/10.1371/journal.pone.0220001
26. Kolankiewicz ACB, Schmidt CR, Carvalho REFLD, Spies J, Dal Pai S, Lorenzini E. Patient safety culture from the perspective of all the workers of a general hospital. Rev Gaúcha Enferm [Internet] 2020;41:e20190177. Available from: https://doi.org/10.1590/1983-1447.2020.20190177
27. Alanazi WMR, Alanazi BAQ, Alanazi AI, Alanazi HHF, Alenezi NAK, Alruwaili DAM, et al. The Impact of Nurse Education on Patient Safety and Quality Control. Saudi J Nurs Health Care [Internet] 2023;6(12):501–5. Available from: 10.36348/sjnhc.2023.v06i12.006
28. Titiesari YD, Barton G, Borthwick M, Keeling S, Keeling P. Infusion medication concentrations in UK’s critical care areas: Are the Intensive Care Society’s recommendations being used? J Intensive Care Soc [Internet] 2017;18(1):30–5. Available from: 10.1177/1751143716662664
29. Oskarsdottir T, Harris D, Sutherland A, Wignell A, Christiansen N. A national scoping survey of standard infusions in paediatric and neonatal intensive care units in the United Kingdom. J Pharm Pharmacol [Internet] 2018;70(10):1324–31. Available from: 10.1111/jphp.12992
30. Cree ML, Stocker CF, Tu QM, Scaini LF. Adherence to standard medication infusion concentrations and its impact on paediatric intensive care patient outcomes. Aust Crit Care [Internet] 2018;31(4):213–7. Available from: 10.1016/j.aucc.2017.07.003
31. De Basagoiti A, Antón X, Calleja A, De Miguel M, Guerra E, Loureiro B, et al. Analysis of standard concentrations of continuous infusions in nine Spanish neonatal intensive care units. Eur J Hosp Pharm [Internet] 2022;29(1):50–4. Available from: https://doi.org/10.1136/ejhpharm-2019-002194
32. Jung B, Couldry R, Wilkinson S, Grauer D. Implementation of standardized dosing units for i.v. medications. Am J Health Syst Pharm [Internet] 2014;71(24):2153–8. Available from: https://doi.org/10.2146/ajhp140046
33. Lucas AT, Rowe E, Eckel SF. Determining the Need for Standardized Infusions and Concentrations at Hospitals within North Carolina. Hosp Pharm [Internet] 2016;51(3):237–45. Available from: https://doi.org/10.1310/hpj5103-237
34. Rodziewicz TL, Houseman B, Vaqar S, Hipskind JE. Medical Error Reduction and Prevention [Internet]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Sep 9]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK499956/
35. Anugrahini C, Hariyati RrTS. Nurses’ Compliance about Patient Safety in Improving Drug Safety as an Effort to Reduce Medication Error: A Literature Review. Indones J Glob Health Res [Internet] 2019;2(4). Available from: 10.37287/ijghr.v2i4.305
36. Bello CB. Adherence to medication administration guidelines among nurses in a health facility in South-West Nigeria. Pan Afr Med J [Internet] 2021;40:56. Available from: 10.11604/pamj.2021.40.56.27562
37. Tariq RA, Vashisht R, Sinha A, Scherbak Y. Medication Dispensing Errors and Prevention [Internet]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Oct 13]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK519065/
38. Alomi YA, Al Nemari MM, Al-Doughan F, Ibrahim YA, Almalki HS, Alaza N, et al. Emergency Medications Order for Adults: Standardized Concentration System in Saudi Arabia. Int J Pharmacol Clin Sci [Internet] 2019;8(4):204–5. Available from: https://doi.org/10.5530/ijpcs.2019.8.44
39. Arenas-López S, Stanley IM, Tunstell P, Aguado-Lorenzo V, Philip J, Perkins J, et al. Safe implementation of standard concentration infusions in paediatric intensive care. J Pharm Pharmacol [Internet] 2017;69(5):529–36. Available from: https://doi.org/10.1111/jphp.12580
40. Barreto HAG, Sestren B, Boergen-Lacerda R, Soares LCDC. Standard concentration infusions of inotropic and vasoactive drugs in paediatric intensive care: a strategy for patient safety. J Pharm Pharmacol [Internet] 2019;71(5):826–38. Available from: https://doi.org/10.1111/jphp.13065
41. Christie-Taylor SA, Tait PA. Implementation of standard concentration medication infusions for preterm infants. Infant 2012;8(5):155–9.
42. Eastham JH, Rizos A, Gama JA, Geriak M, Howard JJ, Johnson SJ, et al. Reduction in Variation of Intravenous Drug Administration in Seventeen San Diego Hospitals with Standardized Drug Concentrations and Dosage Units. Hosp Pharm [Internet] 2009;44(2):150–8. Available from: https://doi.org/10.1310/hpj4402-150
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Published
2026-03-30
How to Cite
Hanifah, S., Nazar, N. I. M., Zin, C. S., Nor, M. B. M. N., & Mahendra, A. D. . (2026). Comparison of Healthcare Professionals’ Knowledge and Compliance with Intravenous Drug Dilution in ICU Settings in Indonesian and Malaysian Hospitals: Healthcare Professionals’ Knowledge and Compliance with Intravenous Drug Dilution. Indonesian Journal of Pharmacy. https://doi.org/10.22146/ijp.19140
Issue
Section
Research Article
