TITLE: TASK ANALYSIS OF INTRAVENOUS DRUG AND FLUID ADMINISTRATION IN THE OPERATING ROOM

AUTHORS: Deborah B. Fraind, Victor Tubbesing, BS, Samuel A. Hughes, PhD, Matthew B. Weinger, MD, MS
AFFILIATION: University of California San Diego, San Diego, CA.

INTRODUCTION: Intravenous drug and fluid administration plays a critical role in anesthesia care. Yet the current system of drug administration in the operating room may be inefficient and promote human error (e.g., syringe swaps). Additionally, needle stick injuries are a significant occupational risk to anesthesia providers. Furthermore, manual charting of drugs and fluids is notoriously inaccurate [Devitt et al. Can J Anaesth 46: 122, 1999]. The purpose of this study was to document the time spent during anesthesia on IV drug and fluid administration tasks, and to identify opportunities for improved design of this critical aspect of anesthesia care.
METHODS: A comprehensive list of drug/fluid-related tasks was refined based upon preliminary observations. This task list was incorporated into custom data collection software. With IRB approval, an observer sat in the OR and categorized in real-time the activities of anesthesia providers into 68 discrete task categories. Both initial case preparation (e.g., room set-up) and routine general anesthesia cases were studied. Case data were segregated into induction, maintenance, and emergence. Data were analyzed for percent of the total time spent on individual drug/fluid-related tasks as well as the relationship between sequential tasks. User errors and inefficiencies, as well as unsuccessful actions, were specifically noted.
RESULTS: Drug/fluid tasks, such as obtaining and filling syringes, consumed 39±9% (mean±SEM) of the initial set-up time at the beginning of an anesthesiologist's typical work day. During 10 cases, drug/fluid tasks comprised 19±4% of induction time, 10±1% of maintenance time, and 10±3% of emergence (n=6) time. During more complex cardiac anesthetics (n=2 thus far), drug/fluid tasks may comprise 30% of all clinical activities. Unsuccessful actions included repeated opening and closing of anesthesia cart drawers in attempts to find and retrieve items, and missing the receptacle when disposing of trash. Inefficient tasks included the acquisition and placement of drug labels on syringes, and the untangling of multiple IV lines.
DISCUSSION: Drug/fluid-related anesthesia tasks account for a significant amount of the total time spent during anesthesia, especially in more complex cases. Yet many drug/fluid tasks are inefficient, may not directly contribute to patient well being, and may promote error. There appears to be substantial opportunity to improve quality of care by making intravenous drug and fluid administration tasks in the operating room more efficient.

Table: Common drug/fluid-related tasks during routine cases