Table 3.

Frequency, percentage and potential consequences of secondary infusion errors

Error type	Frequency (n=32)	Percentage	Potential consequences
Bag mis-alignment (eg, positioning the therapeutic drug bag at or below the level of the maintenance fluid bag)	12	37%	Mixing and concurrently delivering the therapeutic and maintenance fluids
Programming errors (eg, conversion calculation errors)	9	28.13%	Delivering the maintenance fluid and/or the therapeutic drug at an incorrect rate
Confusion in the programming sequence (eg, programming the therapeutic drug at the rate of the maintenance fluid)	6	18.75%	Infusing incorrect infusion rates of the therapeutic drug and/or maintenance fluid
Forgetting to open the clamp on the therapeutic tubing	3	9.38%	Accidental administration of the maintenance fluid when intending to initiate the therapeutic drug infusion, and the maintenance fluid being infused at the rate of the therapeutic drug
Tubing arrangement errors (eg, connecting the infusion line from the therapeutic drug bag into the wrong port on the primary infusion line)	2	6.25%	Free-flowing therapeutic drug into the patient