Focusing on risk: a simple audit study can have a major impact on clinical practice

Recent developments in medical treatments have resulted in the increased use of infusion devices for the administration of highly potent drugs. Drug administration is one of the highest risk areas of clinical practice and infusion devices are associated with a substantial number of adverse drug events. Locally, there was a perception that adverse drug events involving infusion devices appeared to be increasing, and there was anecdotal evidence to suggest that the available number of devices was inadequate to meet the increasing demand. A two‐part, observational audit, carried out in an acute district general hospital, was used to identify weak areas in the systems associated with the use of infusion devices and to implement actions to rectify the weaknesses and consequently reduce the risk to patients and staff.