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Harvard educational review.

Edited by Maya Alkateb-Chami, Jane Choi, Jeannette Garcia Coppersmith, Ron Grady, Phoebe A. Grant-Robinson, Pennie M. Gregory, Jennifer Ha, Woohee Kim, Catherine E. Pitcher, Elizabeth Salinas, Caroline Tucker, Kemeyawi Q. Wahpepah

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Journal Information

• ISSN: 0017-8055
• eISSN: 1943-5045
• Keywords: scholarly journal, education research
• First Issue: 1930
• Frequency: Quarterly

Description

The Harvard Educational Review (HER) is a scholarly journal of opinion and research in education. The Editorial Board aims to publish pieces from interdisciplinary and wide-ranging fields that advance our understanding of educational theory, equity, and practice. HER encourages submissions from established and emerging scholars, as well as from practitioners working in the field of education. Since its founding in 1930, HER has been central to elevating pieces and debates that tackle various dimensions of educational justice, with circulation to researchers, policymakers, teachers, and administrators.

Our Editorial Board is composed entirely of doctoral students from the Harvard Graduate School of Education who review all manuscripts considered for publication. For more information on the current Editorial Board, please see here.

A subscription to the Review includes access to the full-text electronic archives at our Subscribers-Only-Website .

Editorial Board

2023-2024 Harvard Educational Review Editorial Board Members

Maya Alkateb-Chami Development and Partnerships Editor, 2023-2024 Editor, 2022-2024 [email protected]

Maya Alkateb-Chami is a PhD student at the Harvard Graduate School of Education. Her research focuses on the role of schooling in fostering just futures—specifically in relation to language of instruction policies in multilingual contexts and with a focus on epistemic injustice. Prior to starting doctoral studies, she was the Managing Director of Columbia University’s Human Rights Institute, where she supported and co-led a team of lawyers working to advance human rights through research, education, and advocacy. Prior to that, she was the Executive Director of Jusoor, a nonprofit organization that helps conflict-affected Syrian youth and children pursue their education in four countries. Alkateb-Chami is a Fulbright Scholar and UNESCO cultural heritage expert. She holds an MEd in Language and Literacy from Harvard University; an MSc in Education from Indiana University, Bloomington; and a BA in Political Science from Damascus University, and her research on arts-based youth empowerment won the annual Master’s Thesis Award of the U.S. Society for Education Through Art.

Jane Choi Editor, 2023-2025

Jane Choi is a second-year PhD student in Sociology with broad interests in culture, education, and inequality. Her research examines intra-racial and interracial boundaries in US educational contexts. She has researched legacy and first-generation students at Ivy League colleges, families served by Head Start and Early Head Start programs, and parents of pre-K and kindergarten-age children in the New York City School District. Previously, Jane worked as a Research Assistant in the Family Well-Being and Children’s Development policy area at MDRC and received a BA in Sociology from Columbia University.

Jeannette Garcia Coppersmith Content Editor, 2023-2024 Editor, 2022-2024 [email protected]

Jeannette Garcia Coppersmith is a fourth-year Education PhD student in the Human Development, Learning and Teaching concentration at the Harvard Graduate School of Education. A former public middle and high school mathematics teacher and department chair, she is interested in understanding the mechanisms that contribute to disparities in secondary mathematics education, particularly how teacher beliefs and biases intersect with the social-psychological processes and pedagogical choices involved in math teaching. Jeannette holds an EdM in Learning and Teaching from the Harvard Graduate School of Education where she studied as an Urban Scholar and a BA in Environmental Sciences from the University of California, Berkeley.

Ron Grady Editor, 2023-2025

Ron Grady is a second-year doctoral student in the Human Development, Learning, and Teaching concentration at the Harvard Graduate School of Education. His central curiosities involve the social worlds and peer cultures of young children, wondering how lived experience is both constructed within and revealed throughout play, the creation of art and narrative, and through interaction with/production of visual artifacts such as photography and film. Ron also works extensively with educators interested in developing and deepening practices rooted in reflection on, inquiry into, and translation of the social, emotional, and aesthetic aspects of their classroom ecosystems. Prior to his doctoral studies, Ron worked as a preschool teacher in New Orleans. He holds a MS in Early Childhood Education from the Erikson Institute and a BA in Psychology with Honors in Education from Stanford University.

Phoebe A. Grant-Robinson Editor, 2023-2024

Phoebe A. Grant-Robinson is a first year student in the Doctor of Education Leadership(EdLD) program at the Harvard Graduate School of Education. Her ultimate quest is to position all students as drivers of their destiny. Phoebe is passionate about early learning and literacy. She is committed to ensuring that districts and school leaders, have the necessary tools to create equitable learning organizations that facilitate the academic and social well-being of all students. Phoebe is particularly interested in the intersection of homeless students and literacy. Prior to her doctoral studies, Phoebe was a Special Education Instructional Specialist. Supporting a portfolio of more than thirty schools, she facilitated the rollout of New York City’s Special Education Reform. Phoebe also served as an elementary school principal. She holds a BS in Inclusive Education from Syracuse University, and an MS in Curriculum and Instruction from Pace University.

Pennie M. Gregory Editor, 2023-2024

Pennie M. Gregory is a second-year student in the Doctor of Education Leadership (EdLD) program at the Harvard Graduate School of Education. Pennie was born in Incheon, South Korea and raised in Gary, Indiana. She has decades of experience leading efforts to improve outcomes for students with disabilities first as a special education teacher and then as a school district special education administrator. Prior to her doctoral studies, Pennie helped to create Indiana’s first Aspiring Special Education Leadership Institute (ASELI) and served as its Director. She was also the Capacity Events Director for MelanatED Leaders, an organization created to support educational leaders of color in Indianapolis. Pennie has a unique perspective, having worked with members of the school community, with advocacy organizations, and supporting state special education leaders. Pennie holds an EdM in Education Leadership from Marian University.

Jennifer Ha Editor, 2023-2025

Jen Ha is a second-year PhD student in the Culture, Institutions, and Society concentration at the Harvard Graduate School of Education. Her research explores how high school students learn to write personal narratives for school applications, scholarships, and professional opportunities amidst changing landscapes in college access and admissions. Prior to doctoral studies, Jen served as the Coordinator of Public Humanities at Bard Graduate Center and worked in several roles organizing academic enrichment opportunities and supporting postsecondary planning for students in New Haven and New York City. Jen holds a BA in Humanities from Yale University, where she was an Education Studies Scholar.

Woohee Kim Editor, 2023-2025

Woohee Kim is a PhD student studying youth activists’ civic and pedagogical practices. She is a scholar-activist dedicated to creating spaces for pedagogies of resistance and transformative possibilities. Shaped by her activism and research across South Korea, the US, and the UK, Woohee seeks to interrogate how educational spaces are shaped as cultural and political sites and reshaped by activists as sites of struggle. She hopes to continue exploring the intersections of education, knowledge, power, and resistance.

Catherine E. Pitcher Editor, 2023-2025

Catherine is a second-year doctoral student at Harvard Graduate School of Education in the Culture, Institutions, and Society program. She has over 10 years of experience in education in the US in roles that range from special education teacher to instructional coach to department head to educational game designer. She started working in Palestine in 2017, first teaching, and then designing and implementing educational programming. Currently, she is working on research to understand how Palestinian youth think about and build their futures and continues to lead programming in the West Bank, Gaza, and East Jerusalem. She holds an EdM from Harvard in International Education Policy.

Elizabeth Salinas Editor, 2023-2025

Elizabeth Salinas is a doctoral student in the Education Policy and Program Evaluation concentration at HGSE. She is interested in the intersection of higher education and the social safety net and hopes to examine policies that address basic needs insecurity among college students. Before her doctoral studies, Liz was a research director at a public policy consulting firm. There, she supported government, education, and philanthropy leaders by conducting and translating research into clear and actionable information. Previously, Liz served as a high school physics teacher in her hometown in Texas and as a STEM outreach program director at her alma mater. She currently sits on the Board of Directors at Leadership Enterprise for a Diverse America, a nonprofit organization working to diversify the leadership pipeline in the United States. Liz holds a bachelor’s degree in civil engineering from the Massachusetts Institute of Technology and a master’s degree in higher education from the Harvard Graduate School of Education.

Caroline Tucker Co-Chair, 2023-2024 Editor, 2022-2024 [email protected]

Caroline Tucker is a fourth-year doctoral student in the Culture, Institutions, and Society concentration at the Harvard Graduate School of Education. Her research focuses on the history and organizational dynamics of women’s colleges as women gained entry into the professions and coeducation took root in the United States. She is also a research assistant for the Harvard and the Legacy of Slavery Initiative’s Subcommittee on Curriculum and the editorial assistant for Into Practice, the pedagogy newsletter distributed by Harvard University’s Office of the Vice Provost for Advances in Learning. Prior to her doctoral studies, Caroline served as an American politics and English teaching fellow in London and worked in college advising. Caroline holds a BA in History from Princeton University, an MA in the Social Sciences from the University of Chicago, and an EdM in Higher Education from the Harvard Graduate School of Education.

Kemeyawi Q. Wahpepah Co-Chair, 2023-2024 Editor, 2022-2024 [email protected]

Kemeyawi Q. Wahpepah (Kickapoo, Sac & Fox) is a fourth-year doctoral student in the Culture, Institutions, and Society concentration at the Harvard Graduate School of Education. Their research explores how settler colonialism is addressed in K-12 history and social studies classrooms in the United States. Prior to their doctoral studies, Kemeyawi taught middle and high school English and history for eleven years in Boston and New York City. They hold an MS in Middle Childhood Education from Hunter College and an AB in Social Studies from Harvard University.

Submission Information

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Individual subscriptions must have an individual name in the given address for shipment. Individual copies are not for multiple readers or libraries. Individual accounts come with a personal username and password for access to online archives. Online access instructions will be attached to your order confirmation e-mail.

Institutional rates apply to libraries and organizations with multiple readers. Institutions receive digital access to content on Meridian from IP addresses via theIPregistry.org (by sending HER your PSI Org ID).

Online access instructions will be attached to your order confirmation e-mail. If you have questions about using theIPregistry.org you may find the answers in their FAQs. Otherwise please let us know at [email protected] .

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To order online via credit card, please use the subscribe button at the top of this page.

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Checks can be mailed to Harvard Educational Review C/O Fulco, 30 Broad Street, Suite 6, Denville, NJ 07834. (Please include reference to your subscriber number if you are renewing. Institutions must include their PSI Org ID or follow up with this information via email to [email protected] .)

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Article Submission FAQ

Closing the open call, question: “i have already submitted an article to her and i am awaiting a decision, what can i expect”.

Answer: First, any manuscripts already submitted through the open call and acknowledged by HER, as well as all invited manuscripts, R&R’d manuscripts, and manuscripts currently in production are NOT affected in any way by our pause in open calls. Editors are working to move through all current submissions and you can expect to receive any updates or decisions as we move through each step of our production process. If you have any questions, please contact the Co-Chairs, Caroline Tucker and Kemeyawi Wahpepah at [email protected] .

Question: “Can you share more about why you are closing the open call?”

Answer: As a graduate student run journal, we perform our editorial tasks in addition to our daily lives as doctoral students. We have been (and continue to be) incredibly grateful for the authors who share their work with us. In closing the open call, we hope to give ourselves time to review each manuscript in the best manner possible.

Submissions

Question: “what manuscripts are a good fit for her ”.

Answer: As a generalist scholarly journal, HER publishes on a wide range of topics within the field of education and related disciplines. We receive many articles that deserve publication, but due to the restrictions of print publication, we are only able to publish very few in the journal. The originality and import of the findings, as well as the accessibility of a piece to HER’s interdisciplinary, international audience which includes education practitioners, are key criteria in determining if an article will be selected for publication.

We strongly recommend that prospective authors review the current and past issues of HER to see the types of articles we have published recently. If you are unsure whether your manuscript is a good fit, please reach out to the Content Editor at [email protected] .

Question: “What makes HER a developmental journal?”

Answer: Supporting the development of high-quality education research is a key tenet of HER’s mission. HER promotes this development through offering comprehensive feedback to authors. All manuscripts that pass the first stage of our review process (see below) receive detailed feedback. For accepted manuscripts, HER also has a unique feedback process called casting whereby two editors carefully read a manuscript and offer overarching suggestions to strengthen and clarify the argument.

Question: “What is a Voices piece and how does it differ from an essay?”

Answer: Voices pieces are first-person reflections about an education-related topic rather than empirical or theoretical essays. Our strongest pieces have often come from educators and policy makers who draw on their personal experiences in the education field. Although they may not present data or generate theory, Voices pieces should still advance a cogent argument, drawing on appropriate literature to support any claims asserted. For examples of Voices pieces, please see Alvarez et al. (2021) and Snow (2021).

Question: “Does HER accept Book Note or book review submissions?”

Answer: No, all Book Notes are written internally by members of the Editorial Board.

Question: “If I want to submit a book for review consideration, who do I contact?”

Answer: Please send details about your book to the Content Editor at [email protected].

Manuscript Formatting

Question: “the submission guidelines state that manuscripts should be a maximum of 9,000 words – including abstract, appendices, and references. is this applicable only for research articles, or should the word count limit be followed for other manuscripts, such as essays”.

Answer: The 9,000-word limit is the same for all categories of manuscripts.

Question: “We are trying to figure out the best way to mask our names in the references. Is it OK if we do not cite any of our references in the reference list? Our names have been removed in the in-text citations. We just cite Author (date).”

Answer: Any references that identify the author/s in the text must be masked or made anonymous (e.g., instead of citing “Field & Bloom, 2007,” cite “Author/s, 2007”). For the reference list, place the citations alphabetically as “Author/s. (2007)” You can also indicate that details are omitted for blind review. Articles can also be blinded effectively by use of the third person in the manuscript. For example, rather than “in an earlier article, we showed that” substitute something like “as has been shown in Field & Bloom, 2007.” In this case, there is no need to mask the reference in the list. Please do not submit a title page as part of your manuscript. We will capture the contact information and any author statement about the fit and scope of the work in the submission form. Finally, please save the uploaded manuscript as the title of the manuscript and do not include the author/s name/s.

Invitations

Question: “can i be invited to submit a manuscript how”.

Answer: If you think your manuscript is a strong fit for HER, we welcome your request for invitation. Invited manuscripts receive one round of feedback from Editors before the piece enters the formal review process. To submit information about your manuscript for the Board to consider for invitation, please fill out the Invitation Request Form. Please provide as many details as possible. Whether we could invite your manuscript depends on the interest and availability of the current Board. Once you submit the form, we will give you an update in about 2–3 weeks on whether there are Editors who are interested in inviting your manuscript.

Review Timeline

Question: “who reviews manuscripts”.

Answer: All manuscripts are reviewed by the Editorial Board composed of doctoral students at Harvard University.

Question: “What is the HER evaluation process as a student-run journal?”

Answer: HER does not utilize the traditional external peer review process and instead has an internal, two-stage review procedure.

Upon submission, every manuscript receives a preliminary assessment by the Content Editor to confirm that the formatting requirements have been carefully followed in preparation of the manuscript, and that the manuscript is in accord with the scope and aim of the journal. The manuscript then formally enters the review process.

In the first stage of review, all manuscripts are read by a minimum of two Editorial Board members. During the second stage of review, manuscripts are read by the full Editorial Board at a weekly meeting.

Question: “How long after submission can I expect a decision on my manuscript?”

Answer: It usually takes 6 to 10 weeks for a manuscript to complete the first stage of review and an additional 12 weeks for a manuscript to complete the second stage. Due to time constraints and the large volume of manuscripts received, HER only provides detailed comments on manuscripts that complete the second stage of review.

Question: “How soon are accepted pieces published?”

Answer: The date of publication depends entirely on how many manuscripts are already in the queue for an issue. Typically, however, it takes about 6 months post-acceptance for a piece to be published.

Submission Process

Question: “how do i submit a manuscript for publication in her”.

Answer: Manuscripts are submitted through HER’s Submittable platform, accessible here. All first-time submitters must create an account to access the platform. You can find details on our submission guidelines on our Submissions page.

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ISSN: 0017-8055 eISSN: 1943-5045

Welcome to the Harvard Educational Review The Harvard Educational Review is a scholarly journal of opinion and research in education. It provides an interdisciplinary forum for discussion and debate about the field’s most vital issues. Since its founding in 1930, HER has become a prestigious education journal, with circulation to policymakers, researchers, administrators, and teachers.

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The Harvard Educational Review accepts contributions from researchers, scholars, policy makers, practitioners, teachers, students, and informed observers in education and related fields. We welcome original reports of research and theory as well as articles that reflect on teaching and practice in educational settings around the world.

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Voices in Education Blog

Harvard Education Publishing Group’s Voices in Education blog features a variety of perspectives on current education topics, such as race and equity, teacher preparation, and classroom practice.

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Published four times per year, the Harvard Educational Review provides scholarly opinion and research articles on the most vital issues in education.

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Educational Psychology Review

Special Issues can be accessed through the Collections link on the right-hand side Educational Psychology Review is an international forum for the publication of peer-reviewed integrative review articles, special thematic issues, reflections or comments on previous research or new research directions, interviews, and research-based advice for practitioners - all pertaining to the field of educational psychology. The contents provide breadth of coverage appropriate to a wide readership in educational psychology and sufficient depth to inform the most learned specialists in the discipline.

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The effectiveness of concept maps on students’ achievement in science: a meta-analysis.

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Education Review

About the Journal

Welcome! Education Review (ISSN: 1094-5296) publishes reviews of recent books in English, Spanish, and Portuguese spanning a wide range of education scholarship and practice across the globe. We also publish autobiographical essays highlighting the acquired wisdom and pedagogical legacies of esteemed educational researchers.

IMPORTANT NOTE: The journal will be selective regarding new requests to review English titles for the next few months as we restructure our journal offerings.

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Nova legados pedagógicos / new pedagogical legacies, current issue, pequenos grandes livros, resenha do livro a ilusão fecunda: a luta por educação nos movimentos populares.

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Review of Teach truth to power: How to engage in education policy

Review of black male success in higher education: how the mathematical brotherhood empowers a collegiate community to thrive, review of culturally and socially responsible assessment: theory, research, and practice.

ISSN: 1094-5296   

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Uma história de doutorados-sanduíche: A importância de estágios no exterior para a formação da internacionalização das pesquisas em educação

Autor/Org:   Nilda Alves (Org.)

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Disclaimer:  The views or opinions presented in book reviews are solely those of the author(s) and do not necessarily represent those of Education Review .

Education Review/Reseñas Educativas/Resenhas Educativas  is supported by the Scholarly Communications Group at the Mary Lou Fulton Teachers College, Arizona State University. 

Academic Integrity and Artificial Intelligence in Higher Education (HE) Contexts: A Rapid Scoping Review

• Helen Pethrick University of Calgary
• Jason Wiens University of Calgary
• Brenda McDermott University of Calgary

Artificial Intelligence (AI) developments challenge higher education institutions’ teaching, learning, assessment, and research practices. To contribute timely and evidence-based recommendations for upholding academic integrity, we conducted a rapid scoping review focusing on what is known about academic integrity and AI in higher education. We followed the Updated Reviewer Manual for Scoping Reviews from the Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Systematic reviews Meta-Analysis for Scoping Reviews (PRISMA-ScR) reporting standards. Five databases were searched, and the eligibility criteria included higher education stakeholders of any age and gender engaged with AI in the context of academic integrity from 2007 through November 2022 and available in English. The search retrieved 2223 records, of which 14 publications with mixed methods, qualitative, quantitative, randomized controlled trials, and text and opinion studies met the inclusion criteria. The results showed bounded and unbounded ethical implications of AI. Perspectives included: AI for cheating; AI as legitimate support; an equity, diversity, and inclusion lens into AI; and emerging recommendations to tackle AI implications in higher education. The evidence from the sources provides guidance that can inform educational stakeholders in decision-making processes for AI integration, in the analysis of misconduct cases involving AI, and in the exploration of AI as legitimate assistance. Likewise, this rapid scoping review signals key questions for future research, which we explore in our discussion.

Author Biographies

Beatriz antonieta moya, university of calgary.

Beatriz Moya is a Ph.D. candidate in the Werklund School of Education at the University of Calgary in the Educational Research program, specializing in Leadership. Her primary motivation as a student researcher is to contribute to the continuous transformation of higher education institutions’ cultures to pursue academic and research integrity and social justice. For this reason, Beatriz situates herself at the intersections of the Scholarship of Teaching and Learning (SoTL), Leadership, and Academic Integrity. In this space, Beatriz is currently involved in projects seeking to contribute to a ‘glocal’ scholarly dialogue concerning academic integrity as a teaching and learning imperative. For instance, Beatriz is exploring the situated meanings and experiential insights from academic integrity educational leaders, and is also a contributing author for a chapter on academic integrity policy in Latin America in the Handbook of Academic Integrity (2nd ed.). 

Sarah Elaine Eaton, University of Calgary

Dr. Sarah Elaine Eaton, PhD, is an Associate Professor of Education at the University of Calgary, Canada. She served as the inaugural Educational Leader in Residence, Academic Integrity at Taylor Institute for Teaching and Learning, University of Calgary. Dr. Eaton’s research focuses on academic ethics in higher education. Her work can be found in the British Educational Research Journal, the Journal of Academic Ethics, and the Journal of Educational Thought and Interchange, among other places. She is the Editor-in-Chief of the International Journal for Educational Integrity (Springer Nature) and co-founder and co-editor of Canadian Perspectives on Academic Integrity. In 2020 she received the National Research and Scholarship award from the Canadian Society for the Study of Higher Education (CSSHE) for her contributions to research on academic integrity in Canadian higher education. In 2022, she received the outstanding research award from the European Network for Academic Integrity (ENAI). Her books include Plagiarism in Higher Education: Tackling Tough Topics in Academic Integrity, Academic Integrity in Canada: An Enduring and Essential Challenge (Eaton & Christensen Hughes, eds.), Contract Cheating in Higher Education: Global Perspectives on Theory, Practice, and Policy (Eaton, Curtis, Stoesz, Clare, Rundle, & Seeland, eds.) and Ethics and Integrity in Teacher Education (Eaton & Khan, eds.). 

Helen Pethrick, University of Calgary

Helen Pethrick, MA, is a researcher and educator in Calgary, Alberta, Canada. Helen’s research encompasses academic integrity in higher education, post-secondary student mental health, and mentorship in academia. Helen has interdisciplinary expertise in systematic literature review methodology, qualitative research, project management, and knowledge exchange. With Dr. Sarah Elaine Eaton and Jamie J. Carmichael, Helen is co-Editor of the volume Fake Degrees and Fraudulent Credentials in Higher Education (Eaton, Carmichael, & Pethrick, forthcoming 2023). Currently, Helen’s role is Research Associate, Academic Integrity, which involves acting as Project Manager (administrative) for the Academic Integrity and Artificial Intelligence project at the University of Calgary. 

K. Alix Hayden, University of Calgary

Dr. Alix Hayden is a Librarian at the University of Calgary.

Robert Brennan

Holds a PhD in mechanical engineering from the University of Calgary. He is a Professor of Mechanical and Manufacturing Engineering at the University of Calgary, holds the NSERC Chair in Design Engineering, and has served as President of the Canadian Engineering Education Association (CEEA). His research interests range from engineering education to intelligent automation and control systems.  

Jason Wiens, University of Calgary

Dr. Wiens is a Professor (Teaching) in the Department of English at the University of Calgary. His areas of research interest include contemporary poetry, Canadian literature, archival studies, literary audio, and pedagogy.  He has published articles in numerous journals including LIT: Literature Interpretation Theory, Canadian Literature, Studies on Canadian Writing, and Canadian Poetry. He has recently guest edited a special issue of English Studies in Canada on "Pedagogies of the Archive." He is currently a co-investigator on the SSHRC Partnership project The SpokenWeb, and is a co-investigator on the Academic Integrity and Artificial Intelligence project at the University of Calgary.  

Brenda McDermott, University of Calgary

Dr. McDermott completed her PhD in communication studies at the University of Calgary.  Her research involves looking at ableism embedded in teaching and learning practices, particular assessment. She regularly provided training to faculty to help creating learning environments that reflect the diversity of learners.  

Alonso, A. N. (2022). Online translators in online language assessments. CALL-EJ, 23(3), 115-135. http://callej.org/journal/23-3/Alonso2022.pdf

Anselmo, L., Kendon, T. & Moya, B. (2023). A First Response to Assessment and ChatGPT in your Courses. Taylor Institute for Teaching and Learning. https://taylorinstitute.ucalgary.ca/first-response-assessment-and-chatgpt

Anson, C. M. (2022). AI-based text generation and the social construction of “fraudulent authorship”: A revisitation. Composition Studies, 50(1), 37-46.

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Brusini, A. (2023). ChatGPT: A brief introduction and considerations for academic integrity. The Innovative Instructor. https://ii.library.jhu.edu/2023/01/30/chatgpt-a-brief-introduction-and-considerations-for-academic-integrity/

Bubeck, S., Chandrasekaran, V., Eldan, R., Gehrke, J., Horvitz, E., Kamar, E., Lee, P., Tat Lee, Y. Li, Y., Lundberg, S., Nori, H., Palangi, H., Ribeiro, M. T., & Zhang, Y. (2023). Sparks of artificial general intelligence: Early experiments with GPT-4. https://arxiv.org/pdf/2303.12712.pdf

Cassidy, C. (2023, January 10). Australian universities to return to ‘pen and paper’ exams after students caught using AI to write essays. The Guardian. https://www.theguardian.com/australia-news/2023/jan/10/universities-to-return-to-pen-and-paper-exams-after-students-caught-using-ai-to-write-essays

Chen, M. H., Huang, S.-T., Chang, J.S., & Liou, H.-C. (2015). Developing a corpus-based paraphrase tool to improve EFL learners' writing skills. Computer Assisted Language Learning, 28(1), 22-40. http://dx.doi.org/10.1080/09588221.2013.783873

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• Published: 13 December 2023

Attributes of errors, facilitators, and barriers related to rate control of IV medications: a scoping review

• Jeongok Park   ORCID: orcid.org/0000-0003-4978-817X 1 ,
• Sang Bin You   ORCID: orcid.org/0000-0002-1424-4140 2 ,
• Gi Wook Ryu   ORCID: orcid.org/0000-0002-4533-7788 3 &
• Youngkyung Kim   ORCID: orcid.org/0000-0002-3696-5416 4  

Systematic Reviews volume  12 , Article number:  230 ( 2023 ) Cite this article

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Intravenous (IV) medication is commonly administered and closely associated with patient safety. Although nurses dedicate considerable time and effort to rate the control of IV medications, many medication errors have been linked to the wrong rate of IV medication. Further, there is a lack of comprehensive studies examining the literature on rate control of IV medications. This study aimed to identify the attributes of errors, facilitators, and barriers related to rate control of IV medications by summarizing and synthesizing the existing literature.

This scoping review was conducted using the framework proposed by Arksey and O’Malley and PRISMA-ScR. Overall, four databases—PubMed, Web of Science, EMBASE, and CINAHL—were employed to search for studies published in English before January 2023. We also manually searched reference lists, related journals, and Google Scholar.

A total of 1211 studies were retrieved from the database searches and 23 studies were identified from manual searches, after which 22 studies were selected for the analysis. Among the nine project or experiment studies, two interventions were effective in decreasing errors related to rate control of IV medications. One of them was prospective, continuous incident reporting followed by prevention strategies, and the other encompassed six interventions to mitigate interruptions in medication verification and administration. Facilitators and barriers related to rate control of IV medications were classified as human, design, and system-related contributing factors. The sub-categories of human factors were classified as knowledge deficit, performance deficit, and incorrect dosage or infusion rate. The sub-category of design factor was device. The system-related contributing factors were classified as frequent interruptions and distractions, training, assignment or placement of healthcare providers (HCPs) or inexperienced personnel, policies and procedures, and communication systems between HCPs.

Conclusions

Further research is needed to develop effective interventions to improve IV rate control. Considering the rapid growth of technology in medical settings, interventions and policy changes regarding education and the work environment are necessary. Additionally, each key group such as HCPs, healthcare administrators, and engineers specializing in IV medication infusion devices should perform its role and cooperate for appropriate IV rate control within a structured system.

Peer Review reports

Medication errors are closely associated with patient safety and the quality of care [ 1 , 2 ]. In particular, medication errors, which denote a clinical issue of global importance for patient safety, negatively affect patient morbidity and mortality and lead to delays in discharge [ 3 , 4 ]. The National Health Service in the UK estimates that 237 million medication errors occur each year, of which 66 million cause clinically significant harm [ 5 ]. The US Food and Drug Administration reported that they received more than 100,000 reports each year associated with suspected medication errors [ 6 ]. Additionally, it was estimated that 40,000–98,000 deaths per year in the USA could be attributed to errors by healthcare providers (HCPs) [ 7 ]. Previous studies have revealed that medication errors account for 6–12% of hospital admissions [ 8 ].

Intravenous (IV) medication is a common treatment in hospitalized patient care [ 9 ]. It is used in wards, intensive care units (ICUs), emergency rooms, and outpatient clinics in hospitals [ 9 , 10 ]. As direct HCPs, nurses are integral in patient safety during the IV medication process which could result in unintended errors or violations of recommendations [ 3 ]. As many drugs injected via the IV route include high-risk drugs, such as chemotherapy agents, insulin, and opioids [ 10 ], inappropriate dose administration could lead to adverse events (AEs), such as death and life-threatening events [ 11 , 12 ].

IV medication process is a complex and multistage process. There are 12 stages in the IV medication process, which can be classified as follows: (1) obtain the drug for administration, (2) obtain the diluent, (3) reconstitute the drug in the diluent, (4) take the drug at the patient’s bedside, (5) check for the patient’s allergies, (6) check the route of drug administration, (7) check the drug dose, (8) check the patency of the cannula, (9) expel the air from the syringe, (10) administer the drug, (11) flush the cannula, and (12) sign the prescription chart [ 13 ]. IV medication errors can occur at any of these stages. It is imperative to administer the drug at the correct time and rate during the IV medication process [ 13 ]. The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) defined an error in IV medication rates as “too fast or too slow rate than that intended” [ 14 ]. Maintaining the correct rate of IV medication is essential for enhancing the effectiveness of IV therapy and reducing AEs [ 9 ].

Infusion pumps are devices designed to improve the accuracy of IV infusions, with drug flow, volume, and timing programmed by HCPs [ 15 ]. A smart pump is an infusion pump with a software package containing a drug library. During programming, the smart pump software warns users about entering drug parameters that deviate from the recommended parameters, such as the type, dose, and dosage unit of the drug [ 15 ]. In the absence of a device for administering IV medication, such as an infusion pump or smart pump, the IV rate is usually controlled by counting the number of fluid drops falling into the drip chamber [ 9 ].

According to the previous study, applying an incorrect rate was the most prevalent IV medication error, accounting for 536 of 925 (57.9%) total IV medication errors [ 16 ]. Although rate control of IV medications is critical to patient safety and quality care, few studies review and map the relevant literature on rate control of IV medications. Therefore, this study aimed to identify the attributes of errors, facilitators, and barriers related to rate control of IV medications by summarizing the existing literature.

The specific research questions of this study are as follows:

What are the general characteristics of the studies related to rate control of IV medications?

What are the attributes of errors associated with rate control of IV medications?

What are the facilitators and barriers to rate control of IV medications?

This scoping review followed the framework suggested by Arksey and O’Malley [ 17 ] and developed by Levac et al. [ 18 ] and Peters et al. [ 19 ]. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) developed in 2020 by the Joanna Briggs Institute (JBI) were used to ensure reliability in the reporting of methodology (Additional file 1 ) [ 19 ].

Search strategy

According to the JBI Manuals for Evidence Synthesis, a three-step search strategy was adopted [ 19 ]. First, a preliminary search in PubMed was conducted based on the title, abstract, keywords, and index terms of articles to develop our search strategy. In the preliminary search, we used keywords such as “patients,” “nurse,” “IV therapy,” “monitoring,” “rate,” and “medication error.” The search results indicated that studies on medical devices and system-related factors were excluded. Therefore, we decided to exclude the keywords “patients” and “nurse” and focus on “IV therapy,” “monitoring,” “rate,” and “medication error” to comprehensively include studies on factors associated with rate control of infusion medications. Secondly, we used all identified keywords and index terms across all included databases following consultations with a research librarian at Yonsei University Medical Library to elaborate our search strategy. Four databases—PubMed, CINAHL, EMBASE, and Web of Science—were searched using the keywords, index terms, and a comprehensive list of keyword variations to identify relevant studies published before January 2023. The details of the search strategy are described in Additional file 2 . All database search results were exported into Endnote version 20. Finally, we manually searched the reference lists of the included articles identified from the database search. Furthermore, we manually searched two journals related to medication errors and patient safety, and Google Scholar to comprehensively identify the relevant literature. When performing a search on Google Scholar, keywords such as “medication,” “rate,” “IV therapy,” “intravenous administration,” and “medication error” were appropriately combined using search modifiers.

Eligibility criteria

Inclusion criteria were established according to the participants, concept, and context (PCC) framework recommended by the JBI manuals for scoping reviews [ 19 ]. The participants include patients receiving IV therapy, HCPs involved in administering IV medications, and experts from non-healthcare fields related to rate control of IV medications. The concepts were facilitators and barriers to rate control of IV medications, and the contexts were the environments or situations in which errors in rate control of IV medications occurred. While screening the literature identified by the three-step search based on the inclusion criteria, we refined the exclusion criteria through discussion among researchers. The exclusion criteria were as follows: (1) not available in English, (2) not an original article, (3) studies of medication errors in general, (4) not accessible, or (5) prescription error.

Study selection

Once duplicates were automatically removed through Endnote, two independent researchers assessed the eligibility of all articles by screening the titles and abstracts based on the inclusion and exclusion criteria. Studies identified via database searches were screened by GWR and YK and studies identified via other methods were screened by SBY and YK. Full-text articles were obtained either when the studies met the inclusion criteria or when more information was needed to assess eligibility and the researchers independently reviewed the full-text articles. In case of any disagreement in the study selection process, a consensus was reached through discussion among three researchers (GWR, SBY, and YK) and a senior researcher (JP).

Data extraction

Through consensus among the researchers, a form for data extraction was developed to extract appropriate information following the JBI manuals for scoping reviews [ 19 ]. The following data were collected from each study: author information, publication year, country, study design, study period, aims, participants or events (defined as the occurrences related to patient care focused on in the study), contexts, methods, errors related to the control of IV medications (observed results or intervention outcomes), error severity, facilitators, and barriers according to the NCC MERP criteria. Three researchers (GWR SBY, and YK) independently conducted data charting and completed the data extraction form through discussion.

Data synthesis

The general characteristics of included studies such as publication year, country, study design, and study period were analyzed using descriptive statistics to identify trends or patterns. The aims, participants, events, contexts, and methods of the included studies were classified into several categories through a research meeting including a senior researcher (JP) to summarize and analyze the characteristics of the included studies comprehensively. Attributes of errors associated with rate control of IV medications were analyzed and organized through consensus among researchers based on extracted data. Facilitators and barriers to rate control of IV medications were independently classified according to NCC MERP criteria by three researchers (GWR, SBY, and YK) and iteratively modified. Discrepancies were resolved by discussion and re-reading the articles, with the final decision made in consultation with the senior researcher (JP).

A total of 1211 studies were selected through a database search. After reviewing the titles and abstracts of the studies, 42 studies were considered for a detailed assessment by the three researchers. In particular, 2 were not available in English, 3 were not original articles, 24 were studies of medication error in general without details on rate control of IV medications, 2 were regarding prescription errors, and 1 was not accessible. Finally, 10 studies were identified through a database search. Additionally, 23 studies were identified from a manual search. Among the 23, 5 were not original articles, and 6 were studies on medication error in general. Finally, 12 studies were identified via other methods. Hence, 22 studies were included in the data analysis (Fig.  1 , Additional file 3 ).

PRISMA flow chart for literature selection

Characteristics of the studies

General characteristics.

Table 1 presents the general characteristics of the included studies. Two of the included studies had a publication year before 2000 [ 20 , 21 ], and more than half of the studies ( n  = 15) were published in 2010 and later. A majority of the included studies were conducted in Western countries ( n  = 15) [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ], four were conducted in Asia [ 20 , 37 , 38 , 39 ], two were conducted in Australia [ 21 , 40 ], and one was conducted in Egypt [ 2 ]. In terms of the study design, most studies were project studies ( n  = 7) [ 22 , 24 , 27 , 28 , 30 , 34 , 39 ] or prospective observational studies ( n  = 5) [ 2 , 20 , 29 , 32 , 40 ], followed by retrospective studies ( n  = 3) [ 21 , 25 , 35 ], qualitative or mixed-methods studies ( n  = 3) [ 23 , 26 , 33 ], and descriptive cross-sectional studies ( n  = 2) [ 36 , 38 ]. Additionally, there was one controlled pre-posttest study [ 37 ] and one simulation laboratory experiment study [ 31 ]. The study period also varied greatly from 2 days [ 32 ] to 6 years [ 25 ].

The aims of the included studies were divided into two main categories. First, 13 studies identified the current status, causes, and factors influencing errors that could occur in healthcare settings [ 2 , 20 , 21 , 23 , 25 , 26 , 29 , 32 , 33 , 35 , 36 , 38 , 40 ]. Among these, three studies were on errors that may occur in specific healthcare procedures, such as anesthesia [ 20 ], vascular access [ 21 ], and pediatric chemotherapy [ 25 ]. Additionally, three studies explored possible errors associated with specific settings and medications, such as an obstetric emergency ward [ 2 ], cardiac critical care units [ 38 ], and high-alert medications [ 36 ], and three studies investigated the errors associated with the overall IV medication preparation or administration [ 23 , 33 , 40 ]. Moreover, three studies aimed at identifying potential problems associated with the use of IV medication infusion devices [ 26 , 32 , 35 ], and one study was about errors in medication preparation and administration that could occur in a setting using a specific system connected to electronic medical records [ 29 ]. Second, nine studies described the procedure of developing interventions or identified the effect of interventions [ 22 , 24 , 27 , 28 , 30 , 31 , 34 , 37 , 39 ].

Participants and events

Participants in the 22 studies included HCPs such as nurses, doctors, pharmacists, and patients. Notably, four of these studies were only for nurses [ 31 , 37 , 38 , 40 ] and there was also one study involving only pharmacists [ 36 ]. Furthermore, there were five studies wherein people from various departments or roles participated [ 23 , 26 , 27 , 28 , 39 ]. There were three studies wherein the patients were participants, and two studies included both patients and medical staff [ 29 , 33 ].

Among the included studies, nine studies focused on errors in IV medication preparation and administration as events [ 23 , 26 , 30 , 32 , 33 , 34 , 37 , 38 , 40 ] and five studies focused on the administration process only [ 30 , 32 , 34 , 37 , 40 ]. Four studies focused on problems in the administration of all types of drugs including errors associated with rate control of IV medications [ 2 , 22 , 28 , 29 ]. Additionally, four studies focused on events that occurred with IV medication infusion devices [ 24 , 27 , 35 , 39 ], two studies explored the events that occurred during chemotherapy [ 22 , 25 ], and some analyzed events with problems in vascular access [ 21 ], iatrogenic events among neonates [ 28 ], and critical events in anesthesia cases [ 20 ].

Contexts and methods

The contexts can be largely divided into healthcare settings, including hospitals and laboratory settings. Three hospital-based studies were conducted in the entire hospital [ 20 , 22 , 24 ], eight studies were conducted at several hospitals, and the number of hospitals involved varied from 2 to 132 [ 23 , 26 , 32 , 33 , 34 , 35 , 38 , 40 ]. Furthermore, four studies were conducted in different departments within one hospital [ 29 , 30 , 37 , 39 ], three studies were conducted in only one department [ 2 , 27 , 28 ], two studies considered other healthcare settings and were not limited to hospitals [ 21 , 25 ], and one study was conducted in a simulation laboratory setting that enabled a realistic simulation of an ambulatory chemotherapy unit [ 31 ].

Specifically, seven out of the nine studies developed or implemented interventions based on interdisciplinary or multidisciplinary collaboration [ 22 , 24 , 28 , 30 , 34 , 37 , 39 ]. Two studies developed and identified the effectiveness of interventions that created an environment for nurses to improve performance and correct errors associated with medication administration [ 31 , 39 ], and two intervention studies were on error reporting methods or observation tools and the processes of addressing reported errors [ 28 , 30 ]. There were also a study on a pharmacist-led educational program for nurses [ 37 ], a comprehensive intervention from drug prescription to administration to reduce chemotherapy-related medication errors [ 22 ], infusion safety intervention bundles [ 34 ], the implementation of a smart IV pump equipped with failure mode and effects analysis (FMEA) [ 24 ], and a smart system to prevent pump programming errors [ 27 ].

Data collection methods were classified as a review of reported incidents [ 20 , 21 , 22 , 25 , 35 ], a review of medical charts [ 26 ], observations [ 23 , 29 , 30 , 31 , 32 , 33 , 34 , 37 , 40 ], follow-up on every pump alert [ 27 ], and self-reporting questionnaires or surveys [ 36 , 38 ]. Some studies utilized retrospective reviews of reported incidents and self-report questionnaires [ 39 ]. Also, in the study by Kandil et al., observation, nursing records review, and medical charts review were all used [ 2 ].

Attributes of errors associated with rate control of IV medications

Table 2 presents the attributes of errors related to rate control of IV medications in observed results or intervention outcomes, and error severity. Notably, 6 of 13 studies presenting observed results reported errors related to IV medication infusion devices among the rate control errors [ 20 , 25 , 32 , 33 , 35 , 36 ]. Additionally, four studies reported errors in bolus dose administration or IV push and flushing lines among IV rate errors [ 2 , 23 , 36 , 40 ]. Among the 13, nine studies reported error severity, and among these, three studies used NCC MERP ratings [ 25 , 32 , 33 ]. In four studies, error severity was reported by describing several cases in detail [ 2 , 21 , 23 , 25 ], and two studies reported no injuries or damages due to errors [ 26 , 29 ]. Among the nine studies that developed interventions and identified their effectiveness, four presented the frequency of incorrect rate errors as an outcome variable [ 28 , 30 , 34 , 37 ]. Moreover, two studies suggested compliance rates for intervention as outcome variables [ 24 , 31 ].

Among the nine project or experiment studies, three showed a decrease in error rate as a result of the intervention [ 28 , 31 , 34 ]. Three studies developed interventions to reduce rate errors but did not report the frequency or incidence of rate errors [ 22 , 24 , 27 ]. A study reported the frequency of rate errors only after the intervention; the effect of the intervention could not be identified [ 30 ]. Also, three studies showed the severity of errors related to rate control of IV medications [ 24 , 30 , 34 ], two used NCC MERP severity ratings [ 30 , 34 ], and one reported that all errors caused by smart IV pumps equipped with FMEA resulted in either temporary harm or no harm [ 24 ].

Facilitators and barriers to rate control of IV medications

Table 3 presents the facilitators and barriers related to rate control of IV medications according to the NCC MERP taxonomy based on the 22 included studies. Sub-categories of human factors were classified as knowledge deficit, performance deficit, miscalculation of dosage or infusion rate, and stress. The sub-category of design factor was device. System-related contributing factors were classified as frequent interruptions and distractions, inadequate training, poor assignment or placement of HCPs or inexperienced personnel, policies and procedures, and communication systems between HCPs [ 14 ].

Human factors

Among the barriers extracted from the 22 studies, 11 factors belonged to the “knowledge deficit,” “performance deficit,” “miscalculation of dosage or infusion rate,” and “stress (high-volume workload)” in this category. Half of these factors are related to the “performance deficit.” Barriers identified in two or more studies were tubing misplacement [ 24 , 35 ] and non-compliance with protocols and guidelines [ 2 , 25 ], all of which belonged to the “performance deficit.” Additionally, the high workload and environmental characteristics of the ICU, which corresponded to the “stress,” were also identified as barriers to rate control of IV medications [ 23 , 37 ].

Most factors in this category were related to IV medication infusion devices such as infusion pumps and smart pumps. In the study by Lyons et al., the use of devices, such as patient-controlled analgesia pumps and syringe drivers, was a facilitator of rate control of IV medications [ 33 ]. In addition to the use of these devices, the expansion of capabilities [ 26 ], monitoring programming [ 27 ], and standardization [ 22 ] were also facilitators. Unexpected equipment faults, a barrier, were identified in five studies [ 2 , 20 , 25 , 35 , 38 ]. Moreover, the complex design of the equipment [ 23 , 24 ] and incomplete drug libraries in smart pumps [ 33 , 35 ] were identified in two studies each. Factors such as the misassembly of an unfamiliar infusion pump [ 21 ] and smart pumps not connected to electronic systems [ 30 ] were also barriers.

Contributing factors (system related)

The factors belonging to the “frequent interruptions and distractions” in this category were all barriers. Specifically, running multiple infusions at once [ 24 , 27 ], air-in-line alarms, or cleaning air [ 24 ] were identified as barriers. Among the facilitators of the “training,” there were education and training on the use of smart IV pumps [ 24 ] and chemotherapy errors [ 22 ]. There are two factors in the “assignment or placement of a HCP or inexperienced personnel,” where ward-based pharmacists were facilitators [ 36 ], but nurses with less than 6 years of experience were barriers [ 40 ]. The sub-category with the most factors was “policies and procedures,” where the facilitators extracted in the four studies were double-checks through the process [ 22 , 24 , 28 , 36 ]. Among the barriers, two were related to keep-the-vein-open, which was identified in three studies [ 30 , 32 , 33 ]. The lack of automated infusion pumps [ 2 ], the absence of culture for use [ 32 , 33 ], and problems in the drug prescription process [ 33 ] were also identified as barriers. Communication with physicians in instances of doubt identified was the only identified facilitator in the “communication systems between HCPs” [ 28 ].

Resolutions for the barriers to rate control of IV medications

Table 4 presents the resolutions for the barriers to rate control of IV medications in the included studies. The suggested resolutions primarily belonged to the “contributing factors (system-related)” category. Resolutions in the “human factors” category were mainly related to the knowledge and performance of individual healthcare providers, and there were no studies proposing resolutions specifically addressing stress (high-volume workload), which is one of the barriers. Resolutions in the “design” category focused on the development [ 26 , 30 ], appropriate use [ 24 , 33 ], evaluation [ 26 ], improvement [ 24 , 26 , 30 ], and supply [ 23 ] of infusion pumps or smart pumps. Resolutions addressing aspects within the “contributing factors (system-related)” category can be classified into six main areas: interdisciplinary or inter-institution collaboration [ 23 , 25 , 28 , 30 , 34 , 35 , 36 , 37 ], training [ 24 , 37 , 40 ], implementation of policies or procedures [ 29 , 31 , 34 , 35 , 37 , 39 ], system improvement [ 25 , 30 , 32 ], creating a patient safety culture [ 25 , 37 , 38 ], and staffing [ 2 , 38 ].

This scoping review provides the most recent evidence on the attributes of errors, facilitators, and barriers related to rate control of IV medications. The major findings of this study were as follows: (1) there were a few intervention studies that were effective in decreasing the errors related to rate control of IV medications; (2) there was limited research focusing on the errors associated with IV medication infusion devices; (3) a few studies have systematically evaluated and analyzed the severity of errors associated with rate control of IV medications; and (4) the facilitators and barriers related to rate control of IV medications were identified by NCC MERP taxonomy as three categories (human factors, design, and system-related contributing factors).

Among the nine project or experiment studies, only two interventions showed statistically significant effectiveness for IV rate control [ 28 , 31 ]. Six studies did not report the specific statistical significance of the intervention [ 22 , 24 , 27 , 30 , 37 , 39 ], and one study found that the developed intervention had no statistically significant effect [ 34 ]. In another study, administration errors, including rate errors, increased in the experimental group and decreased in the control group [ 37 ]. IV rate control is a major process in medication administration that is comprehensively related to environmental and personal factors [ 3 , 41 ]. According to previous studies, interdisciplinary or multidisciplinary cooperation is associated with the improvement in patient safety and decreased medical errors [ 42 , 43 , 44 ]. Seven of the included studies were also project or experiment studies that developed interventions based on an interdisciplinary or multidisciplinary approach [ 22 , 24 , 28 , 30 , 34 , 37 , 39 ]. Additionally, an effective intervention was developed by a multidisciplinary care quality improvement team [ 28 ]. Therefore, it is crucial to develop effective interventions based on an interdisciplinary or multidisciplinary approach to establish practice guidelines with a high level of evidence related to IV rate control.

Of the 22 included studies, three identified potential problems associated with the use of IV medication infusion devices [ 26 , 32 , 35 ], and four described the application of interventions or explored the effects of the intervention developed to reduce errors that occur when using IV medication infusion devices [ 24 , 27 , 34 , 39 ]. IV medication infusion devices, such as infusion pumps and smart pumps, are widely used in healthcare environments and allow more rigorous control in the process of administering medications that are continuously infused [ 45 ]. Smart pumps are recognized as useful devices for providing safe and effective nursing care [ 15 ]. However, the use of IV medication infusion devices requires an approach different from traditional rate monitoring by counting the number of fluid drops falling into the drip chamber [ 9 ]. However, there exist many problems, such as bypassing the drug library, device maintenance, malfunction, tubing/connection, and programming in the use of IV medication infusion devices [ 32 , 35 ]. None of the four studies that described the application of interventions or explored the effects of the intervention demonstrated statistically significant effects. All four studies had no control group [ 24 , 27 , 34 , 39 ] and two studies had only post-test designs [ 24 , 27 ]. Therefore, further research needs to be conducted to analyze errors in rate control related to IV medication infusion devices and develop effective interventions.

A few studies have systematically evaluated and analyzed the severity of errors associated with rate control of IV medications. Among the 12 studies that reported the severity of errors associated with rate control of IV medications, five studies used NCC MERP, an internationally validated and reliable tool for assessing error severity, and one study used the Severity Assessment Code (SAC) developed by the New South Wales Health Department. Six studies did not use tools to assess error severity. The term “error severity” means the degree of potential or actual harm to patients [ 46 ]. Evaluating the severity of medication errors is a vital point in improving patient safety throughout the medication administration process. This evaluation allows for distinguishing errors based on their severity to establish the development of risk mitigation strategies focused on addressing errors with the great potential to harm patients [ 47 , 48 ]. Specifically, errors associated with rate control of IV medications were categorized as A to E on the NCC MERP and to groups 3 and 4 on the SAC. Additionally, errors associated with rate control of IV medications caused direct physical damage [ 2 , 21 ] and necessitated additional medication to prevent side effects or toxicity [ 23 ]. Therefore, as errors in rate control of IV medications are likely to cause actual or potential harm to the patient, research systematically evaluating and analyzing error severity should be conducted to provide the basis for developing effective risk reduction strategies in the rate control of IV medications.

Facilitators and barriers were identified as human, design, and system-related contributing factors. Among the human factors, “performance deficit” included failure to check equipment properly, tubing misplacement, inadequate monitoring, non-compliance with protocols and guidelines, and human handling errors with smart pumps. Nurses play a major role in drug administration; thus, their monitoring and practices related to IV medication infusion devices can influence patient health outcomes [ 3 , 49 ]. A major reason for the lack of monitoring was overwork, which was related to the complex working environment, work pressure, and high workload [ 3 , 11 , 49 ]. Moreover, two of the included studies identified high workload as a barrier to rate control of IV medications [ 23 , 37 ]. Therefore, to foster adequate monitoring of rate control of IV medications, a systematic approach to alleviating the complex working environment and work pressure should be considered.

Most facilitators and barriers in the devices category were related to IV medication infusion devices. In particular, expanding pump capabilities [ 26 ], monitoring pump programming [ 27 ], standardization [ 22 ], and using a pump [ 33 ] can facilitate rate control of IV medications. However, unexpected equipment faults are significant barriers, as identified in five studies among the included studies [ 2 , 20 , 25 , 35 , 38 ]. Moreover, the design [ 23 , 24 ], user-friendliness [ 21 ], connectivity to electronic systems [ 30 ], and completeness of drug libraries [ 33 , 35 ] are factors that can affect rate control of IV medications. Therefore, it is important to improve, monitor, and manage IV medication infusion devices so that they do not become barriers. Moreover, because rate errors caused by other factors can be prevented by devices, active utilization and systematic management of devices at the system level are required.

Although there are many benefits of infusion and smart pumps for reducing errors in rate control of IV medications, they cannot be used in all hospitals because of the limitation of medical resources. The standard infusion set, which is a device for controlling the rate of IV medication by a controller [ 9 ], is widely used in outpatient as well as inpatient settings [ 32 ]. Devices for monitoring the IV infusion rate, such as FIVA™ (FIVAMed Inc, Halifax, Canada) and DripAssist (Shift Labs Inc, Seattle, USA), which can continuously monitor flow rate and volume with any gravity drip set, have been commercialized [ 33 ]. However, they have not been widely used in hospitals. Therefore, developing novel IV infusion rate monitoring devices that are simple to use, can be used remotely, and are affordable for developing and underdeveloped countries can help nurses to reduce their workloads in monitoring IV infusion rates and thus maintain patient safety.

Most facilitators and barriers were system-related contributing factors, most of which belonged to the “policies and procedures.” In four studies, the absence of hospital policies or culture related to rate control of IV medications was identified as a barrier [ 2 , 30 , 32 , 33 ]. Medication errors related to incorrect rate control are problems that should be approached from macroscopic levels, such as via institutional policies and safety cultures. Therefore, large-scale research including more diverse departments and institutions needs to be conducted.

The second most common categories in system-related contributing factors were “frequent interruptions and distractions” and “training.” Although nurses experienced frequent interruptions and distributions during work, only one of the included studies was on interventions that were developed to create an environment with reduced interruptions [ 31 ]. Additionally, four studies found that education for nurses who are directly associated with medication administration is mandatory [ 22 , 23 , 24 , 36 ]. Therefore, education and a work environment for safety culture should be created to improve IV rate control.

Based on resolutions for barriers to rate control of IV medications, key groups relevant to rate control of IV medications include HCPs, healthcare administrators, and engineers specializing in IV medication infusion devices. HCPs directly involved in the preparation and administration of IV medications need to enhance their knowledge of drugs, raise awareness for the importance of rate control of IV medications, and improve performance related to IV infusion device monitoring. Engineers specializing in IV medication infusion devices should develop these devices by integrating various information technologies used in clinical settings. Additionally, they should identify issues related to these devices and continuously enhance both software and hardware. Healthcare administrators play a crucial role in establishing and leading interdisciplinary or inter-institution collaborations. They should foster leadership, build a patient safety culture within the organization, and implement training, interventions, and policies for correct rate control of IV medications. Decreasing medication errors, including errors in IV rate control, is closely linked to the various key groups [ 50 , 51 , 52 , 53 ], and multidisciplinary collaboration is emphasized for quality care [ 54 , 55 , 56 , 57 ]. Therefore, each key group should perform its role and cooperate for appropriate IV rate control within a structured system.

This review has some limitations that should be considered. As there was no randomized controlled trial in this review, the causal relationship between wrong rate errors and their facilitators or barriers could not be determined. Moreover, only limited literature may have been included in this review because we included literature published in English and excluded gray literature. Since we did not evaluate the quality of the study, there may be a risk of bias in data collection and analysis. Despite these limitations, this study provides a meaningful assessment of published studies related to rate control of IV medications. This contribution will provide an important basis for new patient safety considerations in IV medication administration when determining future policies and device development.

The findings of this review suggest that further research is needed to be conducted to develop effective interventions to improve the practice of IV rate control. Moreover, given the rapid growth of technology in medical settings, research on IV medication infusion devices should be conducted. Additionally, to establish effective risk reduction strategies, it is necessary to systematically evaluate and analyze the severity of errors related to the rate control of IV medications. Several facilitators and barriers to rate control of IV medications were identified in this review to ensure patient safety and quality care, interventions and policy changes related to education and the work environment are required. Additionally, the development of a device capable of monitoring the flow of IV medication is necessary. This review will be useful for HCPs, hospital administrators, and engineers specializing in IV medication infusion devices to minimize errors in rate control of IV medications and improve patient safety.

Availability of data and materials

The corresponding author can provide the datasets that were utilized and/or examined during the present study upon reasonable request.

Abbreviations

Adverse event

Healthcare provider

Intensive care unit

Intravenous

Joanna Briggs Institute

The National Coordinating Council for Medication Error Reporting and Prevention

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L Naseralallah D Stewart M Price V Paudyal 2023 Prevalence, contributing factors, and interventions to reduce medication errors in outpatient and ambulatory settings: a systematic review Int J Clin Pharm https://doi.org/10.1007/s11096-023-01626-5

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This research was supported by the Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety) (Project Number: RS-2020-KD000077) and Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (No. 2020R1A6A1A03041989). This work also supported by the Brain Korea 21 FOUR Project funded by National Research Foundation (NRF) of Korea, Yonsei University College of Nursing.

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Jeongok Park

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Sang Bin You

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Gi Wook Ryu

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Youngkyung Kim

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Conceptualization: JP; study design: JP; data collection: GWR, YK, SBY; data analysis: JP, GWR, YK, SBY; administration: JP; funding acquisition: JP; writing—original draft: JP, GWR, YK; writing—review and editing: JP, YK.

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Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist.

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Search queries and strategies by electronic databases.

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Studies included in the data analysis.

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Park, J., You, S.B., Ryu, G.W. et al. Attributes of errors, facilitators, and barriers related to rate control of IV medications: a scoping review. Syst Rev 12 , 230 (2023). https://doi.org/10.1186/s13643-023-02386-z

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Received : 15 May 2023

Accepted : 08 November 2023

Published : 13 December 2023

DOI : https://doi.org/10.1186/s13643-023-02386-z

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