Drug Administration Errors in Hospital Inpatients: A Systematic Review

Abstract

ContextDrug administration in the hospital setting is the last barrier before a possible error reaches the patient.ObjectivesWe aimed to analyze the prevalence and nature of administration error rate detected by the observation method.Data SourcesEmbase, MEDLINE, Cochrane Library from 1966 to December 2011 and reference lists of included studies.Study SelectionObservational studies, cross-sectional studies, before-and-after studies, and randomized controlled trials that measured the rate of administration errors in inpatients were included.Data ExtractionTwo reviewers (senior pharmacists) independently identified studies for inclusion. One reviewer extracted the data; the second reviewer checked the data. The main outcome was the error rate calculated as being the number of errors without wrong time errors divided by the Total Opportunity for Errors (TOE, sum of the total number of doses ordered plus the unordered doses given), and multiplied by 100. For studies that reported it, clinical impact was reclassified into four categories from fatal to minor or no impact. Due to a large heterogeneity, results were expressed as median values (interquartile range, IQR), according to their study design.ResultsAmong 2088 studies, a total of 52 reported TOE. Most of the studies were cross-sectional studies (N=46). The median error rate without wrong time errors for the cross-sectional studies using TOE was 10.5% [IQR: 7.3%-21.7%]. No fatal error was observed and most errors were classified as minor in the 18 studies in which clinical impact was analyzed. We did not find any evidence of publication bias.ConclusionsAdministration errors are frequent among inpatients. The median error rate without wrong time errors for the cross-sectional studies using TOE was about 10%. A standardization of administration error rate using the same denominator (TOE), numerator and types of errors is essential for further publications.

Does the introduction of pharmacy technician support during nursing medication rounds in hospital wards help reduce the number of omitted medication doses in a NHS hospital in England?

“…Worldwide, medication administration errors (MAEs) affect a median estimate of 19.1% doses administered or omitted in hospitals. [1] Doses given at the wrong time and dose omissions are among the most common MAE subtypes observed [1,2] and the risk of omitted and delayed doses to patients can be life-threatening. [3] Studies of omitted doses in hospitals report rates of 1.9-12.4% of administrable doses, [4][5][6][7][8] 20-30% of drugs [8,9] and 17-79% of inpatients, [5,[8][9][10] with significant heterogeneity in design and setting.…”

Bundle interventions used to reduce prescribing and administration errors in hospitalized children: a systematic review

“…Retrospective studies may have underestimated AE rates because those studies relay on nurses’ documentation which is limited and may not document the actual process of calculating or administering drugs. Direct observation is more objective and gives more reliable results especially when detecting AEs, but its limited use could be due to it being time‐consuming and difficult to carry out consistently for a long time …”

“…AEs, 52,53 but its limited use could be due to it being timeconsuming and difficult to carry out consistently for a long time. 54 Despite the weak design of the studies, investigating the literature on bundle interventions has provided some important insights into the different interventions that have been commonly used, such as education to increase knowledge and understanding. A systematic review that investigated the impact of education alone on prescribing quality did not provide a definitive conclusion.…”

SPODi: Simulador do Perfil Operacional de Dispositivos Intravenosos para Auxilio à Tomada de Decisões Médicas

“…Para busca de trabalhos relacionados, foi realizada uma revisão nas bases Pubmed, Cochrane e Scielo. Estas bases, segundo a literatura, são entendidas como representativas na área [Oliveira dos Santos et al 2018, Berdot et al 2013].…”