Evaluation of drug administration errors in a teaching hospital

Abstract

BackgroundMedication errors can occur at any of the three steps of the medication use process: prescribing, dispensing and administration. We aimed to determine the incidence, type and clinical importance of drug administration errors and to identify risk factors.MethodsProspective study based on disguised observation technique in four wards in a teaching hospital in Paris, France (800 beds). A pharmacist accompanied nurses and witnessed the preparation and administration of drugs to all patients during the three drug rounds on each of six days per ward. Main outcomes were number, type and clinical importance of errors and associated risk factors. Drug administration error rate was calculated with and without wrong time errors. Relationship between the occurrence of errors and potential risk factors were investigated using logistic regression models with random effects.ResultsTwenty-eight nurses caring for 108 patients were observed. Among 1501 opportunities for error, 415 administrations (430 errors) with one or more errors were detected (27.6%). There were 312 wrong time errors, ten simultaneously with another type of error, resulting in an error rate without wrong time error of 7.5% (113/1501). The most frequently administered drugs were the cardiovascular drugs (425/1501, 28.3%). The highest risks of error in a drug administration were for dermatological drugs. No potentially life-threatening errors were witnessed and 6% of errors were classified as having a serious or significant impact on patients (mainly omission). In multivariate analysis, the occurrence of errors was associated with drug administration route, drug classification (ATC) and the number of patient under the nurse's care.ConclusionMedication administration errors are frequent. The identification of its determinants helps to undertake designed interventions.

Errores en las recetas médicas y en la preparación de estas en farmacia de pacientes ambulatorios: El caso del Hospital de Nueva Imperial

“…En pacientes ambulatorios, la incidencia de acontecimientos prevenibles por medicamentos es de 5,4%. Algunos autores han determinado, además, que la tasa de error oscila entre 3,5 y 11.4% de las dosis administradas, y que un paciente hospitalizado presenta 0,9 errores de medicación diarios 4,9,10 . Cuarenta y dos por ciento de los eventos adversos potencialmente mortales o graves se deben a errores en la prescripción, en donde la tasa de error oscila entre 6,3 y 14,7% de errores en las recetas manuscritas [11][12][13] .…”

Intravenous fluid use in the acutely unwell adult medical inpatient: improving practice through a clinical audit process

“…[1][2][3][4] In hospital patients, there is increasing evidence of significant deficiencies in the quality of the process of prescribing, dispensing and administering of medications. [11][12][13][14][15] One inaccuracy may not lead to significant patient harm, but when multiple errors occur together, there can be a significant risk of morbidity and potentially death (for example the mis-prescribing and administration of co-amoxiclav in a patient with a history of penicillin allergy). Thus measures are often undertaken to increase awareness of the dangers of inappropriate prescribing.…”

Medication wrong route administration: a poisons center-based study

“…However we acknowledge that the issue of the frequency of medical errors in the critical care setting is controversially discussed in medical literature [30,31] and our findings might also be influenced by other factors such as underreporting as a consequence of fear of punitive measures [32,33]. In our study, most administration errors occurred on the wards, where work under time pressure due to shortage of personnel and heavy workload are recognized risk factors [34].…”