Medication Administration Discrepancies Persist Despite Electronic Ordering

Abstract

Background Up to 38% of inpatient medication errors occur at the administration stage. Although they reduce prescribing errors, computerized provider order entry (CPOE) systems do not prevent administration errors or timing discrepancies. This study determined the degree to which CPOE medication orders matched actual dose administration times. METHODS At a 658-bed academic hospital with CPOE but lacking electronic medication administration charting, authors randomly selected adult patients with eligible medication orders from historical 1999-2003 CPOE log files. Retrospective manual chart audits compared expected (from CPOE) and actual timing of medication administrations. Outcomes included: dose omissions, median lag times between ordered and charted administrations, unauthorized doses, wrong dose errors, and the rate of nurses' medication schedule shifting. RESULTS Dose omissions occurred in 756 of 6019 (12.6%) audited administration opportunities; only 313 of the omissions (5.2% of opportunities) were unexplained. Wrong doses and unexpected doses occurred for 0.1% and 0.7% of opportunities, respectively. Median lag from expected first dose to actual charted administration time was 27 minutes (IQR 0-127). Nursing staff shifted from ordered to alternate administration schedules for 10.7% of regularly scheduled recurring medication orders. Chart review identified reasons for dose omissions, delays, and dose shifting. CONCLUSION Inpatient CPOE orders are legible and conveyed electronically to nurses and the pharmacy. Nonetheless, ward-based medication administrations do not consistently occur as ordered. Medication administration discrepancies are likely to persist even after implementing CPOE and bar-coded medication administration unless recommended interventions are made to address issues such as determining the true urgency of medication administration, avoiding overlapping duplicative medication orders, and developing a safe means for shifting dosing schedules.

Erros Na Administração De Medicamentos: Evidências E Implicações Na Segurança Do Paciente

“…Dentre os tipos de erros na AM encontrados nesta revisão, o principal deles diz respeito à dosagem medicamentosa, presente em 27 estudos (67,5%) (8,(10)(11)(13)(14)(16)(17)(19)(20)(23)(24)(25)(26)(27)(28)(30)(31)(32)34,36,(42)(43)(44)(45)(46)(47)(48)(49) . Corroborando com tal achado, uma pesquisa (50) que teve como um dos objetivos identificar o perfil dos erros cometidos durante o preparo, encontrou que 67,7% dos erros estavam associados a doses preparadas erroneamente.…”

“…Desta maneira, se não houver a justificativa alusiva a não AM prescrito, explicitada nos registros documentais do paciente, o ato será caracterizado como omissão. E, nessa pesquisa, evidenciou-se que 14 (35,0%) (13)(14)(15)17,(19)(20)(23)(24)36,(44)(45)(47)(48)(49) estudos relataram este tipo de erro.…”

Omission after admission: failure in prescribed medications being given to inpatients

“…A previous audit in 2004 (unpublished) revealed the same finding of 20% of prescriptions not being given. Dose omission from drug charts has previously been identified as a problem, affecting 12.6% of patients, 4 in a study on electronic prescribing. The results of this audit, in a hospital that does not use electronic prescribing, reveal even worse omission rates, perhaps understandably since it related to the first and most difficult 48 hours of admissions.…”

Assessment and Evaluation Tools for Health-Care Ergonomics: Musculoskeletal Disorders and Patient Handling

“…At the same time, reviews show that among studies demonstrating improvement there are also studies showing no safety benefits of CPOE (Eslami et al, 2007), that mainly minor errors are reduced (Reckmann et al, 2009), that error reduction is not always associated with actual reduction of harm/adverse drug events (Wolfstadt et al, 2008;van Rosse et al, 2009), and that the greatest benefits result not from CPOE alone but from CPOE systems that are integrated with decision support functionality (Kaushal et al, 2003). There are also reports that CPOE does not reduce downstream (e.g., medication administration) Downloaded by [Swinburne University of Technology -Australia] at 10:31 18 May 2016 errors (Fitzhenry et al, 2007), that new errors are introduced (Koppel et al, 2005;Campbell et al, 2006;Chuo and Hicks, 2008), that mortality rates increase post-CPOE (Han et al, 2005), and that CPOE systems are sometimes aborted or abandoned (Ornstein, 2003;Aarts et al, 2004).…”