Medication Errors in a Swiss Cardiovascular Surgery Department: A Cross-Sectional Study Based on a Novel Medication Error Report Method

Abstract

The purpose of this study was (1) to determine frequency and type of medication errors (MEs), (2) to assess the number of MEs prevented by registered nurses, (3) to assess the consequences of ME for patients, and (4) to compare the number of MEs reported by a newly developed medication error self-reporting tool to the number reported by the traditional incident reporting system. We conducted a cross-sectional study on ME in the Cardiovascular Surgery Department of Bern University Hospital in Switzerland. Eligible registered nurses (n = 119) involving in the medication process were included. Data on ME were collected using an investigator-developed medication error self reporting tool (MESRT) that asked about the occurrence and characteristics of ME. Registered nurses were instructed to complete a MESRT at the end of each shift even if there was no ME. All MESRTs were completed anonymously. During the one-month study period, a total of 987 MESRTs were returned. Of the 987 completed MESRTs, 288 (29%) indicated that there had been an ME. Registered nurses reported preventing 49 (5%) MEs. Overall, eight (2.8%) MEs had patient consequences. The high response rate suggests that this new method may be a very effective approach to detect, report, and describe ME in hospitals.

Intravenous Medication Administration Errors and their Causes in Cardiac Critical Care Units in Iran

“…In a study conducted in four 90-bed hospital departments of a hospital in Paris, including the cardiac surgery unit, the internal cardiac unit, the vascular department and the nephrology division, and with the participation of 28 nurses, wrong time and dose omission were reported to be the most common errors committed ( 21 ). In a study conducted in five cardiovascular surgery departments in Switzerland over a period of one month and with the participation of 119 nurses and the administration of 24617 doses of medications using the self-reporting technique, the wrong time errors was introduced as the most common medication error committed ( 22 ). In the present study, the wrong time error was proposed as the ninth most common type of error in the administration of intravenous medications.…”

Analysis of Compliance with the Implementation of Medicines Standards by Pharmaceutical Staff at the Dr. Tadjuddin Chalid Central Public Hospital Makassar

“…Patient safety incidents were found in Indonesia in 2011 Hospital Patient Safety Committee (KKPRS) reported 145 patient safety incidents. DKI Jakarta is a province that ranks the highest at 37.9%, Central Java at 15.9%, DI Yogyakarta at 13.8%, East Java at 11.7%, South Sumatra at 6.9%, West Java at 2,8%, Bali with 1.4%, East Kalimantan with 0.69%, and Aceh A similar study was conducted by Küng et al (2013) at the University Hospital of Bern, Switzerland for a period of one month which reported 288 incidents of medication errors from a total of 24,617 doses of medication given to cardiovascular patients, of which 29% of the medication errors were prescribing errors, 13% transcription errors, and 58% in the form of administration errors. In addition, based on the results of a study in 2011-2013 conducted by the Pharmacology Department of Gajah Mada University, it was found that medication errors occurred in 97% of patients (Hartati et al, 2014).…”

Medication Error at the Prescribing Phase

“…Maalangen, et., al., (2019) revealed that there is still a Medication Error in the prescribing and dispensing phases in a hospital in Manado. A similar study was also conducted by Küng et al, (2013), at the University Hospital of Bern, Switzerland which reported 288 Medication Errors from a total of 24,617 treatments given to patients, of which 29% of the Medication Error was prescribing error, 13 % transcribing errors, and 58% in the form of administration errors.…”