Medication errors in patients with enteral feeding tubes in the intensive care unit

Sohrevardi, Seyed Mojtaba; Jarahzadeh, Mohammad Hossein; Mirzaei, Ehsan; Mirjalili, Mahtabalsadat; Tafti, Arefeh Dehghani; Heydari, Behrooz

doi:10.4103/jrpp.jrpp_17_9

Cited by 30 publications

(19 citation statements)

References 14 publications

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“…From a pharmacological point of view, together with previously published results, our findings confirm the existence of important risk areas in critical care related to the administration of medications via NGTs, although the intravenous route is the most widely used in this context [18, 19]; the dose interval of antibiotics [16, 17]; and the dilution, concentration, and infusion speed of high-risk medications [6, 21, 22, 45, 46].…”

Section: Discussionsupporting

confidence: 84%

“…Published work has identified certain pharmacological groups as having extensive multicausality error risks; among these, antibacterial drugs are particularly important because of their widespread use and frequency of errors in their use [16, 17]. Another high-risk group are pharmaceuticals that cannot be administered via a nasogastric tube (NGT) [18, 19] as well as high-risk medications in general [6, 20–22]. However, key determinants must first be identified in order to define effective error prevention strategies [10, 23–25].…”

Section: Introductionmentioning

confidence: 99%

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Medication errors and drug knowledge gaps among critical-care nurses: a mixed multi-method study

Gracia

Serrano

Garrido

2019

BMC Health Serv Res

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Background Medication errors are a serious and complex problem in clinical practice, especially in intensive care units whose patients can suffer potentially very serious consequences because of the critical nature of their diseases and the pharmacotherapy programs implemented in these patients. The origins of these errors discussed in the literature are wide-ranging, although far-reaching variables are of particular special interest to those involved in training nurses. The main objective of this research was to study if the level of knowledge that critical-care nurses have about the use and administration of medications is related to the most common medication errors. Methods This was a mixed (multi-method) study with three phases that combined quantitative and qualitative techniques. In phase 1 patient medical records were reviewed; phase 2 consisted of an interview with a focus group; and an ad hoc questionnaire was carried out in phase 3. Results The global medication error index was 1.93%. The main risk areas were errors in the interval of administration of antibiotics (8.15% error rate); high-risk medication dilution, concentration, and infusion-rate errors (2.94% error rate); and errors in the administration of medications via nasogastric tubes (11.16% error rate). Conclusions Nurses have a low level of knowledge of the drugs they use the most and with which a greater number of medication errors are committed in the ICU. Electronic supplementary material The online version of this article (10.1186/s12913-019-4481-7) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Medication errors and drug knowledge gaps among critical-care nurses: a mixed multi-method study

Gracia

Serrano

Garrido

2019

BMC Health Serv Res

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“…Inappropriate administration of medications by the NGT led to 23 interventions. Crushed pantoprazole gastro-resistant tablets were most often the subject of the CP' s intervention, and this was also observed in other studies [35,36]. The CP suggested to avoid the administration of large particles and www.bjbms.org [37] identified 457 potential interactions in 240 ICU patients, and 25% of DDIs were considered as major (based on the Lexicomp ® and Micromedex ® databases).…”

Section: Discussionmentioning

confidence: 55%

Interventions of a clinical pharmacist in a medical intensive care unit – a retrospective analysis

Cvikl

Sinkovič

2020

Bosn J of Basic Med Sci

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Several studies demonstrated a significant decrease in prescription errors, adverse drug events, treatment costs and improved patient outcomes, when a clinical pharmacist (CP) was a full member of a multidisciplinary team in the intensive care unit (ICU). Our aim was to evaluate the activities of a CP, included in a 12-bed medical ICU team of a university hospital in the course of several months. We conducted a retrospective analysis of all the CP' s interventions from March 2017 to November 2017, carried out and documented after reviewing and discussing patients' medical data with the treating ICU physicians. We identified four main categories of CP' s interventions: pharmacotherapy adjustments to kidney function (PAKF category), drug-drug interactions (DDIs category), therapeutic monitoring of drugs with narrow therapeutic index (TDM category), and drug administration by the nasogastric tube (NGT category). During the study period, 533 patients were admitted to the medical ICU. The CP reviewed the medical data of 321 patients and suggested 307 interventions in 95 patients. There were 147 interventions of the PAKF category, 57 interventions of the TDM category, 30 interventions of the NGT category, and 22 interventions of the DDIs category. Fifty-one interventions were unspecified. The majority of all interventions (203/307) were related to antimicrobial drugs. ICU physicians completely accepted 80.2% of the CP' s suggestions.We observed that regular participation of the CP in the medical ICU team contributed to more individualized and improved pharmacological treatment of patients. Therefore, ICU teams should be encouraged to include CPs as regular team members.

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“…Our reported results, which are highly similar to those previously published by the scientific community in regard to the type of error and drugs involved, confirm these findings. The following aspects pose a risk in ICU: nasogastric tube drug administration (Emami et al, 2012;Sohrevardi et al, 2017); errors in the frequency of antibiotic dose regimens (Agalu et al, 2012;Kiekkas et al, 2011;Muroi et al, 2017;Tainter et al, 2018); and dilution, concentration and infusion rate errors with high-risk medications (Esfahani et al, 2016;Sada et al, 2015;Summa-Sorgini et al, 2012).…”

Section: From a Pharmacological Point Of View Significant Risk Arementioning

confidence: 99%

“…On the one hand, antibiotics are one of the most used medication groups in the ICU, and in turn, with which the greatest number of error opportunities is recorded in relation to the administration schedule (Agalu et al, 2012;Camire et al, 2009;Muroi et al, 2017). Likewise, numerous errors have been detected with manipulation of pharmaceutical forms to be administered through nasogastric tubes (Emami et al, 2012;Sohrevardi et al, 2017). Lastly, many studies have identified high-risk medications as responsible of severe ME (Esfahani et al, 2016;Hsaio et al, 2010;Lu et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Medication errors and risk areas in a critical care unit

Gracia

Sanz

Serrano

et al. 2020

Journal of Advanced Nursing

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Aims The aim of this study was to identify the main medication errors, their causality and the highest risk areas in critical care. Design A descriptive, longitudinal and retrospective study. Methods We performed a systematic analysis of the prescription, transcription and administration records of 2,634 dose units of medications that were administered to a total of 87 critically ill patients during 2018. Results Final results have shown important medication errors and a high number of significant drug interactions; prescription phase had the highest mistake rate (71%) and cause of errors (68%); transcription stage had a more variable error typology. A significant correlation was observed between the presence of causes and contributing factors to error during the prescription and the commission of errors during the nurse transcription, being the main risk areas the time of antibiotic administration, dilution errors, concentration and speed of administration of high‐risk medications and the technique used for nasogastric tube drug administration. Conclusion In critical care, an intolerable number of medication errors are still committed, placing the origin of many of them in the causality and contributing factors identified in the prescription stage. Impact The origin of many of the medication errors and most interactions is in the prescription stage, being the nurse transcription (nurse intervention) in an important filter that prevents a considerable number of errors from finally reaching the patient. The schedule of administration of time‐dependent antibiotics, high‐risk medications and the technique of administering medications through a nasogastric tube are important risk areas for the commission of medication errors.

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Medication errors in patients with enteral feeding tubes in the intensive care unit

Cited by 30 publications

References 14 publications

Medication errors and drug knowledge gaps among critical-care nurses: a mixed multi-method study

Medication errors and drug knowledge gaps among critical-care nurses: a mixed multi-method study

Interventions of a clinical pharmacist in a medical intensive care unit – a retrospective analysis

Medication errors and risk areas in a critical care unit

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