The frequency and nature of medication errors in hospitalized patients with acute coronary syndrome

Abstract

Background Cardiovascular medications have been commonly associated with medication errors. Objective The objective of this study was to investigate the incidence and predictors of medication errors in patients with acute coronary syndrome. Setting the coronary care unit of a university teaching hospital. Methods This was a prospective observational study on 150 patients admitted to the coronary care unit between August 2014 and July 2015. Main outcome measure The principal outcome was the number (frequency) of encountered medication errors. Results Of total 5790 prescription items reviewed, 547 (9.4%) potential medication errors were identified of which 523 (9.0%) were prescribing errors and 24 were monitoring errors. The most frequent prescribing errors were dosing errors (231, 42.2%) followed by loading dose omission error (91, 16.6%), omission of essential drugs on 1st day (43, 7.9%), and timing error (40, 7.3%). Errors frequently encountered with drugs such as aspirin, enoxaparin, beta-blockers followed by angiotensin-converting enzyme inhibitors and clopidogrel. Multivariate logistic regression analysis revealed that renal impairment (OR 6.02; 95% CI 1.4-35.4; p = 0.02) and longer duration of hospital stay (OR 4.01; 95% CI 1.5-10.7; p = 0.005) were predictors of the higher incidence of medication errors. Conclusion Prescribing and monitoring errors in coronary care unit are frequent and avoidable, with the majority of errors were ranked to be of mild to moderate severity. Dosing errors, omission of essential drugs and monitoring errors were most common error types encountered. Dosage adjustment based on estimation of the glomerular filtration rate immediately after admission help avoiding dosage-related errors.

Medication errors and risk areas in a critical care unit

“…In general terms, we identify a global error rate (1.93%) lower than that published in various international studies (9.4-64%) (Ali et al, 2017;Bagheri-Nesami et al, 2015;Sada et al, 2015). It is close to the average recorded by all hospitals in the same Spanish region (1.74%) (Requena et al, 2010).…”

“…The analysis of the sociodemographic variables (gender and age), together with the fact that most of the unit admissions were surgical critical care patients, allows us to assert that the characteristics of our study unit matched with those other mixed ICUs, as shown with the analyses of these aspects in previously published works (Pichala et al, 2013;Sada et al, 2015;Summa-Sorgini et al, 2012). Moreover, the mean average stay (5.97 days), a relevant factor that has been associated with the pharmacological adverse events (Ali et al, 2017), resembles that other research works undertook in this area (Sada et al, 2015;Valentin et al, 2006).…”

“…Without pretending to downplay the mistakes that are committed during drug administration (last filter before they reach the patient), other studies have reported a significant volume of errors during prescription (Ali et al, 2017;Sada et al, 2015;Shehata et al, 2016).…”

“…According to the National Patient Safety Agency of the UK, this phase brings together 50% of ME (Bagheri‐Nesami et al., 2015). Without pretending to downplay the mistakes that are committed during drug administration (last filter before they reach the patient), other studies have reported a significant volume of errors during prescription (Ali et al., 2017; Sada et al., 2015; Shehata et al., 2016). Sociedad Española de Medicina Intensiva y Unidades Coronarias et al.…”

Collaboration between cardiologist and clinical pharmacist on prescription quality: What is the potential clinical impact for cardiology patients?

“…The most frequent therapeutic classes with ME were statins, ACE inhibitors, antiplatelet agents and beta blockers. A study by Sayed et al showed that the prescriptions of patients with ACS or HF frequently had ME 18 . Despite the cardiologists having excellent knowledge of these drugs, the pharmacists can participate in the optimisation of the quality of these prescriptions, particularly with respect to the improvement in the implementation of guidelines.…”