Article

Frequency and determinants of drug administration errors in the intensive care unit.

Hospital Pharmacy Midden-Brabant, The Netherlands.
Critical Care Medicine (Impact Factor: 6.12). 05/2002; 30(4):846-50. DOI: 10.1097/00003246-200204000-00022
Source: PubMed

ABSTRACT The study aimed to identify both the frequency and the determinants of drug administration errors in the intensive care unit.
Administration errors were detected by using the disguised-observation technique (observation of medication administrations by nurses, without revealing the aim of this observation to the nurses).
Two Dutch hospitals.
The drug administrations to patients in the intensive care units of two Dutch hospitals were observed during five consecutive days.
None.
A total of 233 medications for 24 patients were observed to be administered (whether ordered or not) or were observed to be omitted. When wrong time errors were included, 104 administrations with at least one error were observed (frequency, 44.6%), and when they were excluded, 77 administrations with at least one error were observed (frequency, 33.0%). When we included wrong time errors, day of the week (Monday, odds ratio [OR] 2.69, confidence interval [CI] 1.42-5.10), time of day (6-10 pm, OR 0.28, CI 0.10-0.78), and drug class (gastrointestinal, OR 2.94, CI 1.48-5.85; blood, OR 0.12, CI 0.03-0.54; and cardiovascular, OR 0.38, CI,0.16-0.90) were associated with the occurrence of errors. When we excluded wrong time errors, day of the week (Monday, OR 3.14, CI 1.66-5.94), drug class (gastrointestinal, OR 3.47, CI 1.76-6.82; blood, OR 0.21, CI 0.05-0.91; and respiratory, OR 0.22, CI 0.08-0.60), and route of administration (oral by gastric tube, OR 5.60, CI 1.70-18.49) were associated with the occurrence of errors. In the hospital without full-time specialized intensive care physicians (which also lacks pharmacy-provided protocols for the preparation of parenteral drugs), more administration errors occurred, both when we included (OR 5.45, CI 3.04-9.78) and excluded wrong time errors (OR 4.22, CI 2.36-7.54).
Efforts to reduce drug administration errors in the intensive care unit should be aimed at the risk factors we identified in this study. Especially, focusing on system differences between the two intensive care units (e.g., presence or absence of full-time specialized intensive care physicians, presence or absence of protocols for the preparation of all parenteral drugs) may help reduce suboptimal drug administration.

2 Bookmarks
 · 
257 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Research into the distribution of medication errors usually focuses on isolated stages within the medication use process. Our study aimed to provide a novel process-oriented approach to medication incident analysis focusing on medication error chains. Our study was conducted across a 900-bed teaching hospital in Switzerland. All reported 1591 medication errors 2009–2012 were categorized using the Medication Error Index NCC MERP and the WHO Classification for Patient Safety Methodology. In order to identify medication error chains, each reported medication incident was allocated to the relevant stage of the hospital medication use process. Only 25.8% of the reported medication errors were detected before they propagated through the medication use process. The majority of medication errors [74.2%] formed an error chain encompassing two or more stages. The most frequent error chain comprised preparation up to and including medication administration [45.2%]. "Non-consideration of documentation/prescribing" during the drug preparation was the most frequent contributor for "wrong dose" during the administration of medication. Medication error chains provide important insights for detecting and stopping medication errors before they reach the patient. Existing and new safety barriers need to be extended to interrupt error chains and to improve patient safety.
    The Journal of Clinical Pharmacology 04/2014; · 2.84 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: ARTICLE IN PRESS +Model MEDIN-532; No. of Pages 9 Med Intensiva. 2013;xxx(xx): Recibido el 10 de mayo de 2012; aceptado el 6 de noviembre de 2012 PALABRAS CLAVE Seguridad del paciente crítico; Errores de medicación; Eventos adversos; Notificación de incidentes Resumen Objetivo: Estimar la incidencia de los errores de medicación en los servicios de Medicina Inten-siva españoles. Diseño: Análisis post hoc del estudio SYREC. Estudio observacional longitudinal con seguimiento de 24 h de una cohorte de pacientes ingresados en los servicios de Medicina Intensiva partici-pantes. Ámbito: Servicios de Medicina Intensiva españoles. Pacientes: Pacientes ingresados en los servicios de Medicina Intensiva participantes en el estu-dio SYREC durante el periodo de inclusión. Variables principales de interés: Riesgo, riesgo individual y tasa de errores de medicación. Resultados: Participaron 79 servicios de Medicina Intensiva, incluyéndose 1.017 pacientes, registrándose 591 (58%) con al menos un incidente. De estos, 253 (43%) presentaron al menos un incidente relacionado con la medicación. El número total de incidentes notificados fue de 1.424, de los cuales 350 (25%) fueron errores de medicación. El riesgo que tiene un paciente de sufrir un error de medicación por ingresar en un servicio de Medicina Intensiva es del 22% (RIQ: 8%, 50%), mientras que el riesgo individual es del 21% (RIQ: 8%, 42%). La tasa de errores de medicación fue de 1,13 errores de medicación por 100 pacientes/día de estancia. La mayoría ocurrieron en la fase de prescripción (34%) y administración (28%); el 16% produjeron daño al paciente y un 82% se consideraron «sin duda evitables». Conclusiones: Los errores de medicación constituyen una de las clases de incidentes más frecuentes en el paciente crítico, siendo más habituales en las fases de prescripción y * Autor para correspondencia.
    Medicina Intensiva 02/2014; · 1.32 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Patients' risks from medication errors are widely acknowledged. Yet not all errors, if they occur, have the same risks for severe consequences. Facing resource constraints, policy makers could prioritize factors having the greatest severe-outcome risks. This study assists such prioritization by identifying work-related risk factors most clearly associated with more severe consequences. Data from three Canadian paediatric centres were collected, without identifiers, on actual or potential errors that occurred. Three hundred seventy-two errors were reported, with outcome severities ranging from time delays up to fatalities. Four factors correlated significantly with increased risk for more severe outcomes: insufficient training; overtime; precepting a student; and off-service patient. Factors' impacts on severity also vary with error class: for wrong-time errors, the factors precepting a student or working overtime significantly increase severe-outcomes risk. For other types, caring for an off-service patient has greatest severity risk. To expand such research, better standardization is needed for categorizing outcome severities.
    Healthcare policy = Politiques de sante 08/2012; 8(1):109-126.

Full-text (2 Sources)

Download
193 Downloads
Available from
May 21, 2014