Article

Errors in the medication process: Frequency, type, and potential

Aarhus University Hospital, Department of Quality improvement and Patient Safety, Aarhus, Denmark.
International Journal for Quality in Health Care (Impact Factor: 1.58). 03/2005; 17(1):15-22. DOI: 10.1093/intqhc/mzi015
Source: PubMed

ABSTRACT To investigate the frequency, type, and consequences of medication errors in more stages of the medication process, including discharge summaries.
A cross-sectional study using three methods to detect errors in the medication process: direct observations, unannounced control visits, and chart reviews. With the exception of errors in discharge summaries all potential medication error consequences were evaluated by physicians and pharmacists.
A randomly selected medical and surgical department at Aarhus University Hospital, Denmark.
Eligible in-hospital patients aged 18 or over (n = 64), physicians prescribing drugs and nurses dispensing and administering drugs.
Frequency, type, and potential clinical consequences of all detected errors compared with the total number of opportunities for error.
We detected a total of 1065 errors in 2467 opportunities for errors (43%). In worst case scenario 20-30% of all evaluated medication errors were assessed as potential adverse drug events. In each stage the frequency of medication errors were-ordering: 167/433 (39%), transcription: 310/558 (56%), dispensing: 22/538 (4%), administration: 166/412 (41%), and finally discharge summaries: 401/526 (76%). The most common types of error throughout the medication process were: lack of drug form, unordered drug, omission of drug/dose, and lack of identity control.
There is a need for quality improvement, as almost 50% of all errors in doses and prescriptions in the medication process were caused by missing actions. We assume that the number of errors could be reduced by simple changes of existing procedures or by implementing automated technologies in the medication process.

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    • "In emergency of Hospital A, the prescriptions on which the dose was not mentioned counted as 43.9% as compared to 1% in emergency department of Hospital B, probably due to e-prescribing in this department. In a study, the most common types of error throughout the medication process were: lack of drug form, unordered drug, and omission of drug/dose [18]. A small percentage (0.6–7.5%) of under dose can be seen in both hospitals prescriptions, this may lead to incomplete treatment and the patients usually need extra visits to hospitals. "
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    ABSTRACT: The knowledge of medication errors is an essential prerequisite for better healthcare delivery. The present study investigated prescribing errors in prescriptions from outpatient departments (OPDs) and emergency wards of two public sector hospitals in Lahore, Pakistan. A manual prescription system was followed in Hospital A. Hospital B was running a semi-computerised prescription system in the OPD and a fully computerised prescription system in the emergency ward. A total of 510 prescriptions from both departments of these two hospitals were evaluated for patient characteristics, demographics and medication errors. The data was analysed using a chi square test for comparison of errors between both the hospitals. The medical departments in OPDs of both hospitals were the highest prescribers at 45%-60%. The age group receiving the most treatment in emergency wards of both the hospitals was 21-30 years (21%-24%). A trend of omitting patient addresses and diagnoses was observed in almost all prescriptions from both of the hospitals. Nevertheless, patient information such as name, age, gender and legibility of the prescriber's signature were found in almost 100% of the electronic-prescriptions. In addition, no prescribing error was found pertaining to drug concentrations, quantity and rate of administration in e-prescriptions. The total prescribing errors in the OPD and emergency ward of Hospital A were found to be 44% and 60%, respectively. In hospital B, the OPD had 39% medication errors and the emergency department had 73.5% errors; this unexpected difference between the emergency ward and OPD of hospital B was mainly due to the inclusion of 69.4% omissions of route of administration in the prescriptions. The incidence of prescription overdose was approximately 7%-19% in the manual system and approximately 8% in semi and fully electronic system. The omission of information and incomplete information are contributors of prescribing errors in both manual and electronic prescriptions.
    PLoS ONE 08/2014; 9(8):e106080. DOI:10.1371/journal.pone.0106080 · 3.23 Impact Factor
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    • "In detecting problems in the medication process, a direct observation method has been found to be a more efficient and accurate method than reviewing charts and incident reports (Flynn et al., 2002). This method was quite similar to a previous structured observation study conducted in Aarhus University Hospital's medical and surgical wards (Lisby et al., 2005), which also revealed information concerning the lack of patients' identification. However, unlike that study, we identified work environmental and nurse-related factors that could be associated with patient identification. "
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    ABSTRACT: The aims of this study were to clarify how a patient's identity was verified before the administration of medication in medical and surgical wards in a hospital, as well as to study the association between patient identification and the registered nurse's work experience, observed interruptions, and distractions. The study material was collected during April and May 2012 in two surgical and two medical wards in one university hospital in Finland, using a direct, structured observation method. A total of 32 registered nurses were observed while they administered 1058 medications to 122 patients. Patients were not identified at all in 66.8% (n = 707) of medication administrations. Patient identifications were made more often by nurses with shorter work experience in the nursing profession or in the wards (4 years or less), or if distractions existed during medication administration. According to the results, patient identification was not adequately conducted. There is a need for education and change in the culture of medication processes and nursing practice.
    Nursing and Health Sciences 07/2014; 17(2). DOI:10.1111/nhs.12158 · 0.85 Impact Factor
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    • "However, even a highly computerised medication process cannot bring a total elimination of errors. High rates of ADEs may continue to occur after the implementation of CPOE and the related computerised medication systems that lack decision support for drug selection, dosing and monitoring [32]. On the other hand, the whole portfolio of errors has changed substantially: majority of the errors made during drug administration and drug dispensing has been reduced to a very minimum (administration to 13%, dispensing to 1%, transcription to 0%), while the prevailing part of the remaining errors consists of ordering (61%) and monitoring (25%). "
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    ABSTRACT: (1) to rationalise the hypothesis that risks and losses relating to medication process' errors in Czech hospitals are at least comparable with the other developed countries and EU countries especially, (2) to get a valid professional opinion/estimate on the rate of adverse drug events happening in Czech hospitals, (3) to point out that medication errors represent real and serious risks and (4) to induce the hospital management readiness to execute fundamental changes and improvements to medication processes. We read through a lot of studies inquiring into hospitals' medication safety. Then, we selected the studies which brought reliable findings and formulated credible conclusions. Finally, we addressed reputable Czech experts in health care and asked them structured questions whether the studies' findings and conclusions corresponded with our respondents' own experience in the Czech hospital clinical practice and what their own estimates of adverse drug events' consequences were like. Based on the reputable Czech health care expert opinions/estimates, the rate of a false drug administration may exceed 5%, and over 7% of those cause serious health complications to Czech hospital inpatients. Measured by an average length of stay (ALOS), the Czech inpatients, harmed by a false drug administration, stay in hospital for more than 2.6 days longer than necessary. Any positive changes to a currently used, traditional, ways of drug dispensing and administration, along with computerisation, automation, electronic traceability, validation, or verification, must well pay off. Referring to the above results, it seems to be wise to follow the EU priorities in health and health care improvements. Thus, a right usage of the financial means provided by the EC-in terms of its new health programmes for the period 2014-2020 (e.g. Horizon 2020)-has a good chance of a good result in doing the right things right, at the right time and in the right way. All citizens of the EU may benefit using the best practice.
    05/2014; 5(1):7. DOI:10.1186/1878-5085-5-7
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