Errors in the medication process: frequency, type, and potential
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.
SourceAvailable from: Marja Härkänen[Show abstract] [Hide abstract]
ABSTRACT: The purpose of this study is to present a comprehensive and valid estimate of the problems that arise in the medication process in hospitals. Specifically the study aims to examine medication-related adverse outcomes and contributing factors of hospital patients, to study the associations between adverse outcomes and contributing factors, and to compare differences between the detection methods. This study was conducted in one university hospital in Finland. Three types of data sets were analysed statistically including retrospectively collected medication-related incident reports (n=671) from the year 2010, retrospectively collected randomly selected patients’ records (n=463) from the year 2011 using the Global Trigger Tool (GTT) method, and observations (n=1058) of medication administrations by nurses’ with record reviews (n=122) during April to May 2012. In addition, secondary analysis of medication administration errors (n=453) detected by three methods was conducted. A total of (n=1059) medication errors and (n=311) adverse drug events were detected. Harm to patients was caused in 48% of detected medication errors in GTT data, 18% in incident reports, and 3% in observational data. Most of the detected errors were administration or documenting errors. The most common types of medication errors were wrong dose, omission, and wrong administration technique. There were differences between the detection methods when the information of the medication errors stages, types, and severities were compared. The most important work environmental factors contributing to errors were rush, lack of training, problems in the communication systems, in the electronic records, or in the common policies and procedures. Omission of double-checking, problems in communication and flow of information were the most common among the team factors contributing to errors. Of the employee-related factors performance deficit, stress/high volume workload, miscalculation of dosage or infusion rate, and knowledge deficit were the most common. The most important patient-specific factors were the amount of drugs, length of hospital stay, coronary artery disease, and co-morbidity. The most common drug-related factors contributing to errors were other than p.o administration and specific drugs. This study demonstrated that medication-related adverse outcomes are common and incident reports, GTT, and observation methods produce different information about the problems in the medication process. Understanding the complex reality of the hospital environment and the medication process can be limited by using only one detection method, because each detection methods had its limitations. Thus, combining the methods revealed more diverse information regarding medication-related problems in hospital that can be used to increase safety in the medication process.12/2014; , ISBN: 978-952-61-1636-5
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ABSTRACT: The technology-driven medication process is complex, involving advanced technologies, patient participation and increased safety measures. Medication administration errors are frequently reported, with nurses implicated in 26-38% of in-hospital cases. This points to the need for new ways of educating nursing students in today's medication administration. To explore nursing students' experiences and competences with the technology-driven medication administration process. 16 pre-graduate nursing students were included in two focus group interviews which were recorded, transcribed and analyzed using the systematic horizontal phenomenological-hermeneutic template methodology. The interviews uncovered that understanding the technologies; professionalism and patient safety are three crucial elements in the medication process. The students expressed positivity and confidence in using technology, but were fearful of committing serious medication errors. From the nursing students' perspective, experienced nurses deviate from existing guidelines, leaving them feeling isolated in practical learning situations. Having an unclear nursing role model for the technology-driven medication process, nursing students face difficulties in identifying and adopting best practices. The impact of using technology on the frequency, type and severity of medication errors; the technologies implications on nursing professionalism and the nurses ability to secure patient adherence to the medication process, still remains to be studied. Copyright © 2014 Elsevier Ltd. All rights reserved.Nurse Education in Practice 11/2014; DOI:10.1016/j.nepr.2014.11.015