An observational study of intravenous medication errors in the United Kingdom and Germany

Department of Practice and Policy, School of Pharmacy, University of London, UK.
International Journal of Clinical Pharmacy (Impact Factor: 1.27). 07/2003; 25(3):104-11. DOI: 10.1023/A:1024009000113
Source: PubMed


To investigate the incidence and the severity of intravenous (i.v.) drug preparation and administration errors in two countries and three pharmacy services.
A disguised observational method was used to record details of the preparation and administration of prescribed i.v. drugs on two wards in each of three teaching hospitals: one with a traditional British ward pharmacy service (TBP) and two hospitals in Germany, one with a traditional ward stock supply (TGP) and one with a satellite pharmacy service (GSP) with unit dose system. Main outcome measures: Errors in i.v. drug preparation and administration and their potential significance.
The number of observed preparations/administrations were: TBP 77/63, TGP 126/109 and GSP 134/106. The preparation error rates were: TBP 22% (95% confidence interval: 13-31%), TGP 23% (16-30%) and GSP 31% (23-39%). The administration error rates were TBP 27% (16-38%), TGP 49% (39-58%) and GSP 22% (14-30%). The percentage of administration errors on the wards with TGP was statistically significantly higher than in the other two services. Common errors at the study sites with TBP and GSP were omissions. Wrong rate of administration occurred most frequently on the wards with TGP. The majority of errors were likely to be of 'moderate' to 'severe' outcome. Careful drug chart reading could possibly reduce omission errors on the wards with TBP. A change of the German nursing law ('Krankenpflegegesetz') to legally entitle nurses to administer i.v. drugs could probably result in better training, national guidelines and standards.
This study found a high rate of i.v. medication errors of moderate to severe significance. Changes in practice should be considered to make i.v. therapy safer for patients.

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    • "Whereas among the DRPs in our study majority seen were incompatibilities (40.9%, n = 45), followed by complications developed (12.7%, n = 14) after IV administrations, errors in the rate of administration were accounted for 12 patients (10.9%) and errors in the dilution accounted for nine patients (8%). In contrast, another study revealed that wrong rate of administration was the most frequent error, followed by omissions and wrong dose.[20] "
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    ABSTRACT: Background: Infusion therapy through intravenous (IV) access is a therapeutic option used in the treatment of many hospitalized patients. IV therapy is complex, potentially dangerous and error prone. The objectives were to ascertain the drug-related problems (DRPs) involved in IV medication administration and further to develop strategies to reduce and prevent the occurrence of DRPs during IV administration. Materials and Methods: A prospective observational study was carried out for a period of 4 months. Patients receiving more than two medications through IV route were included and studied. Results: Of 110 patients, 76 (69.09%) were male and the rest were female. Nearly, half of the patients (46.3%, n = 51) were reported with DRPs. Of the 80 DRPs (72.72%) documented, 61 problems (55.4%) were seen in patients given IV medications through peripheral line. Among the DRPs majority seen were incompatibilities (40.9%, n = 45), followed by complications developed (12.7%, n = 14), errors in rate of administration (10.9%), and dilution errors (8%). To study the association of DRPs among gender, statistical analysis was performed and significant association was seen between DRPs and gender (P = 0.03). Conclusion: Among the reported DRPs, simultaneous IV administration of two incompatible drugs was the main predicament faced.
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    • "Another study found that the medication administration error rate for intravenous medication is significantly higher than other types of medication, the researchers observing the preparation error rate as 26 % and the administration error rate as 34 % [68]. Our findings therefore are also consistent with the previous studies’ results highlighting that intravenous MEs occur more frequently than preparation errors [68]. In addition, Armitage and Knapman found that the frequency of administration errors ranges from 2.4 % to 47.5 %, depending on the drug distribution system in place [69]. "
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