Analysis of iatrogenic and in-hospital medication errors reported to United States poison centers: a retrospective observational study

Abstract

Medication errors are common in healthcare settings. Previous poison-center studies have evaluated medication errors, but not specifically iatrogenic or in-hospital errors. The purpose of this study was to describe errors attributed to healthcare professionals or occurring in a healthcare facility reported to poison centers. This was a retrospective study of medication errors reported to the US National Poison Data System from 2000 through 2017. Inclusion criteria were reason for exposure coded “unintentional, therapeutic error”, error scenario of health professional/iatrogenic error, or the location of exposure was in a healthcare facility. Variables assessed for each case included age, medication class, error scenario, medical outcome, and day of week and time case initiated. Descriptive statistics were performed. There were 99,431 cases included. Median age was 20 years (interquartile range: 3–53), with ages ranging from 1 day to 108 years; 50.0% of cases were female. The most frequently reported medication categories were antimicrobials (13.6%), followed by analgesics (10.1%), then sedatives/hypnotics (8.9%), although the classes of drugs varied by age group. The most common error scenarios were “wrong medication taken or given,” “other incorrect dose,” and “incorrect dosing route,” although these differed by age group with more “other incorrect dose” reported in 0–5 years and “wrong medication taken or given” predominating in the other age groups. Serious effects (death and major effect) occurred at a higher frequency in the 65 + years age group than in all other age groups. The time of day with the most cases was 7–9 pm, with the lowest around 3–5 am. Fewer cases were reported on weekends than during the other days of the week. This study provides a more detailed evaluation of iatrogenic and in-hospital errors reported to poison centers and their related scenarios. Prevention efforts should continue to focus on reducing the incidence of errors with an emphasis on reducing the most frequent errors.