Analysis of the influencing factors of nursing related medication errors based on the conceptual framework of international classification of patient safety

Abstract

Objective To identify the influencing factors of nursing related medication errors , and put forward the effective prevention and control measures .Methods One thousand three hundred and forty-three cases with medication errors from 15 tertiary hospitals in Shanghai Nursing Quality Control Center were chosen . The influencing factors were analyzed by the research tools which were constructed by the level of influencing factors depending on the international classification of patient safety （ ICPS ） through the method of content analysis.Results The occurrences of medication errors were most frequent （62.84%） in the early morning （8：00-16：00）, and were related to the most therapeutic nursing .The nursing related medication errors happened frequently in elderly patients with more than 70 years old （32.45%）, and which suggested that the abilities of self-care and communication in elderly patients were weak , and the elderly patients were the highest risk of medication errors .The results of safety events of patients in the ICPS were divided into 5 levels including the no, mild, moderate, severe, death.The percent of medication errors including the no , mild, moderate, severe, death in 1 343 cases were respectively 91.88%, 3.35%, 2.76%, 2.01%, 0%.The frequencies of influencing factors of nursing related medication errors in 1 343 cases were 3 185, and the frequencies from high to low were respectively routine violations ,“negligence” and “fault” in the technical mistakes ,“misapplication of good rules” in the error of rule, knowledge-based mistake, communication and illusion.Conclusions Application of the influencing factor of ICPS is helpful to discriminate the system and process defect from the perspective of human error in the nursing managers , and can improve the level of management of patient safety . Key words: International classification of patient safety; Medication error; Influencing factor; Content analysis