Abstract
This study analyzes the influence of medical prescriptions' writing on the occurrence of medication errors in the medical wards of five Brazilian hospitals. This descriptive study used data obtained from a multicenter study conducted in 2005. The population was composed of 1,425 medication errors and the sample included 92 routes through which medication was wrongly administered. The pharmacological classes most frequently involved in errors were cardiovascular agents (31.5%), medication that acts on the nervous system (23.9%), and on the digestive system and metabolism (13.0%). In relation to the prescription items that may have contributed to such errors, we verified that 91.3% of prescriptions contained acronyms and abbreviations; patient information was missing in 22.8%, and 4.3% did not include the date and were effaced. Medication wrong-route administrations are common in Brazilian hospitals and around the world. It is well established that these situations may result in severe adverse events for patients, including death.
Highlights
Errors in healthcare result from a non-intentional action caused by some problem or failure during care delivered to patients[1], and can be committed by any member of the health team at any point of the care process such as when administering medication to patients
In relation to the pharmacological classes involved in wrong-route administrations, according to the Anatomical Therapeutic Chemical (ATC) system, 31.5% of the medication belonged to group C, while captopril was the most frequent drug, representing 16.3% of the total of cases; 23.9% of the medication administered in wrong routes belonged to group N
A study conducted in the United States of America identified 1.8% of medication wrong-route administrations in a total of 146,974 events reported in the United States Pharmacopeia system (USP)(4)
Summary
Errors in healthcare result from a non-intentional action caused by some problem or failure during care delivered to patients[1], and can be committed by any member of the health team at any point of the care process such as when administering medication to patients. Medication errors can occur at any stage of medication therapy, from writing the prescription to the administration of medication to patients, and represents about 65% to 87% of all adverse events[2]. The medical prescription is the document that guides and influences the other stages of the medication process. Medical prescriptions have an important role in the prevention and occurrence of errors. It is known that ambiguous, illegible or incomplete prescriptions, the use of abbreviations, obscured writing and the lack of www.eerp.usp.br/rlae
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