Drug Administration Errors Research Articles

Application of federal indicators in nursing-home drug-regimen review

Numbers of medications per patient and rate of drug administration errors were compared in Wisconsin long-term care facilities that used federal indicators in conducting drug-regimen review versus facilities that did not use the indicators. Data were collected from 1132 charts in 24 facilities randomly selected from a state survey schedule for June-October 1982. Both prescription and nonprescription drugs that patients received during the 30-day period preceding the survey were counted. Medication use was compared by facility type--skilled-nursing facility (SNF), intermediate-care facility (ICF), or ICF for the mentally retarded. The federal indicators were used in 10 facilities. Mean number of medications used per patient where indicators were applied (5.4 versus 6.6 for SNFs and 3.4 versus 5.8 for ICFs ) was not significantly different. In SNFs using the indicators, patients received 5.6 medications where the consultant pharmacist was also the provider and 5.2 where the consultant was not the provider. Medication use was not significantly different by facility type. The number of drug administration irregularities per 100 residents was significantly greater where indicators were not applied. Further study is needed to determine whether use of federal indicators encourages more efficient and appropriate drug therapy for patients in long-term care facilities.

Drug recognition by nurses and anaesthetists.

A survey of nurses and anaesthetists in a 500-bed teaching hospital set out to discover how they located a drug container in order to read its label and verify its contents. Members of each group assessed the value of seven factors thought to help in this location and answered questions on personal errors in drug administration. The nurses found the expected position of the drug container in the trolley or cupboard to be the most important factor, followed by the size of the container. The anaesthetists placed the colour of the container as most important, followed by the manufacturer's distinctive container as their second best guide to drug location. This preference for colour and a distinctive container can be used to reduce the chance of confusing drugs locally. A scheme for colour-coding ampoules in broad groups to reduce gross mistakes in the future is presented.

Drug administration audit.

Drug surveillance has demonstrated that inaccuracy of variable degree exists in medicine administration in hospital practice. Brooks et al. (1) found a 53%-67% incidence of dispensing errors in a study of forty general medical inpatients, but in a larger study of over seven thousand prescriptions to hospital patients, Tesh et al. (2) found only a 3% incidence of error in drug administration. Since 1974 the Aberdeen system (3), designed to reduce dispensing errors, has been used in our hospital. As an elementary effort in medical audit a study of drug administration in a general medical ward was undertaken to determine the current incidence of error.

Evaluation of lidocaine resistance in man using intermittent large-dose infusion techniques

Twelve patients with stable ventricular ectopic beats, nine with apparent resistance to lidocaine, were each studied with multiple intermittent large-dose lidocaine infusions that were started when ectopic beats were at peak frequencies and discontinued when either suppression or toxicity appeared. Of the nine patients with apparently resistant arrhythmias, three had arrhythmias, that were responsive at blood levels within the usual therapeutic range, four had arrhythmias refractory to lidocaine at usual blood levels but responsive at high blood levels, and two patients manifested toxicity without suppression of arrhythmia. Persisting ventricular arrhythmia during lidocaine therapy most often results from mechanical interference with the intravenous infusion route or from errors in drug administration. When these factors are excluded, there is a spectrum of patients who manifest various degrees of refractoriness to lidocaine.

The drug routine in hospital - whose responsibility?

We recently pointed out that doctors may be unaware how often patients fail to follow their instructions.1 Errors seem no less likely to arise in hospital.2–5 One study2 revealed an error rate of about 5% of all drug administrations in long-stay patients under favourable nursing conditions; others reported rates up to 20% in hospitals where checking systems were less rigorous and the nursing staff changed more frequently. Faulty routines may delay starting or stopping treatment, apart from errors in the actual administration of drugs. However, elaboration of any system in order to minimise errors might pass a point of maximum efficiency. For example, drug checking and recording occupies as much as 40% of a nurse’s time in some American hospitals.6