Nature Of Medication Errors Research Articles

An Assessment of Medication Errors Among Pediatric Patients in Three Hospitals in Freetown Sierra Leone: Findings and Implications for a Low-Income Country.

Pediatric patients are prone to medicine-related problems like medication errors (MEs), which can potentially cause harm. Yet, this has not been studied in this population in Sierra Leone. Therefore, this study investigated the prevalence and nature of MEs, including potential drug-drug interactions (pDDIs), in pediatric patients. The study was conducted in three hospitals among pediatric patients in Freetown and consisted of two phases. Phase one was a cross-sectional retrospective review of prescriptions for completeness and accuracy based on the global accuracy score against standard prescription writing guidelines. Phase two was a point prevalence inpatient chart review of MEs categorized into prescription, administration, and dispensing errors and pDDIs. Data was analyzed using frequency, percentages, median, and interquartile range. Kruskal-Wallis H and Mann-Whitney U-tests were used to compare the prescription accuracy between the hospitals, with p<0.05 considered statistically significant. Three hundred and sixty-six (366) pediatric prescriptions and 132 inpatient charts were reviewed in phases one and two of the study, respectively. In phase one, while no prescription attained the global accuracy score (GAS) gold standard of 100%, 106 (29.0%) achieved the 80-100% mark. The patient 63 (17.2%), treatment 228 (62.3%), and prescriber 33 (9.0%) identifiers achieved an overall GAS range of 80-100%. Although the total GAS was not statistically significant (p=0.065), the date (p=0.041), patient (p=<0.001), treatment (p=0.022), and prescriber (p=<0.001) identifiers were statistically significant across the different hospitals. For phase two, the prevalence of MEs was 74 (56.1%), while that of pDDIs was 54 (40.9%). There was a statistically positive correlation between the occurrence of pDDI and number of medicines prescribed (r=0.211, P=0.015). A Low GAS indicates poor compliance with prescription writing guidelines and high prescription errors. Medication errors were observed at each phase of the medication use cycle, while clinically significant pDDIs were also reported. Thus, there is a need for training on prescription writing guidelines and medication errors.

The Price of Perfection: The Cost of Error

In this book proposal, Charles L. Bosk synthesizes 50 years of ethnographic research to consider a key question: Why have decades of patient safety initiatives to reduce preventable deaths and adverse safety events failed to make traction on either one? With his incomparable wit and dry humor, Bosk takes us through the changes to the medical system that accompany his own evolution from a doctoral student to accomplished professional. Bosk's last work prods us to think deeply about the nature of medical error, our attempts to fix it, and what it means to improve medical care.

Evaluation of pattern of medication errors in a tertiary care hospital in South India: A prospective observational study

Background: Medication errors (MEs) increase morbidity, mortality, and economic burden to health-care system. MEs are the sixth highest cause of death in America. Documented data, studies, and reporting of MEs in India are limited. Aims and Objectives: The study was undertaken with the objectives to determine (a) the frequency of MEs and (b) the nature of MEs in the hospital. Materials and Methods: A prospective observational study of 6-month duration was conducted using prescriptions (n = 1007) of patients admitted as inpatients in wards and intensive care unit in the hospital. Sensitization programs were regularly carried out to health-care professionals. The case records and treatment charts of patients in wards were reviewed and the patients or caretakers were interviewed to gather information. Standard hospital pro forma for MEs was used to collect data on MEs. Data were analyzed using descriptive statistics in Excel. Results: Overall, ME rate was 26.81% in the 6 months with a declining trend from the initial 36.11% month of study period. Prescription, dispensing, administration, and documentation errors were, respectively, 92.2%, 4.1%, 3.3%, and 17.8%. Errors pertaining to writing generic names, doses, and routes of drug administration were, respectively, 73%, 48.5%, and 35.2%. Majority (94.8%) of ME belonged to category B of the National Coordinating Council for Medication Error Reporting and Prevention index. Conclusion: The current study observed a high prescription error rate in hospital emphasizing the need for ME sensitization/training program to doctors and nurses. The study observed a declining trend in ME rate that would be attributed to the ongoing sensitization program. The study also indicates an enhanced requirement for the implementation of regular and rigorous reporting system in the hospital.

Medical Dispute Cases Caused by Errors in Clinical Reasoning: An Investigation and Analysis.

Studies that examine medical dispute cases (MDC) due to clinical reasoning (CR) are scarce in Taiwan. A retrospective analysis was undertaken to review MDC filed at four hospitals in Taiwan between 2011 and 2015. Cases were examined for the healthcare professionals involved, their relevance to CR errors, clinical specialties, and seniority. Seventy-eight MDC were identified and 57.7% of which were determined to be related to CR errors (n = 45). Among the 45 cases associated with CR errors, 82.2% (37) and 22.2% (10) were knowledge- and skill-related errors, respectively. The healthcare professionals with the most MDC were obstetrician-gynecologists (10/90, 11.1%), surgeons (8/90, 8.9%), and emergency physicians (7/90, 7.8%). The seniority of less than 5 years or lower had the highest number of attending physicians to be associated with MDC. In contrast, the highest seniority (&gt;25 years) in the physician group and year 6 in the resident group are both shown with zero MDC. In our study, the larger hospitals had a significantly higher incidence of MDC compared to the smaller hospitals (Pearson Correlation Coefficient = 0.984, p = 0.016). An examination of MDC reveals the frequency and nature of medical errors in Taiwanese hospitals. Having identified that CR errors contributed a substantial fraction to the overall MDC, strategies to promote reasoning skills and hence reduce medico-legal issues help safeguard both patients and healthcare professionals.

Avoidance of drug errors between hospital and home

Journal of Prescribing PracticeVol. 4, No. 1 Calculation SkillsAvoidance of drug errors between hospital and homeRuth BroadheadRuth BroadheadE-mail Address: [email protected]Senior Lecturer: Non-Medical Prescribing University of Central LancashireSearch for more papers by this authorRuth BroadheadPublished Online:4 Jan 2022https://doi.org/10.12968/jprp.2022.4.1.18AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article References Alqenae FA, Steinke D, Keers RN. Prevalence and Nature of Medication Errors and Medication-Related Harm Following Discharge from Hospital to Community Settings: A Systematic Review. Drug Saf. 2020;43(6):517-537. https://doi.org/10.1007/s40264-020-00918-3 Google ScholarBritish Medical Association & Royal Pharmaceutical Society. British National Formulary 82. 2021. https://bnf.nice.org.uk/ (accessed 4 December 2021) Google ScholarBroadhead R. Professional, Legal & Ethical issues in Prescribing Practice. 2020. In: Dilyse NuttallRutt-Howard J. The Textbook of Non-Medical Prescribing. 3rd ed. Wiley; 2020. Google ScholarEnsing HT, Koster ES, van Berkel PI, van Dooren AA, Bouvy ML. Problems with continuity of care identified by community pharmacists post-discharge. J Clin Pharm Ther. 2017;42(2):170-177. https://doi.org/10.1111/jcpt.12488 Google ScholarRoyal Pharmaceutical Society. A competency framework for all prescribers. 2021. https://www.rpharms.com/resources/frameworks/prescribing-competency-framework/competency-framework (4 December 2021) Google ScholarWorld Health Organisation. Global patient safety challenge: Medication without harm. 2017. https://www.who.int/initiatives/medication-without-harm (4 December 2021) Google Scholar FiguresReferencesRelatedDetails 2 January 2022Volume 4Issue 1ISSN (print): 2631-8385ISSN (online): 2631-8393 Metrics History Published online 4 January 2022 Published in print 2 January 2022 Information© MA Healthcare LimitedPDF download

Prevalence and Nature of Medication Errors and Medication-Related Harm Following Discharge from Hospital to Community Settings: A Systematic Review.

BackgroundLittle is known about the epidemiology of medication errors and medication-related harm following transition from secondary to primary care. This systematic review aims to identify and critically evaluate the available evidence on the prevalence and nature of medication errors and medication-related harm following hospital discharge.MethodsStudies published between January 1990 and March 2019 were searched across ten electronic databases and the grey literature. No restrictions were applied with publication language or patient population studied. Studies were included if they contained data concerning the rate of medication errors, unintentional medication discrepancies, or adverse drug events. Two authors independently extracted study data.ResultsFifty-four studies were included, most of which were rated as moderate (39/54) or high (7/54) quality. For adult patients, the median rate of medication errors and unintentional medication discrepancies following discharge was 53% [interquartile range 33–60.5] (n = 5 studies) and 50% [interquartile range 39–76] (n = 11), respectively. Five studies reported adverse drug reaction rates with a median of 27% [interquartile range 18–40.5] and seven studies reported adverse drug event rates with a median of 19% [interquartile range 16–24]. For paediatric patients, one study reported a medication error rate of 66.3% and another an adverse drug event rate of 9%. Almost a quarter of studies (13/54, 24%) utilised a follow-up period post-discharge of 1 month (range 2–180 days). Drug classes most commonly implicated with adverse drug events were antibiotics, antidiabetics, analgesics and cardiovascular drugs.ConclusionsThis is the first systematic review to explore the prevalence and nature of medication errors and adverse drug events following hospital discharge. Targets for future work have been identified.Electronic supplementary materialThe online version of this article (10.1007/s40264-020-00918-3) contains supplementary material, which is available to authorized users.

Prevalence and Nature of Medication Errors and Preventable Adverse Drug Events in Paediatric and Neonatal Intensive Care Settings: A Systematic Review.

IntroductionChildren admitted to paediatric and neonatal intensive care units may be at high risk from medication errors and preventable adverse drug events.ObjectiveThe objective of this systematic review was to review empirical studies examining the prevalence and nature of medication errors and preventable adverse drug events in paediatric and neonatal intensive care units.Data SourcesSeven electronic databases were searched between January 2000 and March 2019.Study SelectionQuantitative studies that examined medication errors/preventable adverse drug events using direct observation, medication chart review, or a mixture of methods in children ≤ 18 years of age admitted to paediatric or neonatal intensive care units were included.Data ExtractionData on study design, detection method used, rates and types of medication errors/preventable adverse drug events, and medication classes involved were extracted.ResultsThirty-five unique studies were identified for inclusion. In paediatric intensive care units, the median rate of medication errors was 14.6 per 100 medication orders (interquartile range 5.7–48.8%, n = 3) and between 6.4 and 9.1 per 1000 patient-days (n = 2). In neonatal intensive care units, medication error rates ranged from 4 to 35.1 per 1000 patient-days (n = 2) and from 5.5 to 77.9 per 100 medication orders (n = 2). In both settings, prescribing and medication administration errors were found to be the most common medication errors, with dosing errors the most frequently reported error subtype. Preventable adverse drug event rates were reported in three paediatric intensive care unit studies as 2.3 per 100 patients (n = 1) and 21–29 per 1000 patient-days (n = 2). In neonatal intensive care units, preventable adverse drug event rates from three studies were 0.86 per 1000 doses (n = 1) and 0.47–14.38 per 1000 patient-days (n = 2). Anti-infective agents were commonly involved with medication errors/preventable adverse drug events in both settings.ConclusionsMedication errors occur frequently in critically ill children admitted to paediatric and neonatal intensive care units and may lead to patient harm. Important targets such as dosing errors and anti-infective medications were identified to guide the development of remedial interventions.Electronic supplementary materialThe online version of this article (10.1007/s40264-019-00856-9) contains supplementary material, which is available to authorized users.

Physicians' Disclosure of Medical Error to Patient/Family: The Case of Saudi Arabia

Background: Patient safety is a critical factor towards ensuring high quality healthcare. However, the rise of medical errors among physicians threatens this safety and therefore quality of healthcare. Objectives: To identify the main cause and nature of medical errors, detect main issues and challenges hindering the disclosure of these errors by physicians, and developing a background for developing constructive strategies of disclosure of these errors. Methods: A cross sectional descriptive study with data collection undertaken using self-administered two separated questionnaires to the physicians and patient families that were participating in the study. The physician questionnaire contained a total of 15 questions developed to capture the characteristics of the physicians in terms of demographic information, professional roles and their responses to two scenarios of medical errors. While the patient family questionnaire was made up of six questions that included demographic information and response to medical error disclosure by physicians. Results: Most of participating physicians admitted to disclosing medical errors that are fatal, followed by medical errors with minor or transient harm then disclosing harmful errors in patients who are hopelessly ill, the least likely type of medical error to be disclosed is errors by other doctors. Most are willing to apologize for the incident without admitting the occurrence of an error. While most of the responses of parent/guardian to medical error disclosure was given towards filing a complaint against the doctor to the administration of the hospital, followed by both complaining to a judicial official, and politely asking the doctor what led to the complication and the reason for the error, the least were towards demanding for an explanation by raising a voice to the doctor followed by taking the issue to the media. Conclusion: There is need to improve medical error disclosure of physicians to patients and their families by establishing standardized training for medical error disclosure and developing constructive strategy of medical error disclosure at nation level plus public awareness about medical errors and how to deal with it.

A Cross-sectional Study on Occurrence of Medication Errors in Outpatient Pediatric Department of Public Sector Hospital, Lahore, Pakistan

<p style="text-align: justify;"><strong>Background:</strong> The knowledge of medication errors is an essential prerequisite for better healthcare delivery. Medication errors are potential errors and impart a significant burden on patient quality of life as well as economic status.<strong> Objectives:</strong> The study was conducted with objective to determine the prevalence and nature of medication errors in pediatric out-patients and also to study their prescribing pattern. <strong>Methods:</strong> A quantitative cross-sectional study was conducted in Outpatient Pediatric Department of Public Sector Hospital, Lahore, Pakistan over a period of one month during which 240 prescriptions were evaluated to identify medication errors and prescribing pattern. Data was collected by using a self-designed data collection tool and analyzed using SPSS version 20. <strong>Results:</strong> Current study evaluated 240 outpatient prescription orders out of which 234 were found to have medication errors. Highest percentage of errors observed in studied population including prescription errors (missed prescriber and patient information) (86.8%), prescribing errors (7.6%) and dispensing errors (3.6%) respectively. Upper Respiratory Tract Infection was the extensive complaint of majority of patients and the drugs of concern were mainly antibiotics, antihistamines, analgesics and anti-inflammatory and expectorants. <strong>Conclusion:</strong> The current detection of medication errors reveals about recurrent basis of prescribing errors in addition to prescription parts errors. These findings emphasizes that prescribers need to work in alliance with pharmacist to improve patient&rsquo;s quality of life in primary care. <p style="text-align: justify;"><strong>Key words:</strong> Medication error, Pediatric, Outpatient, Prescription.

The Prevalence and Nature of Medication Errors and Adverse Events Related to Preadmission Medications When Patients Are Admitted to an Orthopedic Inpatient Unit: An Observational Study.

Medication errors commonly occur when patients move from the community into hospital. Whereas medication reconciliation by pharmacists can detect errors, delays in undertaking this can increase the risk that patients receive incorrect admission medication regimens. Orthopedic patients are an at-risk group because they are often elderly and use multiple medications. To evaluate the prevalence and nature of medication errors when patients are admitted to an orthopedic unit where pharmacists routinely undertake postprescribing medication reconciliation. A 10-week retrospective observational study was conducted at a major metropolitan hospital in Australia. Medication records of orthopedic inpatients were evaluated to determine the number of prescribing and administration errors associated with patients' preadmission medications and the number of related adverse events that occurred within 72 hours of admission. Preadmission, 198 patients were taking at least 1 regular medication, of whom 176 (88.9%) experienced at least 1 medication error. The median number of errors per patient was 6 (interquartile range 3-10). Unintended omission of a preadmission medication was the most common prescribing error (87.4%). There were 17 adverse events involving 24 medications in 16 (8.1%) patients that were potentially related to medication errors; 6 events were deemed moderate consequence (moderate injury or harm, increased length of stay, or cancelled/delayed treatment), and the remainder were minor. Conclusion and Relevance: Medication errors were common when orthopedic patients were admitted to hospital, despite postprescribing pharmacist medication reconciliation. Some of these errors led to patient harm. Interventions that ensure that medications are prescribed correctly at admission are required.

Frequency and Nature of Medication Errors and Adverse Drug Events in Mental Health Hospitals: a Systematic Review.

Little is known about the frequency and nature of medication errors (MEs) and adverse drug events (ADEs) that occur in mental health hospitals. This systematic review aims to provide an up-to-date and critical appraisal of the epidemiology and nature of MEs and ADEs in this setting. Ten electronic databases were searched, including MEDLINE, Embase, CINAHL, International Pharmaceutical Abstracts, PsycINFO, Scopus, British Nursing Index, ASSIA, Web of Science, and Cochrane Database of Systematic Reviews (1999 to October 2016). Studies that examined the rate of MEs or ADEs in mental health hospitals were included, and quality appraisal of the included studies was conducted. In total, 20 studies were identified. The rate of MEs ranged from 10.6 to 17.5 per 1000 patient-days (n=2) and of ADEs from 10.0 to 42.0 per 1000 patient-days (n=2) with 13.0-17.3% of ADEs found to be preventable. ADEs were rated as clinically significant (66.0-71.0%), serious (28.0-31.0%), or life threatening (1.4-2.0%). Prescribing errors occurred in 4.5-6.3% of newly written or omitted prescription items (n=3); dispensing errors occurred in 4.6% of opportunities for error (n=1) and in 8.8% of patients (n=1); and medication administration errors occurred in 3.3-48.0% of opportunities for error (n=5). MEs and ADEs were frequently associated with psychotropics, with atypical antipsychotic drugs commonly involved. Variability in study setting and data collection methods limited direct comparisons between studies. Medication errors occur frequently in mental health hospitals and are associated with risk of patient harm. Effective interventions are needed to target these events and improve patient safety.

The frequency and nature of medication errors in hospitalized patients with acute coronary syndrome.

Background Cardiovascular medications have been commonly associated with medication errors. Objective The objective of this study was to investigate the incidence and predictors of medication errors in patients with acute coronary syndrome. Setting the coronary care unit of a university teaching hospital. Methods This was a prospective observational study on 150 patients admitted to the coronary care unit between August 2014 and July 2015. Main outcome measure The principal outcome was the number (frequency) of encountered medication errors. Results Of total 5790 prescription items reviewed, 547 (9.4%) potential medication errors were identified of which 523 (9.0%) were prescribing errors and 24 were monitoring errors. The most frequent prescribing errors were dosing errors (231, 42.2%) followed by loading dose omission error (91, 16.6%), omission of essential drugs on 1st day (43, 7.9%), and timing error (40, 7.3%). Errors frequently encountered with drugs such as aspirin, enoxaparin, beta-blockers followed by angiotensin-converting enzyme inhibitors and clopidogrel. Multivariate logistic regression analysis revealed that renal impairment (OR 6.02; 95% CI 1.4-35.4; p=0.02) and longer duration of hospital stay (OR 4.01; 95% CI 1.5-10.7; p=0.005) were predictors of the higher incidence of medication errors. Conclusion Prescribing and monitoring errors in coronary care unit are frequent and avoidable, with the majority of errors were ranked to be of mild to moderate severity. Dosing errors, omission of essential drugs and monitoring errors were most common error types encountered. Dosage adjustment based on estimation of the glomerular filtration rate immediately after admission help avoiding dosage-related errors.

Prevention of Medication Errors in Hospitalized Patients: The Japan Adverse Drug Events Study.

The nature of medication errors (MEs) and the frequency of identified or intercepted MEs are not being scrutinized in daily practice in Japan. The aim of this study was to clarify the epidemiology of MEs and the risk factors for non-intercepted and unidentified MEs. The Japan Adverse Drug Events (JADE) study was a prospective cohort study carried out at three tertiary-care teaching hospitals in Japan. Participants were consecutive patients (N=3459) aged ≥15 years who were admitted to the study wards. MEs were identified by on-site reviews of all medical charts, self-reports, and prescription queries by pharmacists. Two independent physicians reviewed and classified all MEs and adverse drug events and determined the stages at which the MEs occurred and whether there was interception or identification of the MEs. A total of 514 MEs were observed among 433 patients. Sixty-four percent of MEs occurred at the ordering stage. Among these, 60% were due to duplicate drug orders. Overall, 63% and 45% of MEs were not intercepted or identified during hospitalization, respectively. The independent risk factors for non-intercepted MEs were hospitalization in the surgical ward (odds ratio [OR] 2.94) and the intensive care unit (OR 3.57). MEs by resident physicians were more likely to be intercepted (OR 0.52 for non-intercepted MEs). MEs frequently occurred and most at the ordering stage. Almost half of MEs were not intercepted or identified. Many MEs at the later stages were less likely to be intercepted and resulted in actual patient harm. Systems to improve the identification and interception of MEs should be implemented.

WeCare: Engaging Pediatric Trainees in Patient Safety and Error Reporting

Knowledge regarding the frequency and nature of medical errors is necessary to improve patient safety within a hospital. ‘iCare' is an anonymous event reporting system at the University of Minnesota Masonic Children's Hospital (UMMCH). Graduate medical trainees are on the front lines of the care provided at our institution but rarely utilize the iCare system to report breaches in patient safety.

The rate and nature of medication errors among elderly upon admission to hospital after implementation of clinical pharmacist-led medication reconciliation

ObjectivesTo determine the frequency and nature of erroneous transfer of medication information (medication errors) upon admission to hospital and to study the effect of medication reconciliation.MethodsIncluded patients were 65 years...

Anticoagulant therapy: we have to do better! A systematic review

AimAnticoagulant therapy is considered a high-risk medication strategy with a narrow therapeutic window and the need for close monitoring, particularly with vitamin K antagonists. The nature of the drugs as...

Medication Errors in a Neonatal Intensive Care Unit, Saudi Arabia: a Retrospective Study

Background and Aims: Medication errors (MEs) are important causes of morbidity that may result in death of already sick neonates. We aimed to study the nature of MEs of neonates admitted to level III neonatal intensive care unit (NICU) at Riyadh Military Hospital, Saudi Arabia. Methods: All incident reports (IRs) that were voluntarily reported to the Department of Continuous Quality Improvement and Patient Safety (January 2007 to March 2010) from our NICU were reviewed for MEs. From these reports, we estimated the incidence and nature MEs. In addition, our neonatal database was reviewed for patient characteristics. Results: There were 66 IRs involving MEs with estimated incidence of one per 250 admissions (mean gestational age: 32(SD)& 4.8,wks, birth weight: 1797±1012gm and median age: 19 days). They were more common during day shifts (66.7%). Most prevalent type was dispensing error (91%). Nurses were involved more commonly than pharmacists and physicians (66, 33 and 1%; respectively). The most common type of MEs for nurses: delay/not giving; pharmacists: delay /not dispensing and physicians; incomplete prescriptions. The most common medications involved were antibiotics and TPN. Patient harm that required intervention (category E) occurred in 56% while near-misses occurred in 25% and no harm in 14%. Errors of commission were 61%. Conclusions: In our NICU, the incidence of reported ME was low which could be due to underreporting. We recommend improving reporting system and training all staff involved in medication use about prevention of ME emphasizing on the nature of error in each category.

Postoperative Medication Errors in Otolaryngology

Objective: The epidemiology of medication errors (MEs) in ambulatory and inpatient care is well understood, but little is known about ambulatory surgery. This study aims to quantify the incidence and nature of MEs after ambulatory otolaryngologic surgery. Method: Ambulatory surgery patients were assessed for 1) pre-surgical home medications, 2) clinical history, 3) written prescriptions, 4) discharge instructions, and 5) medication use reported by patients within 48 hours of discharge. Potential MEs were reviewed by an expert panel to determine validity, contributing factors, and potential preventative measures. Results: From 100 surgeries, 12 postoperative MEs were identified. All were without clinical sequelae, in part due to investigator involvement. Contributing factors included providers (2), patients (5), and the healthcare system (5). Causes for MEs included failure to verify patient information (eg, allergies), failure to accurately reconcile medications, and misunderstanding of instructions by the patients. Discharge instructions and medication reconciliation protocols appeared insufficient for optimal postoperative care and resulted in many after-hours calls for clarification. Conclusion: MEs are common following ambulatory otolaryngologic surgery even though regimens are simple and limited to few medications. Key targets for quality improvement include fragmentation in information flow and physician-patient communication.

Medication prescribing errors in the prehospital setting and in the ED

BackgroundMedication errors are a common cause of iatrogenic adverse drug events. The incidence and nature of medication errors during prehospital treatment have not been fully described. ObjectivesThe objectives of this study are to describe the incidence and characteristics of medication errors in adults during prehospital emergency treatment and in the emergency department (ED) and to identify risk factors for medication errors in those settings. MethodsThis is a retrospective study of adult patients transferred by emergency medical services to the ED of a university-affiliated hospital in Israel. The drugs administered in the mobile intensive care unit and in the ED were reviewed by 2 reviewers, who independently decided whether an error had occurred. The primary outcome was the number of drug errors per patient. Secondary outcomes were the type and severity of the errors and variables associated with increased incidence of drug errors. ResultsDuring the study period, 1837 patients were brought to the ED by mobile intensive care unit vehicles. Five hundred thirty-six patient charts (29%) were randomly selected for review; 65 charts (12.12%) could not be found; thus, 471 charts were reviewed. In the emergency vehicle, 188 patients (45.63%) received medications; of those, 12.76% (24 patients) were subject to a medication error. The number of drugs administered and long evacuation times were associated with higher risk for an error (P < .01 and P = .011, respectively). The presence of a physician in the emergency vehicle did not alter the risk of an error (P = .95). In the ED, 332 patients (72.6%) received medications. Of those, medication errors occurred in 120 patients (36.1%). The more medications administered, the higher the risk of error (P < .01). Less errors occurred in trauma patients (P = .041). ConclusionMore medication errors occur in the ED than in the emergency vehicles. Patients treated with multiple medications are more prone to medication errors.

Incidence and Nature of Medication Errors in Neonatal Intensive Care with Strategies to Improve Safety

Neonates are highly vulnerable to medication errors because of their extensive exposure to medications in the neonatal intensive care unit (NICU), the general lack of evidence on pharmacotherapeutic interventions in neonates and the lack of neonate-specific formulations. We searched PubMed and EMBASE to identify relevant original studies published in the English language. Eleven studies were identified on the frequency of medication errors in the NICU. The highest rate was 5.5 medication errors per 100 prescriptions; however, medication error rates varied widely between studies, partly due to differences in the definition of an error and the rigor of the method used to identify medication errors. Furthermore, studies were difficult to compare because medication error rates were calculated differently. Most studies did not assess the potential clinical impact of the errors. The majority of studies identified dose errors as the most common type of error. Computerised physician order entry and interventions by clinical pharmacists (e.g. the participation of pharmacists in ward rounds and review of patients' prescriptions prior to dispensing) were the most common interventions suggested to improve medication safety in the NICU. However, only very limited data were available on evaluation of the effects of such interventions in NICUs. More research is needed to determine the frequency and types of medication errors in NICUs and to develop evidence-based interventions to improve medication safety in the NICU setting. Some of these research efforts need to be directed to the establishment of clear definitions of medication errors and agreement on the methods that should be used to measure medication error rates and their potential clinical impact.