Medication Error Rates Research Articles

Reducing medication errors involving antiretroviral therapy with targeted electronic medical record modifications

ABSTRACTMedication errors are common among HIV-infected patients on anti-retroviral therapy (ART), especially when transitioning to the inpatient setting. In previous studies, medication error rates among hospitalized patients on ART have been reported to exceed 50%. When patients receiving ART are admitted to the hospital, medication errors can be prevented through optimization of administration instructions and dosing defaults in order-entry screens in the electronic medical record (EMR). We sought to evaluate the impact of EMR modifications (defaulted doses, frequencies, and administration instructions) implemented to improve the order-entry process and reduce errors. All adult patients admitted between 10/1/2010–3/31/2012 (pre-EMR modification) and 10/1/2013–3/31/2014 (post-EMR modification) that continued on ART upon admission were included. The primary outcome was the overall rate of medication errors identified through review by the antimicrobial stewardship program (ASP). We also characterized the types of medication errors identified during the two time periods. Following EMR modifications, the medication error rate identified through ASP review was reduced from 50.2% to 28.2% (P < 0.01). The number of medication related errors relating to dosage (regimens requiring dose optimization, renal dose adjustment, and dose timing) were reduced by 22% (P < 0.01). Modifications at the anti-retroviral medication order-entry screens in the EMR significantly reduced medication errors, particularly with respect to dosing and dose timing.

I-PASS Mentored Implementation Handoff Curriculum: Champion Training Materials.

The I-PASS Handoff Program is a comprehensive handoff curriculum that has been shown to decrease rates of medical errors and adverse events during patient handoffs. I-PASS champions are a critical part of the implementation and sustainment of this curriculum, and therefore, a rigorous program to support their training is necessary. The I-PASS Handoff champion training materials were created for the original I-PASS Study and adapted for the Society of Hospital Medicine (SHM) I-PASS Mentored Implementation Program. The adapted materials embrace a flipped classroom approach and adult learning theory. The training includes an overview of I-PASS handoff techniques, an opportunity to practice evaluating handoffs with the I-PASS observation tools using a handoff video vignette, and other key implementation principles. As part of the SHM I-PASS Mentored Implementation Program, 366 champions were trained at 32 sites across North America and participated in a total of 3,491 handoff observations. A total of 346 champions completed the I-PASS Champion Workshop evaluation form at the end of their training (response rate: 94.5%). After receiving the training, over 90% agreed/strongly agreed that it provided them with knowledge or skills critical to their patient care activities and that they were able to distinguish the difference between high- and poor-quality handoffs, competently use the I-PASS handoff assessment tools, and articulate the importance of handoff observations. The I-PASS champion training materials were rated highly by those trained and are an integral part of a successful I-PASS Handoff Program implementation.

Evaluation of pharmacist-led educational interventions to reduce medication errors in emergency hospitals: a new insight into patient care.

Medication errors made by nurses are common in general practice and can lead to harm in patients. The aim of this study was to evaluate the impact of pharmacist-led educational implementations in reducing medication errors made by nurses in an emergency hospital in Cairo, Egypt. A prospective pre-post-interventional study was conducted in an emergency hospital using direct observation for the detection of errors. The rate and severity of medication errors were determined before and after the implementation of educational tools. In total, 1025 and 1024 patients were examined pre- and post-intervention, respectively. Pharmacist interventions resulted in a significant reduction in the medication error rate from 351 (34.2%) in the pre-intervention phase to 157 (15.3%) in the post-intervention phase (P < 0.001). In both the pre- and post-intervention phases, none of the medication errors were associated with harm/death. Furthermore, all types of medication errors declined as a result of the interventions. Clinical pharmacists' interventions focusing on improving nurses' drug knowledge and awareness of errors were shown to be effective in reducing the rate and severity of medication administration errors among nurses in an emergency hospital environment.

Dysphagia and pharmacotherapy in older adults.

The review summarizes current knowledge and recent findings about how to practically apply medication in patients with dysphagia and how swallowing function may be positively or negatively affected by drugs. Oropharyngeal dysphagia is a major health problem in older persons and was recently classified as a geriatric syndrome. Although the knowledge about an effective diagnostic approach increased during the last years, comparatively little is known about how to effectively manage and treat dysphagia and hardly anything is implemented in clinical routine. Studies have shown a considerable lack of knowledge about the adequate modification of medication and demonstrated an increased rate of practical medication errors in patients with dysphagia. With regard to dysphagia therapy, two systematic reviews have identified neuroleptics as potentially harmful for swallowing function. The role of other candidates is controversial. Contrary to this, some pharmacological approaches may be future options for the treatment of dysphagia, with capsaicin currently being the most evaluated and potential one. More professional training and advice about the adequate management of medication in dysphagic patients is necessary for all healthcare professionals. Large observational and interventional studies are needed to identify and confirm the influence of pharmacological substances on the swallowing function.

Patient safety after implementation of a coproduced family centered communication programme: multicenter before and after intervention study

ObjectiveTo determine whether medical errors, family experience, and communication processes improved after implementation of an intervention to standardize the structure of healthcare provider-family communication on family centered rounds.DesignProspective, multicenter before...

Systematic review of computerized prescriber order entry and clinical decision support.

Results of a systematic review of published data on the effect of computerized prescriber order entry (CPOE) with clinical decision support on medication error (ME) and adverse drug event (ADE) rates are presented. Literature searches of MEDLINE, Embase, and other databases were conducted to identify English- and Spanish-language articles on selected CPOE outcomes published from 1995 through 2016; in addition, 5 specific journals were searched for pertinent articles published during the period 2010-16. Publications on controlled prospective studies and before-and-after studies that assessed MEs and/or ADEs as main outcomes were selected for inclusion in the review. Nineteen studies met the inclusion criteria. Data on MEs and ADEs could not be pooled, mainly due to heterogeneity in outcome definitions and study methodologies. The reviewed evidence indicated that CPOE implementation led to an overall reduction in errors at the prescription stage of the medication-use process (relative risk reduction, 0.29 [95% confidence interval, 0.10-0.85]; I 2 = 99%) and reductions in most types of prescription errors, but CPOE also resulted in the emergence of other types of errors. CPOE reduces the overall ME rate in the prescription process, as well as specific types of errors, such as wrong dose or strength, wrong drug, frequency, administration route, and drug-drug interaction errors. The implementation of CPOE can lead to new errors, such as wrong drug selection from drop-down menus.

Implementation of Bar-Code Medication Administration to Reduce Patient Harm.

ObjectiveTo assess the impact of implementing bar-code medication administration (BCMA) technology on the rate of medication administration errors in the inpatient setting, specifically those that affect the patient and result in harm.Patients and MethodsImplementation of the new technology began in September 2008 in a staged rollout of 4 or 5 units at a time in 11 separate waves. All corresponding medication administrations and voluntarily reported medication-related adverse events from March 1, 2007, through September 30, 2013, were included for analyses. Adherence to the use of BCMA technology and the number of adverse events were tracked and compared across the preimplementation period through follow-up. Actual errors, not potential errors, were included in the analysis.ResultsAfter the BCMA technology was introduced, reported medication administration errors decreased by 43.5%. More importantly, the rate of harmful medication errors decreased from 0.65 per 100,000 medications preintervention to 0.29 per 100,000 medications postintervention. This resulted in a 55.4% decrease in actual patient harm events. None of the errors at category E or higher was caused by BCMA factors.ConclusionConsistent use of BCMA technology improves patient safety by decreasing the number of patients harmed by medication administration errors.

597. Pharmacist-Led Interventions for Inpatient HIV-Related Medication Errors

BackgroundInpatient HIV-related medication errors occur in up to 86% of patients. The purpose of this study was to evaluate the number of antiretroviral therapy (ART)- and opportunistic infection (OI)-related medication errors following the implementation of pharmacist-directed interventions.MethodsThis quasi-experiment assessed adult patients with HIV who received ART, OI prophylaxis, or both from December 1, 2014 to February 28, 2017 (pre-intervention) or December 1, 2017 to February 28, 2018 (post-intervention). Pre-intervention patients were assessed retrospectively, verbal and written education were provided, then prospective audit and feedback was conducted for post-intervention patients. The primary outcome was rate of ART-related medication errors in the pre- vs. post-intervention groups. Secondary outcomes included time to resolution of ART- and OI-related medication errors, OI-related medication errors, types of errors, rate of acceptance of recommendations, in-hospital mortality, length of stay, and 30-day readmission.ResultsSixty-seven patients were included in each group (pre- and post-intervention). ART errors occurred in 44.8% and 32.8% (P = 0.156), respectively. OI prophylaxis errors occurred in 11.9% vs. 9% (P = 0.572), respectively. No difference was found in types of errors between groups, except medication omission decreased significantly in the post-intervention group (31.3% vs. 11.9%; P = 0.006). The number of pharmacist-based interventions increased in the post-intervention group (6.3% vs. 52.9%; P = 0.001). No statistical difference was found in average time to error resolution (72 vs. 48 hours; P = 0.123), but errors resolved during admission significantly increased (50% vs. 86.8%; P < 0.001). No difference was found in rate of intervention acceptance, which was high in both groups.ConclusionIn this quasi-experiment, ART and OI prophylaxis medication errors were numerically reduced in the pharmacist-led intervention period, and medication errors were resolved a day faster in the post-intervention period. Future interventions targeting prescribing errors upon admission include follow-up education and evaluation of medication reconciliation practices in HIV-infected patients.Disclosures All authors: No reported disclosures.

Incident reports versus direct observation to identify medication errors and risk factors in hospitalised newborns.

Newborns are often exposed to medication errors in hospitals. Identification and understanding the causes and risk factors associated with medication errors will help to improve the effectiveness of medication. We sought to compare voluntary incident reports and direct observation in the identification of medication errors. We also identified corresponding risk factors in order to establish measures to prevent medication errors. Medication errors identified by a clinical pharmacist and those recorded in our incident reporting system by caregivers were analysed. Main outcomes were rates, type and severity of medication error, and other variables related to medication errors. Ultimately, 383 medication errors were identified by the clinical pharmacist, and two medication errors were declared by caregivers. Prescription errors accounted for 38.4%, preparation errors for 16.2%, and administration errors for 45.4%. The two variables significantly related to the occurrence of medication errors were gestational age < 32.0weeks (p = 0.04) and the number of drugs prescribed (p < 0.01).Conclusion: Caregivers underreported the true rate of medication errors. Most medication errors were caused by inattention and could have been limited by simplifying the medication process. Risk of medication errors is increased in newborns < 32.0weeks and increases with the number of drugs prescribed to each patient. What is Known: • Newborns in hospitals are particularly susceptible to medication errors. • Identification and understanding the reasons for medication errors should help us to establish preventive measures to reduce the occurrence of such errors. What is New: • Direct observation of the medication process, though time consuming, is essential to accurately assess the frequency of medication errors, which are underreported by caregivers. Most medication errors are caused by inattention and could be limited by simplifying the medication process. • The risk of medication errors was significantly increased in very preterm newborns (< 32weeks) and when the number of prescription per patient increased.

Pediatric Pharmacists' Participation in Cardiopulmonary Resuscitation Events.

The Pediatric Pharmacy Advocacy Group (PPAG) understands the dilemma and varying factors that many institutions face concerning the routine participation of pharmacists in emergency resuscitation events. Acknowledging these obstacles, the PPAG encourages all institutions to strongly consider creating, adopting, and upholding policies to address pharmacists' participation in cardiopulmonary resuscitation (CPR) as evidenced by the impact pharmacist participation has shown on the reduction of hospital medication error and mortality rates in children. The PPAG advocates that pharmacists be actively involved in the institution's CPR, medical emergency team committees, and preparation of emergency drug kits and resuscitation trays. The PPAG advocates that all institutions requiring a pharmacist's participation in CPR events consider adoption of preparatory training programs. Although the PPAG does not advocate any one specific program, consideration should be taken to ensure that pharmacists are educated on the pharmacotherapy of drugs used in the CPR process, including but not limited to basic life support, Advanced Cardiac Life Support, and Pediatric Advanced Life Support algorithms; medication preparation and administration guidelines; medication compatibility; recommended dosing for emergency medications; and familiarity with the institutional emergency cart.

Frequency of medication error in pediatric anesthesia: A systematic review and meta-analytic estimate.

Clinical evidence shows that pediatric anesthesia patients are subject to a higher rate of life-threatening medical errors than their adult counterparts. Medication error in adult anesthesia is estimated to occur to 1 in 133 anesthetic administrations, but such a figure has not been determined for pediatric anesthesia patients. Individual studies of medication error in pediatric anesthesia have ranged from rates of 0.01% to 1.92% of anesthetic uses. The present study is a systematic review that employs a meta-analytic estimate to determine the rate of medication error in pediatric anesthesia. A systematic review of the literature on pediatric anesthesia medication error was conducted using Medline, Cochrane Database, PROSPERO, and Clinicaltrials.gov. A meta-analytic estimate was used to determine the medication error rate for all of the included studies. Subgroup sensitivity analysis was used to evaluate possible sources of heterogeneity in included studies. Of the 433 initially screened records, 13 studies met inclusion criteria. Meta-analytic estimate of medication error rate across all studies was 0.08% (95% CI 0.05%-0.10%), or 1 out of 1250 anesthetics. Ten different countries were represented in the studies. Sample size of anesthetics reported on ranged from 296 to 2316635. Data collecting periods ranged from 3months to 15years. Six included studies individually reported higher rates of medication error in patients under 1year of age. The present systematic review revealed a medication error rate of 1 per 1250 anesthetic administrations in pediatric anesthesia. This result is significantly lower than would be expected given reported rates of medication error in adult anesthesia, which raises questions regarding the validity of research methods and reporting of medication error in pediatric anesthesia. Future investigations of medication error should employ methodologies other than self-reporting of error, such as retrospective chart review.

Acritical perspective on the modified personal interview.

Medical school interviews are critical for screening candidates for admission. Traditionally, the panel format is used for this process, although its drastically low reliabilities sparked the creation of the highly reliable multiple mini-interview (MMI). However, the multiple mini-interview’s feasibility issues made it unappealing to some institutions, like the University of Toronto, who created the modified personal interview (MPI) as a more feasible alternative. The lack of literature about the MPI, however, prevents the medical community from determining whether this interview format achieves this goal. Therefore, evidence was compiled and critically appraised for the MPI using Kane’s validity framework, which enables analysis of four levels of inference (Scoring, Generalization, Extrapolation, Implication). Upon examining each level, it was concluded that assumptions made at the ‘Scoring’ and ‘Generalization’ levels had the least support. Based on these findings, it was recommended that in-person rater training become mandatory and the number of stations increase twofold from four to eight. Moreover, the following research initiatives were suggested to improve understanding of and evidence for the modified personal interview: (1) formally blueprint each station; (2) conduct predictive validity studies for the modified personal interview, and (3) relate admission to medical school on the basis of the MPI with medical error rates. By making these changes and studying these initiatives, the MPI can become a more feasible and equally effective alternative to the MMI with more evidence to justify its implementation at other medical schools.

Hospital Nurse Case Managers Drive Integrated Care

Adverse events in hospitals constitute a serious problem with grave consequences. Most are preventable. Thomas et.al has shown that preventable adverse drug events, events related to medical procedures, and falls are especially common in elderly complex patients Data from the NHS in 2017 show rates of medical errors and adverse events in 8% to 12% of hospitalizations. A WHO patient safety report states that strategies to reduce the rate of adverse events in the European Union alone would lead to the prevention of more than 750,000 harm-inflicting medical errors per year, to over 3.2 million fewer days of hospitalization, 260 000 fewer incidents of permanent disability, and 95 000 fewer deaths per year. Nurse case management (NCM) has developed mainly in the USA to improve cost and quality care for complex patients. Despite the positive research results and widespread implementation of NCM in the USA, NCM is not common in Israeli and European hospitals. Continuity of care within the hospital and with community health services is the backbone of the vision of the new Assuta Ashdod Hospital in Israel. NCMs play a key role. One of the most important tasks of the NCMs, from admission until discharge, is collaboration with community health care and social services, to make the patient's transition back to the community as seamless as possible. At admission, patients are identified for the NCM as complex patients by an algorithm in the electronic medical record. The NCM performs a multidisciplinary evaluation and coordinates the development of a hospital treatment and discharge plan. During the patient's hospitalization, the NCM is responsible for ensuring that all elements of the treatment plan are performed and is responsible for updating this plan according to the patient's needs and changing condition. The first NCMs underwent intensive training and began to work in the Assuta Ashdod Hospital in October - just four months after its opening. An implementation study is being performed to provide quantitative and qualitative assessment regarding the process of NCM integration into the hospital and the benefits and limitations of NCM. Data will be collected for six months from the hospital's computerized systems and will be supplemented by satisfaction questionnaires administered to the patients, the multidisciplinary staff and the NCM staff. This study will assist not only in evaluating and improving the process at Assuta Ashdod Hospital, but also in developing recommendations for other medical organizations in Israel and Europe for the successful implementation of NCM in hospitals as an important driver for integrated care. The full evaluation and conclusions for the implementation process of NCM will be completed in Spring 2018, but lessons are already being learned for addressing the challenge of successful integrated care between hospital and community services. Key lessons so far include: the importance of appropriate training of the NCMs, alignment of expectations and a corresponding distribution of responsibilities between the various teams in the hospital and the community and the management of the personal relationships among working team members.

Facilitated self-reported anaesthetic medication errors before and after implementation of a safety bundle and barcode-based safety system

BackgroundAnaesthetic medication administration errors are a significant threat to patient safety. In 2002, we began collecting data about the rate and nature of anaesthetic medication errors and implemented a variety of measures to reduce errors. MethodsFacilitated self-reporting of errors was carried out in 2002–2003. Subsequently, a medication safety bundle including ‘smart’ infusion pumps were implemented. During 2014 facilitated self-reporting commenced again. A barcode-based medication safety system was then implemented and the facilitated self-reporting was continued through 2015. ResultsDuring 2002–2003, a total of 11 709 paper forms were returned. There were 73 reports of errors (0.62% of anaesthetics) and 27 reports of intercepted errors (0.23%). During 2014, 14 572 computerised forms were completed. There were 57 reports of errors (0.39%) and 11 reports of intercepted errors (0.075%). Errors associated with medication infusions were reduced in comparison with those recorded in 2002–2003 (P<0.001). The rate of syringe swap error was also reduced (P=0.001). The reduction in error rate between 2002–2003 and 2014 was statistically significant (P=0.0076 and P=0.001 for errors and intercepted errors, respectively). From December 2014 through December 2015, 24 264 computerised forms were completed after implementation of a barcode-based medication safety system. There were 56 reports of errors (0.23%) and six reports of intercepted errors (0.025%). Vial swap errors in 2014–2015 were significantly reduced compared with those in 2014 (P=0.004). The reduction in error rate after implementation of the barcode-based medication safety system was statistically significant (P=0.0045 and P=0.021 for errors and intercepted errors, respectively). ConclusionsReforms intended to reduce medication errors were associated with substantial improvement.

Effect of Systematic Physician Cross-checking on Reducing Adverse Events in the Emergency Department The CHARMED Cluster Randomized Trial: Freund Y, Goulet H, Leblanc J, et al. JAMA Intern Med. 2018;178(6):812-819

Medical errors remain a major cause of mortality and morbidity. In the fast paced, high volume environment of the Emergency Department (ED), physicians must attend to multiple patients at a time and make rapid decisions, often with incomplete information. For these reasons, the ED is a high-risk environment for medical errors. The goal of this study was to evaluate how the implementation of systematic cross-checking between 2 emergency physicians would affect the rate of medical errors in the ED.

Systematic physician cross-checking between emergency department physicians is associated with a significant reduction in adverse events.

Randomised crossover trial.1 Setting: 6 Emergency departments (EDs) in France. Patients: Random sample of adults (mean age 57.5 years) attending the EDs between 8:30 and 16:00 on a weekday, within one of two 10-day inclusion periods. 1680 patients in total (840 in each arm). Intervention: Attendance during periods of cross-checking. This comprised a brief case presentation by one ED physician followed by feedback from a second ED physician, occurring three times per day. Outcomes: Rates of ED medical error, defined as preventable serious adverse events (injuries that might have resulted from medical care or lack thereof, but could have been prevented) or near misses (medical errors with the potential to cause an adverse event but which did not, either by chance or after an intervention). These errors were determined by a two-level review with the initial screening of charts by an …

Application of a Chemotherapy Standard Form in Patients with Breast Cancer: Comparison of Private and Public Centers

Background: Medication errors are important in chemotherapy centers, which can cause excessive morbidity and extra cost for patients because of the high toxicity and low therapeutic index of antineoplastic agents. Using standardized forms for prescription and administration of medications is one of the ways of reducing medication errors in the chemotherapy process. Objectives: In the current study, the authors aimed to evaluate the effects of the standard forms implementation and detect medication error and adverse drug event (ADE) rates involving in chemotherapy regimens used in breast cancer in the public/private outpatient chemotherapy settings. Methods: A cross-sectional interventional study was performed prospectively at two adult outpatient cancer centers, Mashhad, Iran. To avoid errors, a standardized order sheet was established to document information regarding breast cancer chemotherapy. The effect of the standard sheet on decreasing errors in ordering and administering was evaluated. The epidemiology of the errors and adverse drug events was reported. Results: Of the 217 visits (164 at a public hospital and 70 at a private clinic) of 84 adult patients (64 at the hospital and 20 at the clinic) involving 385 medications, 41% were associated with a medication error. Of these errors, 5% occurred in the private clinic compared to 95% of the errors occurring in the public hospital. A standardized approach helped to reduce errors in the selection of the regimen type. However, physicians did not calculate doses based on the standard sheets so the most common error type was improper dose prescription (38.2% of the 89 cited error types). The effect of standard sheets in the administration phase could not be assessed due to the incomplete data presented by nurses. 62% of the errors originated in the prescription phase of medication and 33% originated in the administration phase. The ADE rate was 9.6% but no life-threatening adverse drug event was recorded. Conclusions: Based on the current study, the medication errors occurred more commonly in the public setting and the prescribing errors were the most common ones. Standardized order sheets would be very beneficial in minimizing the medication errors if are used accurately

I-PASS Mentored Implementation Handoff Curriculum: Implementation Guide and Resources.

Communication failures during shift-to-shift handoffs of patient care have been identified as a leading cause of adverse events in health care institutions. The I-PASS Handoff Program is a comprehensive handoff program that has been shown to decrease rates of medical errors and adverse events. As part of the spread and adaptation of this program, a comprehensive implementation guide was created to assist individuals in the implementation process. The I-PASS Mentored Implementation Guide grew out of materials created for the original I-PASS Study, Society of Hospital Medicine (SHM) mentored implementation programs, and the experience of members of the I-PASS Study Group. The guide provides a comprehensive framework of all elements required to implement the large-scale I-PASS Handoff Program and contains detailed information on generating institutional support, training activities, a campaign, measuring impact, and sustaining the program. Thirty-two sites across North America utilized the guide as part of the SHM program. The guide served as a main reference for 477 hours of mentoring phone calls between site leads and their mentors. Postprogram surveys from wave 2 sites revealed that 85% (N = 34) of respondents felt the quality of the guide was very good/excellent. Site leads noted that they referenced the guide most often during the early part of the program and that they referenced the sections on the curriculum and handoff observations most often. The I-PASS Mentored Implementation Guide is an essential resource for those looking to implement the large-scale I-PASS Handoff Program at their institution.

The Impact of Training on Medication Error Rate of the Emergency Department in Hospitals Affiliated to Golestan University of Medical Sciences

Abstract Introduction: Medication errors are the most common type of medical errors that can cause serious problems for public health and are considered a threat to patient safety. This study was conducted to determine the effectiveness of patient safety training on nurses’ medication errors at the emergency department of a hospital of Golestan Province in Iran. Methods: The present quasi-experimental study was conducted from March to September 2016. The study population consisted of nurses working at a hospital affiliated to Golestan University of Medical Sciences and a sample of 40 nurses at the emergency department of this hospital were selected through a census. The data collection tools used included a demographic questionnaire and Wakefield’s Medication Error questionnaire for nurses (consisting of 21 domains), which were used once their reliability was confirmed. A patient safety training program was designed and implemented for the selected emergency nurses in the form of a twoday workshop. The obtained data were analyzed using the SPSS-18 software with the Wilcoxon test. Results: Results showed that the rate of medication errors (80.62%) of nurses were at a low level. The majority of nurses (80.62%) scored low in terms of the frequency of medication errors; after the training, a significantly greater number of nurses scored low in terms of this index (90.31%; P < 0.001). The analyses showed the effectiveness of the patient safety training program for nurses in the two domains of wrong time error and missed dose error (P < 0.001); however, the training had no significant effects in the other domains. Conclusions: As patient safety training can be effective on nurses’ medication errors, retraining courses on safe medication administration are necessary regarding nurses’ significant role in the prevention of medication errors.

Pharmacy quality improvement project to enhance the medication management process in pediatric patients.

Improvement in the quality of the medication management process is a crucial component of twenty-first-century medicine. To improve the quality of medication management process within pediatric specialty through designing a quality improvement project for the pharmaceutical care services in a children' hospital to solve the drug-related problems during drug prescribing, administration, and monitoring. A total of 900 medical files were evaluated (100 file/month) from the pediatric medical ward to detect any medication errors during prescribing, administration, or monitoring of the drugs. Three pharmacy quality indicators were designed to detect any medication errors during prescribing, administration, or monitoring of the drugs, then a collective datasheet was designed to record any defect in the system during drug management process within the hospital. A quality improvement project was designed using many quality improvement techniques to decrease the rates of medication errors in each drug handling stage. Brainstorming, fishbone chart, questionnaire, and voting were the main quality tools used to detect the causes of medication errors problem in pediatric patients. Certain actions were implemented which included educational program, implementation of clinical pharmacy, intravenous admixture, and drug information services. The quality improvement interventions succeeded in decreasing the rates of medication errors in each stage. These interventions succeeded in decreasing the rates of medication errors in prescribing, administration, and monitoring stages from 47, 60, and 56% respectively to ≤ 15% within 9months. Pharmacists can have a key role in improving the health-care system's quality in developing countries' health-care systems.