Types Of Medication Administration Errors Research Articles

Prevalence and factors associated with medication administration errors in the neonatal intensive care unit: A multicentre, nationwide direct observational study.

To determine the prevalence of medication administration errors and identify factors associated with medication administration errors among neonates in the neonatal intensive care units. Prospective direct observational study. The study was conducted in the neonatal intensive care units of five public hospitals in Malaysia from April 2022 to March 2023. The preparation and administration of medications were observed using a standardized data collection form followed by chart review. After data collection, error identification was independently performed by two clinical pharmacists. Multivariable logistic regression was used to identify factors associated with medication administration errors. A total of 743 out of 1093 observed doses had at least one error, affecting 92.4% (157/170) neonates. The rate of medication administration errors was 68.0%. The top three most frequently occurring types of medication administration errors were wrong rate of administration (21.2%), wrong drug preparation (17.9%) and wrong dose (17.0%). Factors significantly associated with medication administration errors were medications administered intravenously, unavailability of a protocol, the number of prescribed medications, nursing experience, non-ventilated neonates and gestational age in weeks. Medication administration errors among neonates in the neonatal intensive care units are still common. The intravenous route of administration, absence of a protocol, younger gestational age, non-ventilated neonates, higher number of medications prescribed and increased years of nursing experience were significantly associated with medication administration errors. The findings of this study will enable the implementation of effective and sustainable interventions to target the factors identified in reducing medication administration errors among neonates in the neonatal intensive care unit. We adhered to the STROBE checklist. An expert panel consisting of healthcare professionals was involved in the identification of independent variables.

Identifying the most common and costly medication errors: Implications for healthcare managers

Medication administration errors, although preventable, continue to have adverse effects on patient outcomes and healthcare facilities’ financial well-being. Researchers have demonstrated that, although process interventions have been implemented, new technology has been deployed, and training and education have increased, the errors persist. Limited research appears to have established the most prevalent, harmful and costly types of medication administration errors. Therefore, the purpose of this study is to assist healthcare managers of inpatient facilities to identify the most common and costly medication administration errors. Donabedian’s model for healthcare quality, derived from the three categories of structure, process and outcomes, was utilised to determine how mistakes persist despite numerous interventions targeted at these factors. A correlational analysis was conducted utilising Pearson’s R and multiple linear regression to define the relationships between the independent variable of ‘specific malpractice allegation’ (ie medication administration error type) and dependent variables of ‘severity of alleged injury’ and ‘total payment’. Results were determined by the correlation coefficient after regression diagnostics. Analysis of the data indicates a greater prevalence of administration errors related to wrong medication and wrong dose; of these, wrong medication errors resulted in greater harm to the patient, although medications administered via the wrong route resulted in the payment of greater amounts. In addition, payment amounts increase with greater severity of harm. Implications for healthcare managers include implementing processes to reduce medication administration errors as well as implementing targeted risk management programmes in inpatient settings.

Medication administration errors made among undergraduate nursing students: A need for change in teaching methods.

Systems factors, such as interruptions, contribute to nursing errors. Gaining an understanding of what contributes to nursing student errors can inform educational strategies aimed to improve patient safety. The aims of this study were to investigate: (a) within-subjects differences in error rates among nursing students during interrupted compared to uninterrupted simulated medication administration, (b) types of medication administration errors made by nursing students, and (c) nursing students' perceptions of their ability to independently administer medication. A descriptive comparative within-subjects design was utilized in this two-site study. Data on errors were collected via direct observation. Senior baccalaureate nursing student participants discussed their experience of interrupted and uninterrupted simulated medication administration during individual debriefing sessions. Nearly one-third of participants made errors. Error rates were similar in interrupted (19.4%) and uninterrupted (16.7%) conditions. Near-misses, which were not included in the error rates, were reported by 8% of participants. The most common error types were documentation and dose errors. Students attributed the interruption and lack of independent medication administration practice as causes for errors. Educational programs must adequately prepare nursing students for independent safe medication administration in complex work environments. The inclusion of systems factors in educational modalities is critical.

Types of medication administration errors and comparisons among nursing graduands in Indonesia, Taiwan, and Thailand: A cross-sectional observational study

BackgroundDespite medication administration safety having been introduced, practiced, and examined in nursing schools for many years, errors are commonly reported among new nurses. Understanding medication errors that nursing graduands might commit is essential for patient safety and fostering collaboration among neighboring countries. ObjectivesTo assess and compare types of medication administration errors identified by nursing graduands in Asian countries using a medication errors scenario. DesignA cross-sectional observational study. SettingsOne university four-year nursing program each in Indonesia, Taiwan, and Thailand. ParticipantsA total of 145 baccalaureate nursing graduands in their last semester, including 42 from Indonesia, 35 from Taiwan, and 68 from Thailand. MethodsThe medication errors scenario contained 11 errors. The faculty examiner directly observed and graded the graduands' performance in identifying medication errors using an objective structured medication administration checklist. Descriptive and inferential analyses were used. ResultsOverall, 4.4 ± 1.8 errors on average were identified in the medication errors scenario. The most common types of errors differed among the three countries. More than half of the graduands did not check the patient's wristband (n = 75; 51.7%) or discovered the wrong name on it (n = 88; 60.7%). Giving medication without an indication (n = 129; 89.0%) and giving medication with potential for an allergic reaction (n = 111; 76.6%) were the most common errors. ConclusionsMedication administration errors are common in nursing graduands. Specific types and various frequencies of errors were noted across three countries. Nursing faculties should investigate possible reasons for common types of errors and develop effective education strategies for graduands to prevent errors. Collaboration among neighboring countries is encouraged to improve overall global medication safety.

The Impact of a Bedside Medication Scanning Device on Administration Errors in the Hospital Setting: A Prospective Observational Study

IntroductionThe medication administration process is complex and influenced by interruptions, multi-tasking and responding to patient’s needs and is consequently prone to errors.1 Over half (54.4%) of the 237 million medication errors estimated to have occurred in England each year were found to have taken place at the administration stage and 7.6% were associated with moderate or severe harm. The implementation of a Closed Loop Medication Administration solution aims to reduce medication administration errors and prevent patient harm.AimWe conducted the first evaluation to assess the impact of a novel optical medication scanning device, MedEye, on the rate of medication administration errors in solid oral dosage forms.MethodsWe performed a before and after study on one ward at a tertiary-care teaching hospital that used a commercial electronic prescribing and medication administration system and was implementing MedEye (a bedside tool for stopping and preventing medication administration errors). Pre-MedEye data collection occurred between Aug-Nov 2019 and post-MedEye data collection occurred between Feb-Mar 2020. We conducted direct observations of nursing drug administration rounds before and after the MedEye implementation. Observers recorded what they observed being administered (e.g., drug name, form, strength and quantity) and compared this to what was prescribed. Errors were classified as either a ‘timing’ error, ‘omission’ error or ‘other’ error. We calculated the rate and type of medication administration errors (MAEs) before and after the MedEye implementation. A sample size calculation suggested that approximately 10,000 medication administrations were needed. Data collection was reduced due to the COVID 19 pandemic and implementation delays.ResultsTrained pharmacists or nurses observed a total of 1,069 administrations of solid oral dosage forms before and 432 after the MedEye intervention was implemented. The percentage of MAEs pre-MedEye (69.1%) and post-MedEye (69.9%) remained almost the same. Non-timing errors (combination of ‘omission’ + ‘other’ errors) reduced from 51 (4.77%) to 11 (2.55%), which had borderline significance (p=0.05) however after adjusting for confounders, significance was lost. We also saw a non-significant reduction in ‘other’ error types (e.g., dose and documentation errors) following the implementation of MedEye from 34 (3.2%) to 7 (1.62%). An observer witnessed a nurse dispense the wrong medication (prednisolone) instead of the intended medication (furosemide) in the post-MedEye period. After receiving a notification from MedEye that an unexpected medication had been dispensed, the nurse corrected the dose thus preventing an error. We also identified one instance where the nurse correctly dispensed a prescribed medication (amlodipine) but this was mistakenly identified by the MedEye scanner as another prescribed medication (metoclopramide).ConclusionsThis is the first evaluation of a novel optical medication scanning device, MedEye on the rate of MAEs in one of the largest NHS trusts in England. We found a non-statistically significant reduction in non-timing error rates. This was notable because incidents within this category e.g., dose errors, are more likely to be associated with harm compared to timing errors.2 However, further research is needed to investigate the impact of MedEye on a larger sample size and range of medications.

Factors contributing to medication administration errors and barriers to self-reporting among nurses: a review of literature

Background: Medication Administration Errors (MAEs) are common among nurses and can threaten all patients’ outcomes. Furthermore, MAEs are the leading cause of incidents in patient safety records worldwide.Objective: To review the types of medication administration errors, factors contributing to MAEs and barriers to self-reporting among nurses.Methods: A review of the literature was done and included original articles and grey literature from January 2011 until July 2017. An advanced search was done in Medline, HINARI, PubMed, CINAHL, Science direct, Google Scholar and gray literature using a Boolean combination of different keywords such as “medication administration error”, “adverse drugs reactions”, barriers and “self-reporting”.Results: 257 articles were eligible for review but only27 articles met the inclusion criteria. Types of MAEs mainly focused on seven rights (right patient, right drug, right dose, right time, right route, right reason and right documentation). With regards to the types of MAEs, the wrong time was most prevalent in this study. Being overworked was the main factor contributing to medication administration errors. The barriers to self-reporting during MAEs were dominated by fear of disciplinary action. Nurses’ characteristics such as age, experience, education, variations in how errors are defined and organizational factors such as power, distance and lack of reporting policies were found to be barriers to self-reporting. In addition to that, others were identified.Conclusion: Globally, MAEs remain a pervasive problem among nurses. Contributing factors range from individual to organizational factors, and barriers to self-report are due to fear of legal action and punishment. There is a need to devise measures that will prevent these errors and to promote positive clinical outcomes of patients in healthcare settings.Keywords: contributing factors, medication administration errors, barriers, self-reporting, nurse

Drug Calculation Cards and Medication Errors in the Neonatal Intensive Care Units

Introduction: Medication administration errors are the most common medication errors. One of the most important causes of medication administration errors is a mistake in calculating the dose of medication by nurses. This study was conducted to evaluate the effects of using the Drug Calculation Cards on the amount and type of medication administration errors in the Neonatal Intensive Care Units (NICUs). Methods: This quasi-experimental study was conducted with one-group before-after design to examine the effects of using the Drug Calculation Cards on the amount and type of medication administration errors. Eligible NICU nurses in selected centers affiliated to Qazvin University of Medical Sciences were registered (n = 33) in the study within three months. Then, before intervention data were collected using “medication administration errors reporting” questionnaire. Three months later the intervention (drug calculation card) was done and the same medication administration errors reporting questionnaire was dispersed. The data were entered to the SPSS version 14 and was analyzed using descriptive statistics. Results: The mean medication administration error during the three months before and three months after the intervention were 12.41 ± 14.48 and 9.62 ± 12.72, respectively, which had a statistically significant difference (P = 0.004). Conclusions: Using the Drug Calculation Cards by nurses in

Nurses’ experiences and perceptions of medication administration errors

Background and objective: Medication administration errors are the most common medical errors that happen in hospital settings. This study aimed to find out the most common types of medication administration errors done by the hospital nurses and identifying factors that lead to medication administration errors. Methods: This cross-sectional survey was conducted across Erbil teaching hospitals over a period of three months from June 2016 to September 2016. A convenience sample of 250 nurses who were working in acute, subacute, and general wards and had direct contact with the medication administration were included in this study. Data were collected using a self-reported questionnaire. Results: According to this study the most common types of medication errors were, noticing allergy after drugs administration and administering drugs at a wrong time. The highest leading factors of medication administration errors were illegible medication orders of the physicians, lack of adequate staffing and workload. High statistical differences were found between the frequency of medication administration errors with nurses’ educational level, overall working experience, and nurses understanding language. Conclusion: This study concluded that medication administration errors have multiple causes and types of errors are various.

Association between workarounds and medication administration errors in bar-code-assisted medication administration in hospitals.

To study the association of workarounds with medication administration errors using barcode-assisted medication administration (BCMA), and to determine the frequency and types of workarounds and medication administration errors. A prospective observational study in Dutch hospitals using BCMA to administer medication. Direct observation was used to collect data. Primary outcome measure was the proportion of medication administrations with one or more medication administration errors. Secondary outcome was the frequency and types of workarounds and medication administration errors. Univariate and multivariate multilevel logistic regression analysis were used to assess the association between workarounds and medication administration errors. Descriptive statistics were used for the secondary outcomes. We included 5793 medication administrations for 1230 inpatients. Workarounds were associated with medication administration errors (adjusted odds ratio 3.06 [95% CI: 2.49-3.78]). Most commonly, procedural workarounds were observed, such as not scanning at all (36%), not scanning patients because they did not wear a wristband (28%), incorrect medication scanning, multiple medication scanning, and ignoring alert signals (11%). Common types of medication administration errors were omissions (78%), administration of non-ordered drugs (8.0%), and wrong doses given (6.0%). Workarounds are associated with medication administration errors in hospitals using BCMA. These data suggest that BCMA needs more post-implementation evaluation if it is to achieve the intended benefits for medication safety. In hospitals using barcode-assisted medication administration, workarounds occurred in 66% of medication administrations and were associated with large numbers of medication administration errors.

Medicines administration for residents with dysphagia in care homes: A small scale observational study to improve practice

BackgroundIn the UK, 69.5% of residents in care homes are exposed to one or more medication errors and 50% have some form of dysphagia. Hospital research identified that nurses frequently crush tablets to facilitate swallowing but this has not been explored in care homes. This project aimed to observe the administration of medicines to patients with dysphagia (PWD) and without in care homes. MethodA convenient sample of general practitioners in North Yorkshire invited care homes with nursing, to participate in the study. A pharmacist specialised in dysphagia observed nurses during drug rounds and compared these practices with national guidelines. Deviations were classified as types of medication administration errors (MAEs). ResultsOverall, 738 administrations were observed from 166 patients of which 38 patients (22.9%) had dysphagia. MAE rates were 57.3% and 30.8% for PWD and those without respectively (p<0.001). PWD were more likely to experience inappropriate prescribing (IP). Signs of aspiration were more frequently observed in PWD when IP occurred (p<0.001). ConclusionObservation of medication administration practices by independent pharmacists may enable the identification of potentially dangerous practices and be used as a method of staff support. Unidentified signs of aspiration suggest that nurses require training in dysphagia and need to communicate its presence to the resident’s GP. Further research should explore the design of an effective training for nurses.

The effects of a patients' own drugs scheme on the incidence and severity of medication administration errors

AbstractBackgroundMany UK hospitals are introducing patients' own drugs (PODs) schemes, in which patients' own medication is used during their stay. It has been suggested that these will reduce medication administration errors (MAEs), particularly those due to medication unavailability.ObjectiveTo explore the effects of introducing a PODs system on the incidence and severity of MAEs.Method and settingAn observational method was used to identify MAEs before and after introducing a PODs system on one surgical and one medical ward in a teaching hospital in the United Kingdom. MAEs were classified as being due to unavailability (U-MAEs) or other reasons (O-MAEs). A validated severity assessment method was applied to the MAEs identified.Key resultsThe overall MAE rate for the traditional ward pharmacy system was 4.3 per cent and for the PODs system it was 4.2 per cent (P=0.99, chi square test). There were also no significant differences in U-MAE or O-MAE rates, types of MAE or their severity. There were several potential reasons why the PODs system did not reduce U-MAEs. These included the informal use of patients' own medication in the traditional ward pharmacy system and one patient prescribed a non-formulary drug who accounted for many of the U-MAEs observed. Logistic regression analyses indicated that U-MAE rates were affected by time of day and day of week, and O-MAE rates by day of week and administering nurse.ConclusionIt was concluded that the introduction of a PODs system had little effect on MAEs.

Effect of bar-code-assisted medication administration on medication administration errors and accuracy in multiple patient care areas

The effect of a commercially available bar-code-assisted medication administration (BCMA) technology on six indicators of medication administration accuracy and nine types of medication administration errors in distinct patient care areas were studied. This prospective, before-and-after, observational study was conducted in two medical-surgical units, one medical intensive care unit (ICU), and one surgical ICU of a 386-bed academic teaching hospital. Nursing staff were observed administering medications one month before and three months after implementation of BCMA technology. Observations were conducted by two pharmacists and four pharmacy students on weekdays and weekends. Medication administration accuracy was measured using the accuracy indicator of the California Nursing Outcomes Coalition. The majority of medication administrations occurred during the 9 a.m. medication round. After BCMA implementation in the medical-surgical units, improved adherence to patient identification policies was observed, but more distractions of the nursing staff occurred and the medications administered were less frequently explained to the patient. Although an increase in wrong-time errors was observed in the medical-surgical units, the total number of medication errors did not change. When wrong-time errors were excluded, the rate of medication errors decreased by 58%. In the ICUs, the charting of medication administration improved after BCMA implementation, but total medication errors and wrong-time errors did not change. Implementing BCMA technology decreased medication administration errors in medical-surgical units but not in ICUs when time errors were excluded. BCMA technology affected different types of medication administration errors in different patient care areas.

Medication administration errors in adult patients in the ICU.

To quantify the incidence and specify the types of medication administration errors from a list of error-prone medications and to determine if patient harm resulted from these errors. An observational evaluation. Five intensive care units (ICUs) in the United States. Eight hundred fifty-one patients who were at least 18 years of age and admitted to surgical, medical or mixed ICUs during a 3 month period were included. None. A list of error-prone medications was adapted from the literature and evaluated for medication errors and patient harm. Of 5,744 observations in 851 patients, 187 (3.3%) medication administration errors were detected. the therapeutic classes most commonly associated with errors were vasoactive drugs 61 (32.6%) and sedative/analgesics 48 (25.7%). The most common type of error was wrong infusion rate with 71 (40.1%) errors. Twenty-one errors did not reach the patient and 159 reached the patient but did not result in harm, increased monitoring or intervention. Five errors required increased patient monitoring and two required intervention. None of the errors resulted in patient death. This multicenter evaluation found fewer medication administration errors than the published literature, possibly due to the varying observational techniques and pharmacist involvement. Lorazepam and wrong infusion rates are associated with errors that occurred frequently, resulted in the greatest potential for harm and were common oversights in the system. These errors should be considered potential areas for betterment in the medication use process to improve patient safety.