Types Of Medication Errors Research Articles

Therapeutic equivalent substitute that is new or unfamiliar to the chronic patient may result in medication error

The developing generic market has huge advantages of availability and affordability of therapy. The question of whether a therapeutic equivalent substitute under an unfamiliar name may cause confusion that leads to medical errors has not been sufficiently studied. This paper seeks to answer this question. The study was triggered following sporadic reports according to which patients mistakenly consider therapeutic equivalents as unrelated medications rather than substitutes. Family physicians and pharmacists in one of eight districts of Clalit, Israel's largest healthcare provider were surveyed. The survey's questions recall episodes of medication uncertainty, confusion, misidentification, and medication mistakes associated with switching from one therapeutic equivalent to another. A total of 66 physicians and 63 pharmacists responded to the surveys (61 percent and 45 percent, respectively). The results recall uncertainty, confusion, misidentification, and mainly cases of medication mistakes in which patients consumed both therapeutic equivalents simultaneously as was reported by 81 percent of physicians and 70 percent of pharmacists. There are two limitations in this work, the first is the study type, which is recall survey; the second is the response rate which is not unusual among health care professionals. However, the high face-validity and the consistency of the findings in both physicians and pharmacists surveyed indicates high validity of the study conclusions. A practical implication is unique medication error of consuming both therapeutic equivalents simultaneously. The authors wish to raise awareness of the potential of such error, which may be difficult to disclose as each of the therapeutic equivalents is apparently the intended medication but consuming them simultaneously results practically in doubling the intended dose. Given the forecast for generic market growth, awareness is not enough and worldwide regulatory cooperation should be made otherwise these types of medication errors will inevitably emerge. The study is original as a literature search revealed no studies evaluating potential medication mistakes attributed to a switch between therapeutic equivalents.

P3‐285: Frequency and type of medication errors by dementia caregivers

P3‐285: Frequency and type of medication errors by dementia caregivers

Streamlining the medication process improves safety in the intensive care unit

Multiple interventions were made to optimize the medication process in our intensive care unit (ICU). 1 Transcriptions from the medical order form to the administration plan were eliminated by merging both into a single document; 2 the new form was built in a logical sequence and was highly structured to promote completeness and standardization of information; 3 frequently used drug names, approved units, and fixed routes were pre-printed; 4 physicians and nurses were trained with regard to the correct use of the new form. This study was aimed at evaluating the impact of these interventions on clinically significant types of medication errors. Eight types of medication errors were measured by a prospective chart review before and after the interventions in the ICU of a public tertiary care hospital. We used an interrupted time-series design to control the secular trends. Over 85 days, 9298 lines of drug prescription and/or administration to 294 patients, corresponding to 754 patient-days were collected and analysed for the three series before and three series following the intervention. Global error rate decreased from 4.95 to 2.14% (-56.8%, P < 0.001). The safety of the medication process in our ICU was improved by simple and inexpensive interventions. In addition to the optimization of the prescription writing process, the documentation of intravenous preparation, and the scheduling of administration, the elimination of the transcription in combination with the training of users contributed to reducing errors and carried an interesting potential to increase safety.

Assessing the calculation skills of child health nursing staff

ObjectiveThe aim of this audit was to establish if there is need for a pharmacist-led regular education programme covering the various prescribing scenarios and dose calculations required for nursing staff...

Dispensing error rate in a tertiary hospital

BackgroundThe ward drug trolley process is error-prone so therefore pharmacists should take measure to recognise and prevent them.PurposeTo evaluate the rates and types of dispensing errors (DE) during the drug...

Analysis of medication errors in a private hospital: pharmacist interventions

BackgroundThe medication errors (ME) represent the largest single cause of errors in the hospital setting, and some of them result in serious patient morbidity/mortality. A knowledge of ME in every...

Profiling harmful medication errors in an acute Irish teaching hospital

Medication error reporting systems in hospitals are faced with the challenge of processing vast numbers of reports which identify a myriad of safety issues. With such large volumes of data and limited resources it makes sense to adopt a prioritisation approach. Several published studies have focused solely on the subset of errors which cause patient harm. The majority of such research has concerned the individual analysis of criteria associated with medication errors. However, the research described here used an alternative approach which involved linking the three criteria of medication class, patient outcome, and type of error, in order to describe the medication-related scenarios presenting greatest risk to the organisation. To identify the highest-priority medication-related risks in an acute teaching hospital. To profile harmful medication errors submitted to a voluntary reporting system in a tertiary healthcare setting in Ireland. A database of medication errors, reported via an internal voluntary reporting system over a 5-year period, was analysed. The criteria of medication class, patient outcome and type of error were analysed separately and then cross-tabulated. The medication classes, error types and adverse patient outcomes most frequently associated with harm were identified. The cross-tabulation highlighted ten priority risk areas which accounted for the majority of patient harm. A cross-tabulation strategy for prioritising medication-associated risks was successfully applied to a hospital database comprising medication errors. The profile developed for harmful medication errors in this acute tertiary healthcare setting was broadly in line with that published for error reporting systems internationally.

Prevalence of medication administration errors in two medical units with automated prescription and dispensing

To identify the frequency of medication administration errors and their potential risk factors in units using a computerized prescription order entry program and profiled automated dispensing cabinets. Prospective observational study conducted within two clinical units of the Gastroenterology Department in a 1537-bed tertiary teaching hospital in Madrid (Spain). Medication errors were measured using the disguised observation technique. Types of medication errors and their potential severity were described. The correlation between potential risk factors and medication errors was studied to identify potential causes. In total, 2314 medication administrations to 73 patients were observed: 509 errors were recorded (22.0%)-68 (13.4%) in preparation and 441 (86.6%) in administration. The most frequent errors were use of wrong administration techniques (especially concerning food intake (13.9%)), wrong reconstitution/dilution (1.7%), omission (1.4%), and wrong infusion speed (1.2%). Errors were classified as no damage (95.7%), no damage but monitoring required (2.3%), and temporary damage (0.4%). Potential clinical severity could not be assessed in 1.6% of cases. The potential risk factors morning shift, evening shift, Anatomical Therapeutic Chemical medication class antacids, prokinetics, antibiotics and immunosuppressants, oral administration, and intravenous administration were associated with a higher risk of administration errors. No association was found with variables related to understaffing or nurse's experience. Medication administration errors persist in units with automated prescription and dispensing. We identified a need to improve nurses' working procedures and to implement a Clinical Decision Support tool that generates recommendations about scheduling according to dietary restrictions, preparation of medication before parenteral administration, and adequate infusion rates.

Human factors methods to reduce medication error: using task analysis in a pediatric and adult pharmacy

Medication error is an issue that no hospital is immune from, leading to 7,000 deaths and 1.3 million patient injuries each year. The purpose of this study was to decrease the risk and occurrence of medication errors by analyzing the hospital pharmacy. Task analyses were performed and it was found that communication, expectation, and procedural issues were leading to the occurrence of the most common type of medication error in the pharmacy. Recommendations were made to improve the process and reduce the occurrence of this type of error.

Definitionen zu Pharmakovigilanz und Arzneimitteltherapiesicherheit (AMTS)

Terms and definitions for drug safety management have changed and are not used uniformly. Due to the different use of definitions many studies cannot be compared directly. After the amendment of the EU Directive on pharmacovigilance in 2012 a proposal for using these terms und definitions now exists. However, some definitions and terms are imprecise. Furthermore, the authors make suggestions regarding a more detailed version of the terms in pharmacovigilance in order to have a better differentiation for types of medication errors.

A Follow-Up Report Card on Computer-Assisted Diagnosis—the Grade: C+

Diagnostic errors result in an estimated 40,000 to 80,000 US hospital deaths annually1; they are the most common type of medical error cited in malpractice claims and result in the largest payouts2; they lead to more patient readmissions than other types of errors3; and autopsy studies confirm the ubiquity of missed diagnoses.4 Although not all diagnostic errors result in harm, many do.5 Typically these mistakes represent either cognitive errors, such as those resulting from a lack of knowledge, or communication errors, such as those resulting from poor handoffs and follow-up.6,7 Differential diagnosis (DDX) generators have the potential to assist in the former, while other types of clinical decision support can address the latter.

Reducing Medical Errors and Adverse Events

Medical errors account for ∼98,000 deaths per year in the United States. They increase disability and costs and decrease confidence in the health care system. We review several important types of medical errors and adverse events. We discuss medication errors, healthcare-acquired infections, falls, handoff errors, diagnostic errors, and surgical errors. We describe the impact of these errors, review causes and contributing factors, and provide an overview of strategies to reduce these events. We also discuss teamwork/safety culture, an important aspect in reducing medical errors.

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.

Optimizing Patient Safety During Hemodialysis

PUBLICATION OF THE LANDMARK REPORT TO ERR IS Human: Building a Safer Health System by the Institute of Medicine galvanized the health care system to focus relentlessly on improving patient safety. These efforts have many forms, often leveraging current health information technology to collect and analyze information about the characteristics of avoidable complications. Many efforts focus on known weaknesses in the health care delivery process, such as discontinuity of care, lack of integrated accountability among clinicians for patient outcomes, and communication errors. Failure mode analysis, root cause analysis, and examination of “near misses” are often tools used for improving patient safety. However, observers agree that there remain fundamental problems with patient safety in an increasingly complex medical environment. The use of hemodialysis for the treatment of irreversible kidney failure represents an important opportunity to improve patient safety. Hemodialysis has gradually been transformed from an extraordinary to a commonplace medical procedure during the past 50 years. Today, more than 50 million hemodialysis treatments are performed annually in the United States alone. Moreover, as dialysis therapy has matured, an increasingly elderly, frail population with extensive comorbidities is now being treated with high attendant risks for procedure-related complications. Meanwhile, technical improvements in nearly all aspects of the hemodialysis procedure have greatly increased overall safety. Today, there is better standardization of equipment, more use of automated controls and real-time monitors built into dialysis equipment for adjusting critical components of the dialysis procedure, and use of higher purity of water in dialysate than in the past. However, many gaps remain in the safety net around this complex medical procedure and current approaches for improving safety in the dialysis population are often suboptimal. Published studies that systematically evaluate the frequency and type of adverse events and medical errors occurring in dialysis units are rare. Many patient safety problems in dialysis units are “known knowns,” including medication errors, risks for intradialytic hypotension, and complications related to vascular access. These problems can be addressed using strategies already proven to have benefit in other clinical settings, such as medication reconciliation, and targeted interventions for prevention of falls. Other safety problems, such as clusters of unusual infections, fit readily into failure mode analysis models. The greatest opportunities and challenges, however, probably involve identifying “unknown unknowns” that affect patient safety. Two salient studies, separated by more than 40 years and each published in JAMA, illustrate the inherent value of alert clinicians and researchers working together to illuminate “unknown unknowns” in dialysis care. In 1968, during the early days of dialysis therapy, clinicians made the serendipitous observation that transient neutropenia occurred 2 to 15 minutes after starting dialysis. The neutropenia was followed by the appearance of circulating immature neutrophils and by the end of dialysis the white blood cell count was normal. The occurrence of severe transient neutropenia during dialysis was then confirmed in 33 consecutive patients undergoing dialysis treatments. The clinicians became investigators and demonstrated that this was a systemic phenomenon by drawing blood samples from the antecubital vein of the contralateral arm (ie, venipuncture in the arm away from the dialysis access site) and further noted that the neutropenia developed when only a small fraction of the blood volume had passed through the dialyzer. Subsequent research clarified that when blood came into contact with dialysis membranes manufactured out of unmodified cellulose, commonly used in that era, vigorous activation of the alternate complement pathway ensued. The transient neutropenia was due to profound complementmediated neutrophil activation, which caused aggregation of neutrophils in tissue beds such as the lungs. When later work established that there were important clinical consequences from repetitive neutrophil activation with each dialysis treatment, new more biocompatible dialysis membranes were developed, and eventually unmodified cellulosic dialyzers were removed from the market.

Medication errors during medical emergencies in a large, tertiary care, academic medical center

PurposeEvaluate the rate, type and severity of medication errors occurring during Medical Emergency Team (MET) care at a large, tertiary-care, academic medical center. MethodsA prospective, observational evaluation of 50 patients that required MET care was conducted. Data on medication use were collected using a direct-observation method whereby an observer documented drug information such as drug, dose, frequency, rate of administration and administration technique. Subsequently, a team of three clinicians assessed rate, type and severity of medication errors using definitions consistent with United States Pharmacopeia MEDMARX system. Severity was assessed on a scale of minor, moderate and severe. ResultsOne hundred eighty six doses were observed for 36 different medications. A total of 296 errors were identified; of these 196 errors (66%) were inappropriate aseptic technique. Of the remaining 100 errors, 46% were prescribing errors, 28% administration technique errors, 14% mislabeling errors, 10% drug preparation errors and 2% improper dose prescribing. Examples included: (1) prescribing errors, (2) administering wrong doses, (3) mislabeling, and (4) wrong administration technique such as not flushing intravenous medication through intravenous access. The rate of medication administration errors was 1.6 errors/dose including aseptic technique and 0.5 errors/dose excluding aseptic technique. A notable portion (14%) of errors was considered at least moderate in severity. ConclusionsOne out of 2 doses was administered in error after errors of using inappropriate aseptic technique were excluded. There is a need for education and systematic changes to prevent medication errors during medical emergencies as an effort to avoid harm.

219 A Prospective, Multicenter Study of Medication Errors Intercepted by Emergency Department Pharmacists

The primary objectives of this study were to determine 1) the methods by which patients at risk for medication errors (MEs) were first identified in the emergency department (ED) and 2) the activities of pharmacists in the ED that led to ME interception. A secondary objective was to determine the phase, type and severity of MEs intercepted. This was a prospective, multicenter cohort study conducted in 4 geographically diverse academic and community EDs in the United States. All EDs had pharmacists present who functioned as drug therapy consultants, reviewed medication orders, attended medical and trauma resuscitations and facilitated medication distribution. Pharmacists at each site recorded ME interceptions for 250 hours of cumulative time when present in the ED (1000 hours total for all 4 sites). Items recorded included: 1) the method by which patients at risk for MEs were first identified, 2) the activities of the pharmacist that led to ME interception and 3) detailed information regarding each interception such as the phase of the medication use process in which the ME occurred, error type and description of event. In addition, each interception was independently evaluated and assigned a severity rating by a physician and a pharmacist investigator who were not involved in the data collection process and blinded to study site. Descriptive analyses were performed for all variables. A total of 16,446 patients were encountered during the study, resulting in 364 ME interceptions. Patients at risk for MEs were first identified when the pharmacist was contacted by housestaff (n=142, 39%), or when the pharmacist initiated contact (n=222, 61%) based on patient severity, medical condition or medication order. The pharmacists' activities that led to ME interception were as follows: consulting with staff or presence at the bedside (n=187, 51.4%), reviewing written or computerized medication orders (n=127, 34.9%), and other (n=50, 13.7%). Most MEs (n=300, 82.4%) were intercepted during the prescribing phase of the medication use process. Types of MEs intercepted were wrong dose (n=161, 44.2%), wrong drug (n=50, 13.7%), indicated medication not ordered (n=44, 12.9%), wrong administration rate or technique (n=38, 10.4%) and other (n=71, 19.5%). The final severity ratings of MEs were as follows: minor (n=34, 9.3%), significant (n=238, 65.4%), serious (n=83, 22.8%), and life threatening (n=9, 2.5%). Housestaff-initiated contact with the pharmacist and pharmacist presence in the ED is necessary to identify a large proportion of patients at risk for MEs. Pharmacists' review of written or computerized medication orders accounts for a smaller proportion of ME interceptions.

Reducing Prescribing Errors in Paediatric Patients by Assessment and Feedback Targeted at Prescribers

Prescribing errors are the most common type of medical errors and can result in harm particularly in young children. Doctors were enrolled in a programme of written assessment in prescribing skills and individualized feedback. Pharmacists audited the impact. The setting was the paediatric wards and neonatal unit of a District General Hospital. 16 doctors were tested and received feedback. A total of 110 errors were identified in this test, out of a 51 were classified as major including wrong dose and frequency, and prescribing medication the patient had an allergy to. Audit of impact of this intervention revealed a reduction of errors from 47 to 21, and patients affected from 19 to 11 per 100 (P = 0.001) emergency admissions compared to an audit before the intervention. An intervention combining a comprehensive multifaceted assessment and detailed feedback can lead to reduction of prescribing errors in paediatric trainees.

The Impact of Automation of Systems on Medical Errors: Evidence from Field Research

We use panel data from multiple wards from two hospitals spanning a three-year period to investigate the impact of automation of the core error prevention functions in hospitals on medical error rates. Although there are studies based on anecdotal evidence and self-reported data on how automation impacts medical errors, no systematic studies exist that are based on actual error rates from hospitals. Further, there is no systematic evidence on how incremental automation over time and across multiple wards impacts the rate of medical errors. The primary objective of our study is to fill this gap in the literature by empirically examining how the automation of core error prevention functions affects two types of medical errors. We draw on the medical informatics literature and principal-agency theory and use a unique panel data set of actual documented medical errors from two major hospitals to analyze the interplay between automation and medical errors. We hypothesize that the automation of the sensing function (recording and observing agent actions) will have the greatest impact on reducing error rates. We show that there are significant complementarities between quality management training imparted to hospital staff and the automation of control systems in reducing interpretative medical errors. We also offer insights to practitioners and theoreticians alike on how the automation of error prevention functions can be combined with training in quality management to yield better outcomes. Our results suggest an optimal implementation path for the automation of error prevention functions in hospitals.

Negligence and the Challenge of Collaborative Care

This paper considers the utility of tort law, when applied to modern methods of health care delivery. The new generation of health care delivery methods are based on collaborations between disparate health care providers who form distributed and ephemeral teams. In many cases, this type of dynamic collaboration requires the use of information and communication technologies in order to function. In this domain, systems-level concerns become far more important than in the traditional settings studied in medical malpractice law, such as hospitals and clinics. Our claim is that the increasing importance of collaborative workflows in health care will yield a corresponding increase in systematic medical errors. Since the goals of tort law are difficult to satisfy in collaborative contexts, we believe that tort law (particularly negligence) will be an ineffective means of discouraging this type of medical error. In addition to providing a timely introduction to cutting edge developments in care delivery, we present several recommendations for policy makers and health care organizations. The challenges posed by collaboration will become more intense as the health care system moves towards distributed models of care delivery.

Medication prescribing errors in a pediatric inpatient tertiary care setting in Saudi Arabia

BackgroundMedication errors (MEs) are among the most common types of medical errors and one of the most common and preventable causes of iatrogenic injuries. The aims of the present study were; (i) to determine the incidence and types of medication prescribing errors (MPEs), and (ii) to identify some potential risk factors in a pediatric inpatient tertiary care setting in Saudi Arabia.FindingsA five-week retrospective cohort study identified medication errors in the general pediatric ward and pediatric intensive care unit (PICU) at King Abdulaziz Medical City (KAMC) through the physical inspection of physician medication orders and reviews of patients' files. Out of the 2,380 orders examined, the overall error rate was 56 per 100 medication orders (95% CI: 54.2%, 57.8%). Dose errors were the most prevalent (22.1%). These were followed by route errors (12.0%), errors in clarity (11.4%) and frequency errors (5.4%). Other types of errors were incompatibility (1.9%), incorrect drug selection (1.7%) and duplicate therapy (1%). The majority of orders (81.8%) had one or more abbreviations. Error rates were highest in prescriptions for electrolytes (17.17%), antibiotics (13.72%) and bronchodilators (12.97%). Medication prescription errors occurred more frequently in males (64.5%), infants (44.5%) and for medications with an intravenous route of administration (50.2%). Approximately one third of the errors occurred in the PICU (33.9%).ConclusionsThe incidence of MPEs was significantly high. Large-scale prospective studies are recommended to determine the extent and outcome of medication errors in pediatric hospitals in Saudi Arabia.