Types Of Medication Errors Research Articles

Analysis of medication errors by RCA method and implementation of reducing strategies to ‎improve patient safety in Hujjat Kuh-Kamari Hospital in Marand - 2017‎

Background: Medical errors are one of the major challenges which threaten patient’s safety. Meanwhile, medication errors are common types of medical errors that have attracted the attention of many people. It is known as the eighth cause of death in USA. It has also caused many different injuries, death, or increase in medical costs in other countries. Regarding the importance of patient's safety and reduction of medical errors, this study was conducted to evaluate and analyze of medication errors and implementation of strategies to reduce errors in Hujjat Kuh-Kamari Hospital in 2017. Methods: This research is an analytical and interventional study. All reported errors in 2017 were summed up by personnel and patient safety staffs at monthly medical units and analyzed using the RCA (Root Cause Analysis) by medical error analysis team and were ultimately analyzed in Ishikawa diagram. Then, by identifying CPD (Caring Problem Delivery) and the SPD (System Problem Delivery) factors, the main causes of these errors were evaluated from the moment of prescribing and filing until giving the medication; then appropriate strategies were provided and approved to reduce these errors by the Error Analysis Team. These strategies were then provided to the treatment units. Finally, a reassessment of medication errors was performed again in 2018and compared withthe results obtained in 2018 to determine the strategies effectiveness. Results: The results of the study showed that the errors were in different forms, such as incorrect dose, incorrect registration of the drug, lack of registration of the drug, incorrect entry at list, failure to implement it, and wrong implementation of medication order. According to the analysis of the errors, the causes of the occurrence of these errors were the cases such as incorrect checking of the orders (20%), the problem with readability of the order (15.5%), the similarity of the medication in terms of the name, form and appearance (14%) the incomplete written name of medication by the doctor (7.8%) the incomplete written name of medication by the nurse (8.7%), and other errors. Ultimately, solutions were provided to the units as follows: •Checking the orders again by the next person in the next shift and matching it with the orders in patient's list. •Matching the medications in patient's list and records by the secretary of the unit at the time of registration in HIS system. •Sending letter to doctors to write the medication orders better and in a readable way. •Separating similar medications and identifying the risky and similar medications with yellow and red labels. These errors were assessed in 2018 again, and all errors were reduced by an average of 8.35%. However, the errors related to doctors' handwriting were increased up to 0.4%. Conclusion:Considering the importance of patient safety and receiving safe services in hospitals, it is important to identify errors and its causes, examine the strengths and weaknesses of reporting errors, share errors and find ways to reduce or eliminate these errors for improving patient safety in the hospital. Therefore, it is necessary to create organizational culture and patient safety culture in order to feel responsible for the system and patients in the medical staff. In this regard, encouraging staff to report errors, contributing them to the analyze errors, using staff comments, considering the management's responsibility about patient safety, reporting errors, and encouraging staff whoare pioneer in patient safety advancement can be very helpful.

262: Improving error identification with an inpatient maternal-fetal medicine pharmacist

Although the fast-paced environment of inpatient obstetrics may predispose to medication errors, there is relatively little information about their nature and frequency. In September 2017, our Midwestern level-IV hospital hired a dedicated inpatient maternal-fetal medicine clinical pharmacy specialist. The pharmacist attends daily board rounds on labor and delivery, rounds on all antepartum patients, and monitors medication orders. The objectives of this quality improvement study were to: (1) quantify the number and types of interventions made by the pharmacist and (2) to compare rates of reported errors before and after her hiring. We hypothesized that the rate of identified medication errors would be increased in the time period after the pharmacist was employed. From February 1, 2018 through May 31, 2018, the pharmacist tabulated her interventions on a daily basis under the categories of medication error, drug interactions, monitoring, cost savings, medication management, and other. The number and types of medication errors reported to our institutional event reporting system in the eight months prior to and first eight months after the pharmacist’s hiring were compared. Figure 1 depicts the number of interventions (n=1,217) within the different categories per month. The most frequent interventions were discontinuation of medications that were no longer indicated (n=232), providing drug information/education of clinical staff (n=251), and providing initial dose recommendations (n=116). There were 74 cost-saving interventions. The number of reported medication errors (n=71) to the centralized reporting system doubled (3/month to 6/month, p=0.007) after the pharmacist’s hiring (Figure 2), and the majority of these were reported by the pharmacist herself. The most frequent types of errors were wrong dose, route, or schedule (n=33) and medication not given or given without order (n=18). In the initial months after commencing her role, the pharmacist provided over 1,000 direct clinical interventions to improve patient care in a high-risk environment. Furthermore, medical errors can only be systematically addressed when they are noticed, and this study highlights that a significant proportion of medication errors (50% in this study) are not reported by providers. These results suggest the addition of a pharmacist to the obstetric team may lead to interventions which ultimately improve medication safety.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

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.

CONTRIBUTING FACTORS TO MEDICATION ERRORS AS PERCEIVED BY NURSING STUDENTS IN ILIGAN CITY, PHILIPPINES

Background: Nursing students are allowed to give medication with clinical supervision to enhance skills in medication administration. However, studies suggest that some students commit medication errors due to knowledge, personal, administrative and environmental factors.&#x0D; Objective: This study will identify factors that cause student nurses to commit medication errors and correlate it to the number of perceived medication errors committed.&#x0D; Methods: A correlational design was used to correlate the factors contributing to medication administration and the number of medication errors committed by the students. 388 randomly selected nursing students were asked to answer Modified Medication Error Questionnaire which measures the knowledge, administrative, personal and environmental factors which may contribute to medication administration errors. Medication administration errors are measured according to the number of times a student commits as perceived by them.&#x0D; Results: Lack of knowledge of the drug and equipment to be used for administration, decrease in confidence, poor clinical assessment of patients’ conditions, and poor follow ups from clinical instructor are identified concerns under knowledge factor. Poor positive feedback, inadequate supervision and belittling ways of clinical instructors are identified under the administrative factor. Fear of administering an injection or giving medications is a common problem under personal factor. Inappropriate labelling of medications, unfavorable room temperature, lack of space, inadequate lighting, disorganized medication administration schedule and noise are problems found under environmental factor. A minority of 17.3% claimed that they have encountered a medication error in any of their clinical duties.&#x0D; Conclusion: Knowledge, administrative, personal and environmental factors have no effect towards medication errors. However, the relationship between age and the number of perceived medications errors is established. More in-depth investigation is recommended to determine the type of medication errors committed and its detrimental effects towards patient safety.

Prevention of medication errors at hospital admission: a single-centre experience in elderly admitted to internal medicine.

Background Transition of care on admission to the hospital and between clinical areas are risk points for medication errors. All type of medication errors can be reduced by improving communication at each transition point of care. Objectives This study examines the impact of pharmacist obtained best possible medication histories on medication errors at admission due to unintentional medication discrepancies in older patients. Setting This was a prospective, single-center study conducted in an Internal Medicine Department of a tertiary care teaching hospitalin Saudi Arabia. Methods Patients ≥ 65years with an existing drug therapy on admission were eligible. The best possible medication historytaken by the pharmacist from different sources of medication information was compared to theadmission medication order to identify and correct unintentional discrepancies. The discrepancies were classified according to the type of errors. An independent multidisciplinary team adjudicated the potential for harm of each type of medication error. Main outcome measure Number and proportion of unintentional medication discrepancies upon admission and associated medication errors. Secondary outcomes included clinical significance anddrug classes involved in the discrepancies and risk factors for the occurrence of these discrepancies. Results A total of 375 evaluable patients were identified. Among 375 medication histories, 609 discrepancies were detected of which 226 were recorded as unintentional. 151 patients (42.4%) had ≥ 1 unintended discrepancy. Drug omission (37%) was the most frequent type of error. Nervous system (24.5%), and cardiovascular system (21.2%) were the most common drug classes involved in medication errors. Three-fifths of the UMD had the potential to cause temporary harm with initial or prolonged hospitalization. The number of medications prescribed upon admission (OR 1.32, 95% CI 1.09-1.54, p < 0.034), number of sources consulted for the best possible medication history(OR 1.53, 95% CI 1.38-1.76, p < 0.01) and the completion of medication review process within 24h (OR 0.89, 95% CI 0.86-0.94, p < 0.03) of the admission were the 3 most significant predictors of the discrepancies. Conclusions In elderly patients, medication histories are often recorded inaccurately by physicians at the time of hospital admission, this creates the potential for medication errors starting at admission. In older adults, best possible medication historiesare also useful in detecting drug related pathology or drug-drug interactions.

System Safety in Healthcare

“Incident reporting” is frequently used as a general term for all voluntary patient safety event reporting systems which rely on those involved in patient care. Initial reports often come from frontline personnel directly involved in an event or the actions leading up to it (e.g., the nurse, pharmacist or physician caring for a patient when an error occurred). Voluntary event reporting is therefore a special form of surveillance for near misses or unsafe conditions that are unlikely to show up in formal surveys [Ref. 1]. The purpose of incident reports is to help identify potential and actual risks and, thus, mitigate hazards. Incident reports also alert risk managers to potential lawsuits. They are generated for at least five types of medical errors: near misses, adverse events, intentional unsafe acts, never events and sentinel events. These events may affect any person on the premises, including patients, employees, physicians, visitors, students or volunteers.

Incidence of various medication errors in pediatrics in a tertiary care hospital

Background: Medication errors in pediatrics are an important cause of iatrogenic disease in hospital patients[1]. Despite this, studies regarding the medication errors in India are very few. Aims: To determine the incidence and type of errors in a tertiary care hospital over a period of 4 months. Material and methods: It is a prospective observational study. Medication errors were documented instandard reporting forms from April 2018 to July 2018. Main outcome measures were incidence and types of medication errors in pediatrics. Results:The medication error was 1 per 9.5 patients i.e, 10.5%.The dispensing errors and clerical errors constituted 66.04% of all errors. Maximum medication error was found under the age of 2 years (49.07%). Incorrect IV infusion rate was 24.90% followed by prescribing incorrect dose 21.97%. Most common drugs implicated in medication errors were IV fluids followed by IV antibiotics. Conclusion: Adequate number of staff and electronic mode of prescription and compulsory documentation of errors will reduce iatrogenic errors significantly.

Safety of bivalent human papillomavirus vaccine in the US vaccine adverse event reporting system (VAERS), 2009-2017.

Human papillomavirus (HPV) vaccines prevent infection with oncogenic virus types. We analysed reports to the US Vaccine Adverse Event Reporting System (VAERS) of adverse events (AE) following bivalent HPV vaccine (2vHPV). We conducted descriptive analysis of 2vHPV reports, reviewed individual reports, calculated crude AE reporting rates and conducted empirical Bayesian data mining. Of 241 2vHPV reports, 158 were in females, 64 in males (2vHPV is approved for females only) and 19 with unknown sex; 95.8% were classified as nonserious. Dizziness, headache, nausea and injection site reactions were the most common symptoms. Crude AE reporting rates were 33.3 reports per 100 000 doses distributed overall, and 1.4 per 100 000 for serious reports. Empirical Bayesian data mining identified disproportional reporting for three types of medical errors; assessment indicated findings that were probably driven by inadvertent 2vHPV use in males. We did not identify any new or unexpected safety concerns in our review of 2vHPV reports to VAERS.

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.

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.

How common are cognitive errors in cases presented at emergency medicine resident morbidity and mortality conferences?

Abstract Background Cognitive errors are a major contributor to medical error. Traditionally, medical errors at teaching hospitals are analyzed in morbidity and mortality (M&amp;M) conferences. We aimed to describe the frequency of cognitive errors in relation to the occurrence of diagnostic and other error types, in cases presented at an emergency medicine (EM) resident M&amp;M conference. Methods We conducted a retrospective study of all cases presented at a suburban US EM residency monthly M&amp;M conference from September 2011 to August 2016. Each case was reviewed using the electronic medical record (EMR) and notes from the M&amp;M case by two EM physicians. Each case was categorized by type of primary medical error that occurred as described by Okafor et al. When a diagnostic error occurred, the case was reviewed for contributing cognitive and non-cognitive factors. Finally, when a cognitive error occurred, the case was classified into faulty knowledge, faulty data gathering or faulty synthesis, as described by Graber et al. Disagreements in error type were mediated by a third EM physician. Results A total of 87 M&amp;M cases were reviewed; the two reviewers agreed on 73 cases, and 14 cases required mediation by a third reviewer. Forty-eight cases involved diagnostic errors, 47 of which were cognitive errors. Of these 47 cases, 38 involved faulty synthesis, 22 involved faulty data gathering and only 11 involved faulty knowledge. Twenty cases contained more than one type of cognitive error. Twenty-nine cases involved both a resident and an attending physician, while 17 cases involved only an attending physician. Twenty-one percent of the resident cases involved all three cognitive errors, while none of the attending cases involved all three. Forty-one percent of the resident cases and only 6% of the attending cases involved faulty knowledge. One hundred percent of the resident cases and 94% of the attending cases involved faulty synthesis. Conclusions Our review of 87 EM M&amp;M cases revealed that cognitive errors are commonly involved in cases presented, and that these errors are less likely due to deficient knowledge and more likely due to faulty synthesis. M&amp;M conferences may therefore provide an excellent forum to discuss cognitive errors and how to reduce their occurrence.

Medication errors in a pediatric anesthesia setting: Incidence, etiologies, and error reduction strategies

Study objectiveThe objective of the study was to: a) characterize the frequency, type, and outcome of anesthetic medication errors spanning an 8.5-year period, b) describe the targeted error reduction strategies and c) measure the effects, if any, of a focused, continuous, multifaceted Medication Safety Program. DesignRetrospective analysis. SettingAll anesthetizing locations (57). PatientsAll anesthesia patients at all Boston Children's Hospital anesthetizing locations from January 2008 to June 2016 were included. InterventionsMedication libraries, zero-tolerance philosophy, independent verification, trainee education, standardized dosing; retrospective study. MeasurementsNumber and type of medication errors. Main results105 medication errors were identified among the 287,908 cases evaluated during the study period. Incorrect dose (55%) and incorrect medication (28%) were the most frequently observed errors. Beginning within 3 years of the implementation of the 2009 Medication Safety Program, the incidence declined to an average of 3.0 per 10,000 cases in the years from 2010 to 2016 (57% reduction) and declined to an average of only 2.2 per 10,000 cases since 2012 (69% reduction). Logistic regression indicated a 13% reduction per year in the odds of a medication error over the time period (odds ratio = 0.87, 95% CI: 0.79–0.95, P = 0.004). ConclusionsAlthough medication errors persisted, there was a statistically significant reduction in errors during the study period. Formalized Medication Safety Programs should be adopted by other departments and institutions; these Programs could help prevent medication errors and decrease their overall incidence.

Abstract PCCLB-45: MEDICATION MISADVENTURES: WHAT, WHY AND BY WHOM?

Aims & Objectives: Various types of medication errors (MEs) 1. prescribing error 2. administration error 3. monitoring error and 4. dispensing error with different classes of severity (NCC MERP scale) are common in hospitals. Prescription and administration errors can be reduced by targeted awareness program for medical and nursing cadre respectively. Aim of this ongoing study is to assess the incidence and determinants of medication errors and adverse drug events (ADEs) among hospitalized children and to identify the staff cadre that needs more focused education and observation strategy to reduce MEs. Methods Ongoing prospective observational study. Interim analysis was done on first 70 patients Results Mean age of patients was 6.2 years with M: ratio of 1.32:1. Out of 4975 doses, 284 MEs were detected with incidence of 56 per 100 patient days and 57 per 1000 medication doses. No patient developed adverse drug events (ADEs) so far. Highest severity of the errors was in Category C of NCC MERP (error occurred that reached the patient but did not cause patient harm). Prescriptions error (259: 91.2%), attributable to medical staff cadre was most common type of error followed by administration error (25: 8.8%), attributable to nursing staff cadre. Among prescribing errors, orders not being written in block letters or with illegible writing was the most common error (43.5% of total errors) followed by missing stop date (Figure 2). Conclusions MEs are common among hospitalized children, and prescription error is most common type suggesting need of awareness and knowledge enhancement programs for medical personnel.

Frequency of Chemotherapy Medication Errors: A Systematic Review

Objective: To synthesize peer-reviewed knowledge on the frequency of different types of chemotherapy medication errors. Methods: The data were collected from studies published between January 1, 2000, and March 3, 2018, and are identified through online resources such as Medline/PubMed, PubMed Central, Agency for Healthcare Research, and Quality and the Cochrane Library. The manuscripts published in peer-reviewed scientific journals in English language were included in the study. Initially, 19,723 articles were retrieved and finally 11 were found to be eligible to include in the review and were assessed for quality. Error percentages were calculated from the ratio of error type (numerator) to sample size (denominator: medication orders or prescriptions). Results: Overall, the chemotherapy medication errors ranged from 0.004% to 41.6% among various studies. Chemotherapy medication errors ranged from 0.1% to 24.6% in prescribing, 0.40% to 0.50% in preparation, 0.03% in dispensing, and 0.02% to 0.10% in administering phases. Conclusion: Prescribing phase had the highest number of chemotherapy medication errors reported, and least was reported during dispensing phase. We also noticed a need for harmonization for reporting of medication errors.

The underreporting of medication errors: A retrospective and comparative root cause analysis in an acute mental health unit over a 3-year period.

Medication errors remain a commonly reported clinical incident in health care as highlighted by the World Health Organization's focus to reduce medication-related harm. This retrospective quantitative analysis examined medication errors reported by staff using an electronic Clinical Incident Management System (CIMS) during a 3-year period from April 2014 to April 2017 at a metropolitan mental health ward in Western Australia. The aim of the project was to identify types of medication errors and the context in which they occur and to consider recourse so that medication errors can be reduced. Data were retrieved from the Clinical Incident Management System database and concerned medication incidents from categorized tiers within the system. Areas requiring improvement were identified, and the quality of the documented data captured in the database was reviewed for themes pertaining to medication errors. Content analysis provided insight into the following issues: (i) frequency of problem, (ii) when the problem was detected, and (iii) characteristics of the error (classification of drug/s, where the error occurred, what time the error occurred, what day of the week it occurred, and patient outcome). Data were compared to the state-wide results published in the Your Safety in Our Hands (2016) report. Results indicated several areas upon which quality improvement activities could be focused. These include the following: structural changes; changes to policy and practice; changes to individual responsibilities; improving workplace culture to counteract underreporting of medication errors; and improvement in safety and quality administration of medications within a mental health setting.

Review of medication errors that are new or likely to occur more frequently with electronic medication management systems.

Objective The aim of the present study was to identify and quantify medication errors reportedly related to electronic medication management systems (eMMS) and those considered likely to occur more frequently with eMMS. This included developing a new classification system relevant to eMMS errors. Methods Eight Victorian hospitals with eMMS participated in a retrospective audit of reported medication incidents from their incident reporting databases between May and July 2014. Site-appointed project officers submitted deidentified incidents they deemed new or likely to occur more frequently due to eMMS, together with the Incident Severity Rating (ISR). The authors reviewed and classified incidents. Results There were 5826 medication-related incidents reported. In total, 93 (47 prescribing errors, 46 administration errors) were identified as new or potentially related to eMMS. Only one ISR2 (moderate) and no ISR1 (severe or death) errors were reported, so harm to patients in this 3-month period was minimal. The most commonly reported error types were 'human factors' and 'unfamiliarity or training' (70%) and 'cross-encounter or hybrid system errors' (22%). Conclusions Although the results suggest that the errors reported were of low severity, organisations must remain vigilant to the risk of new errors and avoid the assumption that eMMS is the panacea to all medication error issues. What is known about the topic? eMMS have been shown to reduce some types of medication errors, but it has been reported that some new medication errors have been identified and some are likely to occur more frequently with eMMS. There are few published Australian studies that have reported on medication error types that are likely to occur more frequently with eMMS in more than one organisation and that include administration and prescribing errors. What does this paper add? This paper includes a new simple classification system for eMMS that is useful and outlines the most commonly reported incident types and can inform organisations and vendors on possible eMMS improvements. The paper suggests a new classification system for eMMS medication errors. What are the implications for practitioners? The results of the present study will highlight to organisations the need for ongoing review of system design, refinement of workflow issues, staff education and training and reporting and monitoring of errors.

Building a Stronger Safety Net

If you have been in practice for even a short time, you may recall hearing about different types of medication errors that have occurred in your department or facility. In some cases, this same error—unbelievably—repeats itself, even after the organization spends significant time and resources investigating and “fixing” the issue at hand. Such repetitive events often leave practitioners, managers, and entire organizations discouraged and wondering what happened, where they went wrong, and what to do next. As illustrated in the following scenario, recalcitrant errors often deserve a reanalysis of the event to understand if an important component was overlooked but—more importantly—a critical assessment and revision of the preventive actions taken. Susan F. Paparella, Member, Bux-Mont Chapter, is Vice President at The Institute for Safe Medication Practices (ISMP*), Horsham, PA.

Medication Errors Caused by Nurses and Physicians in a Swiss Acute Care Community Hospital: Frequency and Correlation to Nurses’ Reported Workload / Von Pflegefachpersonen und Ärzten/-innen verursachte Medikamentenfehler in einem Schweizer Akutspital: Häufigkeit und Korrelation zur Arbeitsbelastung von Pflegefachpersonen

Abstract Objectives This study was carried out in a Swiss acute care community hospital to investigate the frequency, type, causes and potential clinical consequences of medication errors (MEs) caused by nurses and physicians in all stages of a technology-supported medication process, the relationship between the nurses’ workload and the medication administration errors (MAEs) and their reason for workload. Methods In this descriptive cross-sectional study, a questionnaire, the adapted Medication Error Self Reporting Tool (A-MESRT), was used to identify MEs in all stages of the medication process and record nurses’ self-perceived workload during medication administration. Results A total of 1936 completed A-MESRTs were returned. A total of 751 (38.8%) respondents reported different MEs. The highest number of errors occurred during medication administration (43%), followed by errors during dispensing (34%) and physician ordering errors using a computerised physician order entry (CPOE) system (23%). Of the 768 (100%) handwritten orders, 232 (30.2%) were erroneous. Moreover, the greater the individual nurse’s workload during a shift, the higher was the relative probability of committing an MAE (χ2 = 85.479, df = 1, OR = 2.129, p &lt; 0.001). Furthermore, the three main causes of high or very high workload were revealed: (1) many newly operated patients to monitor; (2) complex multimorbid patients, for example, those with delirium; and (3) patients with complications after surgery. Conclusion The A-MESRT showed that the highest rate of MEs caused by nurses and physicians is in the non-technologically supported steps, demonstrating the potential benefits of a technology-supported medication process. Moreover, this study revealed a statistically significant correlation between nurses’ workload and MAEs.

Scope on Medication Errors during Pregnancy ina Sample Iraqi Two Cities Samawah &amp; Diwania.

The pregnancy is sensitive period and administration of drugs may lead to threating of fetus life or cause malformations teratogenicity etc. A cross-sectional study of medication errors of 100 prescriptions dispensed to a pregnant women in a sample of Iraqi two cities (Sammawa &amp; Diwania) during October,2016. The total number of medication errors identified was 364 (74%),included 110 irrational &amp; inappropriate prescribing,47 over prescribing,19 under prescribing,and 8 ineffective prescribing errors. The drug interactions were classified to drug-drug interactions 126 interactions identified and drug food interactions 54 interactions was recorded. 0.8 % of all interactions was major,76 % moderate and 23% mild. Luminal (Phenobarbital) is the drug that caused the most of medication error that identified as it dispensed 23 times but all of these patient luminal was irrational and inappropriate and it caused the most of interactions recorded as 44 interactions was caused by luminal. While duphaston (Dydrogesterone) was prescribed 21 times,and this considered as irrational &amp; inappropriate prescribing. Duvadilane (isoxsuprine) prescribed irrationally 17 times. The parenteral iron administered without sensitivity test nor calculating the dose depending on the body weight and blood Hb.Most of antibiotics and antifungal prescribed for incorrect duration or dose. The other errors were related to other drugs duration,dose and indication errors. Percentage of medication errors were high. Types of medication errors were mostly drug-drug interaction,irrational and inappropriate use. The impact of these medication errors may include teratogenic effect.

Reducing medication errors using LSS Methodology: A systematic literature review and key findings

The paper aims to systematically review the literature on Lean, Six Sigma, Lean Six Sigma (LSS) intervention and its tools and techniques to reduce the medication errors in hospitals. Subject-specific journals according to the top journal ranking lists in the Business School and Healthcare sector were used for the assessment. Eight databases including Medline, PubMed, EBSCOhost, Web of Knowledge, Scopus, Embase, CINAHL and PsycINFO were used to collect relevant articles from the year 1996–2016. A total of 24 studies were identified have from the search meeting the criteria for the systematic literature review. Increased interest in the application of process excellence methodologies such as Lean, Six Sigma and LSS to reduce medication errors especially from the developed countries was found. Several themes have emerged in this paper including: tools and techniques of Lean and Six Sigma in the context of medication errors, Lean and Six Sigma methodology, types of medication errors, LSS project selection, benefits, challenges and success factors. The study is expected to benefit healthcare practitioners in implementing the LSS methodology to reduce medication errors.