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PubMed2003

Types of medical errors commonly reported by family physicians.

In a group of studies about medical errors in family medicine, the five error types most often observed and reported by U.S. family physicians were: (1) errors in prescribing medications; (2) errors in getting the right laboratory test done for the right patient at the right time; (3) filing system errors; (4) errors in dispensing medications; and (5) errors in responding to abnormal laboratory test results. "Errors in prescribing medications" was the only one of these five error types that was also commonly reported by family physicians in other countries.

Drug Prescriptions↗

PubMed1999

Nurses' perceptions: when is it a medication error?

This study investigates nurses' perceptions of medication errors and appropriate reporting. Results of the study suggest that nurses may not report because of fear of reprisal. Further, there may be a need to allow for nursing judgment in some instances; at those time, the term "medication error" may not be the most appropriate. Implications for nursing administration include further exploration of nonpunitive processes in response to adverse drug events.

Adult↗

PubMed2000

Reports spotlight medication errors: make changes before tragedy strikes.

Three organizations recently published reports on medication errors--the Institute for Healthcare Improvement, the Institute of Medicine, and the Joint Commission on Accreditation of Healthcare Organizations. The ED is at higher risk for medication errors than other areas of the hospital because of extreme time pressure, high patient volumes, verbal orders, and multiple staff caring for patients. Medication errors often are caused by unclear labeling, lack of a check system for medication dosages, and similar drugs kept in close proximity to each other. Recommended strategies include a check system in which one nurse prepares a dose and another nurse reviews it, and avoiding look-alike and sound-alike medications.

Procedural Sedation↗

PubMed2006

[Medication errors in pediatric inpatients: a multicentric prospective study].

OBJECTIVE: To improve the knowledge of medication errors in paediatrics: rate of occurrence, error characteristics, risk factors. PATIENTS AND METHODS: Our prospective study included nine uninformed teaching paediatric wards (general paediatrics, emergency departments, intensive care units) using a describing questionnaire built from medical reports analysis (event description, medical issues, contributing personal and structural factors) during a two-months period. RESULTS: Seventy-five questionnaires were collected and analysed. Medical errors reported concerned prescription: 21 cases and administration: 45 cases. Ten errors led to adverse effects. An attributable factor was noted in 39 cases. Concerning prescription errors, no respect to protocol: 11 cases, lack of knowledge: 3 cases, personal communication failure: 3 cases were noted. Concerning administration errors, human mistakes (lack of experience, miscommunication, calculation error): 8 cases, unclear prescription: 6 cases and system flaws: 6 cases were noted. Several attribuable causes were reported in 8 cases. CONCLUSIONS: Medication errors in paediatrics inpatients are common and contributing factors intricated. Paediatricians should help hospitals develop effective programs for safety providing medications, reporting medication errors, errors analysis strategy and creating a safe environment of medication for all hospitalised paediatric patients.

Child↗

PubMedDate not supplied

How many deaths are due to medical error? Getting the number right.

CONTEXT: The Institute of Medicine (IOM) report on medical errors created an intense public response by stating that between 44,000 and 98,000 hospitalized Americans die each year as a result of preventable medical errors. OBJECTIVE: To determine how well the IOM committee documented its estimates and how valid they were. METHODS: We reviewed the studies cited in the IOM committee's report and related published articles. RESULTS: The two studies cited by the IOM committee substantiate its statement that adverse events occur in 2.9% to 3.7% of hospital admissions. Supporting data for the assertion that about half of these adverse events are preventable are less clear. In fact, the original studies cited did not define preventable adverse events, and the reliability of subjective judgments about preventability was not formally assessed. The committee's estimate of the number of preventable deaths due to medical errors is least substantiated. The methods used to estimate the upper bound of the estimate (98,000 preventable deaths) were highly subjective, and their reliability and reproducibility are unknown, as are the methods used to estimate the lower bound (44,000 deaths). CONCLUSION: Using the published literature, we could not confirm the Institute of Medicine's reported number of deaths due to medical errors. Due to the potential impact of this number on policy, it is unfortunate that the IOM's estimate is not well substantiated.

Data Collection↗

PubMed1996

Medication errors. How common are they and what can be done to prevent them?

Medication errors are common in hospitals, but only about 1 in a 100 actually results in harm to the patient. Conversely, only about 30% of injuries due to drugs in hospitals are associated with a medication error, and are thus preventable. Nonetheless, drugs are used so frequently that the total number of preventable drug injuries that occur is substantial, and these injuries are costly. Changing the systems by which drugs are ordered and administered holds substantial potential for reducing the number of drug-related injuries. Computerised ordering systems, in which orders are written on-line by a physician and the physician can receive feedback on the suitability of the order during the process of making it, appear likely to have an especially large impact on reducing medication errors.

Humans↗

PubMedDate not supplied

[Medication errors in two Brazilian hospitals].

OBJECTIVE: To determine medication errors in a public and in a private hospital. METHOD: Cross-sectional. 638 dosis opportunities for errors (administered dosis + omitted dosis) were assessed in January, 2005. Medication error was defined as any given dose different from a legible prescription on patient chart. The error rate was calculated by the following equation: number of dosis/error opportunities. The errors were classified according to the categories: omission, unordered dose, extra-dose, wrong dose, wrong route, wrong form, wrong time. RESULTS: Out of 638 opportunities of error, 209 (32,9%) were wrong in some way. When wrong time errors were excluded, this rate decreased to 156 (25%). The most frequent types of errors were omission and unordered dosis, 67 (10,5%) and 65 (10,2%), respectively. There was no significant difference on the total error rate according to the type of hospital (public or private). CONCLUSIONS: The public hospital showed a double-fold unordered dose error rate as compared to the private hospital. Inversely, the private hospital showed a double-fold wrong time error rate than the public hospital.

Brazil↗

PubMed2003

Impact of emerging technologies on medication errors and adverse drug events.

Published evidence on the effects of computerized physician order entry (CPOE), automated dispensing machines (ADMs), bar coding, and computerized medication administration records (CMARs) on medication errors and adverse drug events (ADEs) were reviewed. Emerging technologies have been recommended as potential mechanisms for reducing medication errors. Critical evaluations of the impact of these new technologies on medication errors and other adverse outcomes are lacking. PubMed was searched to identify all peer-reviewed publications linking four technologies (CPOE, ADMs, bar coding, and CMARs) with reductions in medication errors and ADEs and secondary endpoints. All controlled studies that assessed the impact of the technologies were evaluated. The appropriateness of the use of these technologies was also examined. Few studies were identified that evaluated the technologies' impact on these endpoints. Of the evaluated technologies, CPOE was the most studied; however, investigations were limited to selected medical centers. The appropriateness of use of the technologies was evaluated even more infrequently. A literature review revealed a paucity of controlled, generalizable studies confirming the benefits of technologies intended to reduce medication errors and ADEs. Very little evidence on the appropriateness of the use of these technologies was found.

Drug Therapy, Computer-Assisted↗

PubMed2005

Teaching medical students about medical errors and patient safety: evaluation of a required curriculum.

PURPOSE: To assess the effectiveness of a brief curriculum about patient safety and medical errors with third-year medical students. METHOD: From 2000-03, third-year medical students at New York Medical College, Valhalla, New York, were required to participate in a new curriculum on patient safety and medical errors during their family medicine clerkships. Five hundred seventy-two students participated in a four-hour curriculum that included interactive discussion, readings, a videotape session with a standardized patient, and a small-group debriefing facilitated by a family physician. Before and after participating in the curriculum, students were asked to complete questionnaires on self-awareness about patient communication and safety. Curriculum evaluations and follow-up surveys were also distributed. Responses to each statement on the before and after questionnaires were compared using the Wilcoxon signed-rank test for matched data. RESULTS: Five hundred eleven (89%) students reported that the opportunity to present an error to a patient increased their confidence about discussing this issue with patients, and 537 (94%) students reported that they strongly agreed or agreed that the standardized patient and feedback exercise was a useful learning experience. A total of 535 before and after questionnaires were used in the analysis. A comparison of before and after questionnaire data revealed statistically significant increases in the self-reported awareness of students' strengths and weaknesses in communicating medical errors to patients (p <or= .01). CONCLUSION: These findings suggest that awareness about patient safety and medical error can be increased and sustained through the use of an experiential curriculum, and the students rated this as a valuable experience.

Attitude of Health Personnel↗

PubMed1999

Hospital drug distribution systems in the UK and Germany--a study of medication errors.

The aim of this study was to compare the incidence of medication errors and the stages of the drug distribution system at which they occur in a United Kingdom (UK) hospital using the ward pharmacy system, a German hospital using the unit dose system and a German hospital using their traditional system. Medication errors were identified by observing the preparation and administration of regularly scheduled solid oral medication. In the UK hospital using the ward pharmacy system, the medication error rate was 8.0% (95% confidence interval 6.2-9.8%). The majority of these errors occurred at the stage of medication administration. In the hospital using the traditional German system, the error rate was 5.1% (4.4-5.8%). With the German unit dose system, the error rate was 2.4% (2.0-2.8%). In both German systems the errors were mainly attributable to the stage of transcription. It was noted that patient turnover was much higher in the wards using the ward pharmacy system and therefore the study sites may not be comparable. However, recommendations can be made in order to reduce the error rate associated with each system. Errors associated with the ward pharmacy system may be reduced if medication is stored in individual patient medicine cabinets and patients' own drugs used. Errors occurring with the traditional system and the unit dose system may be reduced if the original prescription is used for medication administration.

Data Collection↗

PubMed2005

Prescribing medication errors in hospitalised patients: a prospective study.

The aims of this prospective study were to determine the incidence and types of prescribing medication errors and ways to prevent them from reaching patients. Data were collected from 4951 prescriptions over a 25 week period in 2002. Medication errors were classified as: incorrect dose, incorrect dose interval, duplication of therapy and drug interactions. The medical record analysis was used to compare prescribing with Croatian literature drug data and AHFS first Web version 2 (American Society of Health System Pharmacists). The incidence of medication errors in the entire sample, including all potential drug interactions, was 14.7%. However, as only 8 interactions (out of 356 potentially possible interactions) were assessed as clinically significant, then the total number of all types of medication errors was 379. This resulted in an incidence of 7.7%. Dosage errors were the most frequent errors, followed by incorrect interval, drug duplication and drug interaction. The difference between the incidence of potentially possible and clinically significant drug interactions was quite large (7.2 vs. 0.2%). Thus, a critical attitude is necessary when evaluating available data on drug interactions. Our findings point to the need of systematic control of prescribed therapies, which could be ensured by the application of the Unit Dose Drug Distribution System. A medication errors reporting program should be established both at the hospital and at national levels in Croatia.

Adult↗

PubMed2006

An empirically derived taxonomy of factors affecting physicians' willingness to disclose medical errors.

BACKGROUND: Physician disclosure of medical errors to institutions, patients, and colleagues is important for patient safety, patient care, and professional education. However, the variables that may facilitate or impede disclosure are diverse and lack conceptual organization. OBJECTIVE: To develop an empirically derived, comprehensive taxonomy of factors that affects voluntary disclosure of errors by physicians. DESIGN: A mixed-methods study using qualitative data collection (structured literature search and exploratory focus groups), quantitative data transformation (sorting and hierarchical cluster analysis), and validation procedures (confirmatory focus groups and expert review). RESULTS: Full-text review of 316 articles identified 91 impeding or facilitating factors affecting physicians' willingness to disclose errors. Exploratory focus groups identified an additional 27 factors. Sorting and hierarchical cluster analysis organized factors into 8 domains. Confirmatory focus groups and expert review relocated 6 factors, removed 2 factors, and modified 4 domain names. The final taxonomy contained 4 domains of facilitating factors (responsibility to patient, responsibility to self, responsibility to profession, responsibility to community), and 4 domains of impeding factors (attitudinal barriers, uncertainties, helplessness, fears and anxieties). CONCLUSIONS: A taxonomy of facilitating and impeding factors provides a conceptual framework for a complex field of variables that affects physicians' willingness to disclose errors to institutions, patients, and colleagues. This taxonomy can be used to guide the design of studies to measure the impact of different factors on disclosure, to assist in the design of error-reporting systems, and to inform educational interventions to promote the disclosure of errors to patients.

Attitude of Health Personnel↗

PubMed2004

Medical errors: an introduction to concepts.

The prevalence of medical errors in health care systems has generated immense interest in recent years. The research on adverse events in hospitalized populations has consistently revealed high rates of adverse events. Some of these adverse events result from medical errors and a majority of these errors may be preventable. These errors can occur anywhere and at anytime in health care processes. The consequences of these errors may vary from little or no harm to being ultimately fatal to the patients. It is important to recognize that a degree of error is inevitable in any human task and human fallibility in health care should be accepted. The underlying precursors for many of these human errors may primarily be attributed to latent systemic factors inherent in today's increasingly complex health care system. The focus of adverse event analyses on individual shortcomings without appropriate attention to system issues leads to ineffective solutions. The cognitive influence on medical decision-making and error generation is also significant and should not be discounted.

Cognition↗

PubMed1991

Characteristics of medication errors in pediatrics.

A six-month prospective study was carried out by 16 poison control centers in France to assess the epidemiology of medication errors in pediatrics. In this study, 1108 medication errors were analyzed. Mean population age was 3.2 years (median 2 years, range 3 days-15 years), and 30 percent of the children were under 1 year of age. The most frequent error characteristics were family responsibility, 87 percent (a member of the patient's family most often committed the error in medication use); parental prescribing decision, 31.5 percent (medication administered to the child by the parents without medical consultation or the advice of a pharmacist); incorrect execution of the prescription by the parents, 30 percent (error in dispensing, route of administration, etc.); oral forms, 52 percent (errors occurred most frequently with oral as opposed to other forms); incorrect dosage, 31.5 percent; and drug error, 30 percent (the drug dispensed was not the one prescribed). Iatrogenic injury occurred in 186 patients (17 percent) and 161 were hospitalized (15 percent). The majority of these were for surveillance only. The clinical outcome caused by medication error was unfavorable in two cases. The types of drugs most frequently misused included morphinic cough suppressants (9.5 percent), salicylates (9.1 percent), and ear, nose, and throat drops (9 percent); 459 proprietary medicines were specified. Prevention of medication errors should involve certain main requirements: formulations and package instructions specific to pediatric patients to ensure appropriateness and accuracy, detailed information given to patients by physicians and pharmacists about their prescriptions, and more public information concerning the risks of remedies or medication administered to children by parents who do not seek medical advice.

Adolescent↗

PubMed2004

Profiles in patient safety: medication errors in the emergency department.

Medication errors are frequent in the emergency department (ED). The unique operating characteristics of the ED may exacerbate their rate and severity. They are associated with variable clinical outcomes that range from inconsequential to death. Fifteen adult and pediatric cases are described here to illustrate a variety of errors. They may occur at any of the previously described five stages, from ordering a medication to its delivery. A sixth stage has been added to emphasize the final part of the medication administration process in the ED, drawing attention to considerations that should be made for patients being discharged home. The capability for dispensing medication, without surveillance by a pharmacist, provides an error-producing condition to which physicians and nurses should be especially vigilant. Except in very limited and defined situations, physicians should not administer medications. Adherence to defined roles would reduce the team communication errors that are a common theme in the cases described here.

Adolescent↗

PubMed2000

Reducing medication errors: potential benefits of bolus thrombolytic agents.

A recent Institute of Medicine report highlighted the high incidence of medical errors in clinical practice, and the important fact that errors are associated with increased mortality. The administration of thrombolytic therapy for acute myocardial infarction is a particularly high-risk situation for emergency physicians. The combination of extreme time pressure with a narrow "therapeutic window" increases the potential for adverse outcomes due to dosing errors. Numerous trials have found that the dose of thrombolytic therapy is closely related to outcomes, with too low a dose associated with lower rates of infarct-related artery patency and higher doses associated with increased bleeding and intracranial hemorrhage. In the GUSTO-I trial, 13.5% of patients treated with streptokinase and 11.5% of patients treated with tissue plasminogen activator (t-PA) had a medication error (i.e., incorrect dose or infusion length). Most importantly, 30-day mortality was significantly higher in patients with medication errors: for t-PA dosing errors mortality was 7.7% vs 5.5% for patients who received the correct t-PA dose (p < 0.001), with similar findings for streptokinase. More recent data from the InTIME2 trial and other studies showed that use of a bolus thrombolytic agent reduced the rate of medication errors. Thus, use of the simpler bolus thrombolytic agents may reduce emergency department medication errors, and thus improve overall clinical outcome.

Clinical Trials as Topic↗

PubMed2006

Differences in perioperative medication errors with regard to organization characteristics.

RESEARCHERS CONDUCTED a descriptive, comparative, secondary analysis using a national database to investigate differences in perioperative medication error characteristics with regard to organization characteristics. PERIOPERATIVE MEDICATION ERROR records reported to the MEDMARX database between Sept 1, 1998, and Aug 31, 2003, were examined (N = 5,210), and variables were analyzed using descriptive and inferential statistics. Statistically significant differences were found for three out of four research questions. THE STUDY'S FINDINGS provide a foundation for perioperative medication error analysis and serve as a starting point for organizations to begin investigating the medication error problem in their facilities.

Bed Occupancy↗

PubMed2007

Interrater agreement with a standard scheme for classifying medication errors.

PURPOSE: The interrater agreement for and reliability of the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) index for categorizing medication errors were determined. METHODS: A letter was sent by the U.S. Pharmacopeia to all 550 contacts in the MEDMARX system user database. Participants were asked to categorize 27 medication scenarios using the NCC MERP index and were randomly assigned to one of three tools (the index alone, a paper-based algorithm, or a computer-based algorithm) to assist in categorization. Because the NCC MERP index accounts for harm and cost, and because categories could be interpreted as substantially similar, study results were analyzed after the nine error categories were collapsed to six. The interrater agreement was measured using Cohen's kappa value. RESULTS: Of 119 positive responses, 101 completed surveys were returned for a response rate of 85%. There were no significant differences in baseline demographics among the three groups. The overall interrater agreement for the participants, regardless of group assignment, was substantial at 0.61 (95% confidence interval [CI], 0.41-0.81). There was no difference among the kappa values of the three study groups and the tools used to aid in medication error classification. When the index was condensed from nine categories to six, the interrater agreement increased with a kappa value of 0.74 (95% CI, 0.56-0.90). CONCLUSION: Overall interrater agreement for the NCC MERP index for categorizing medication errors was substantial. The tool provided to assist with categorization did not influence overall categorization. Further refining of the scale could improve the usefulness and validity of medication error categorization.

Adverse Drug Reaction Reporting Systems↗