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A 3-year study of medication incidents in an acute general hospital

L Song1, W C M Chui, C P Lau

  • 1Department of Medicine, University of Hong Kong, Hong Kong, China.

Journal of Clinical Pharmacy and Therapeutics
|March 5, 2008
PubMed
Abstract

Insights

Medication errors like wrong dosage or drug are common. Computerized systems reduced incidents, while handwritten prescriptions and junior doctors were frequent sources of errors.

Area of Science:

  • Patient Safety
  • Healthcare Quality Improvement
  • Medication Error Analysis

Background:

  • Inappropriate medication use poses significant patient harm risks.
  • Medication incident reports (MIRs) serve as a crucial feedback mechanism for quality assurance in healthcare settings.

Purpose of the Study:

  • To analyze medication incident reports (MIRs) to identify patterns and sources of medication errors.
  • To evaluate the impact of computerized medication order entry systems versus handwritten prescriptions on medication safety.

Main Methods:

  • Analysis of 1278 medication incident reports (MIRs) from a Hong Kong university-affiliated hospital (2004-2006).
  • Categorization of errors by time, nature, source, and severity.
  • Comparison of error rates associated with handwritten prescriptions (HP) versus computerized medication order entry.

Main Results:

  • A decreasing trend in MIRs was observed from 2004 to 2006.
  • The most frequent errors were wrong strength/dosage (36.5%) and wrong drug (16.7%).
  • Handwritten prescriptions (HP) and preregistration house officers were significantly involved in medication errors, though most errors were detected before administration.

Conclusions:

  • Wrong dosage and wrong drug errors are the most prevalent.
  • Handwritten prescriptions (HP) and involvement of preregistration house officers are key areas for intervention.
  • Implementation of computerized systems shows a promising reduction in medication incidents.

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