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Published on: August 30, 2018
Omissions and Deviations From Safe Drug Administration Guidelines in 2 Medical Wards and Risk Factors: Findings From
Georgios Savva, Anastasios Merkouris1, Andreas Charalambous
1From the Department of Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus.
Objectives:
This study aimed to record the type and frequency of errors, with an emphasis on omissions, during administration of medicines to inpatients and to investigate associated factors.
Methods:
This was a descriptive observational study. The medication process in 2 medical wards was observed by 2 observers using a structured observation form. χ2 Test, Kruskal-Wallis test, and regression analysis were used to explore associations between factors and errors.
Results:
From the 665 administrations observed, a total of 2371 errors were detected from which 81.2% were omissions and 18.8% were errors of commission. Omissions in the infection prevention guidelines (46.6%) and in the 5 rights of medication safety principles (35.8%) were a predominant finding. In particular, omitting to hand wash before administering a drug (98.4%), omitting to disinfect the site of injection (37.7%), and omitting to confirm the patient's name (74.4%) were the 3 most frequently observed omissions. Documentation errors (13.1%) and administration method errors (4.5%) were also detected. Regression analysis has shown that the therapeutic class of the drug administered and the number of medicines taken per patient were the 2 factors with a statistical significance that increased the risk of a higher number of errors being detected.
Conclusions:
Errors during drug administration are still common in clinical practice, with omissions being the most common type of error. In particular, omissions in the basic infection and safety regulations seem to be a very common problem. The risk of a higher number of errors being made is increased when a cardiovascular drug is administered and when the number of medicines administered per patient is increased.
Insights
Medication errors, particularly omissions in safety protocols, are frequent in hospitals. Factors like drug type and patient medication load increase error risk.
Area of Science:
- Clinical Pharmacy
- Patient Safety
- Healthcare Quality Improvement
Background:
- Medication administration errors pose a significant threat to patient safety in healthcare settings.
- Omission errors, a specific type of medication error, are often underreported but critical.
- Understanding the frequency and associated factors of these errors is crucial for developing effective interventions.
Purpose of the Study:
- To quantify the types and frequency of medication administration errors among inpatients.
- To specifically focus on the prevalence of omission errors during drug administration.
- To identify factors associated with an increased risk of medication errors.
Main Methods:
- A descriptive observational study design was employed.
- Direct observation of medication administration processes in two medical wards.
- Statistical analyses including chi-squared test, Kruskal-Wallis test, and regression analysis were utilized.
Main Results:
- A total of 2371 errors were identified across 665 observed administrations.
- Omission errors constituted 81.2% of all detected errors.
- Key omissions included failure to hand wash (98.4%), disinfect injection sites (37.7%), and verify patient identity (74.4%).
- Cardiovascular drug administration and polypharmacy (increased number of medicines per patient) were significantly associated with higher error rates.
Conclusions:
- Medication administration errors, especially omissions, remain prevalent in clinical practice.
- Deficiencies in basic infection control and medication safety principles are common.
- Administering cardiovascular drugs and managing patients with multiple medications increases the likelihood of errors.
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