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Published on: November 9, 2016
Prevalence and determinants of medication administration errors in clinical wards: A two-centre prospective
Janique Gabriëlle Jessurun1, Nicole Geertruida Maria Hunfeld1,2, Michelle de Roo3
1Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Aims And Objectives:
To identify the prevalence and determinants of medication administration errors (MAEs).
Background:
Insight into determinants of MAEs is necessary to identify interventions to prevent MAEs.
Design:
A prospective observational study in two Dutch hospitals, a university and teaching hospital.
Methods:
Data were collected by observation. The primary outcome was the proportion of administrations with one or more MAEs. Secondary outcomes were the type, severity and determinants of MAEs. Multivariable mixed-effects logistic regression analyses were used for determinant analysis. Reporting adheres to the STROBE guideline.
Results:
MAEs occurred in 352 of 2576 medication administrations (13.7%). Of all MAEs (n = 380), the most prevalent types were omission (n = 87) and wrong medication handling (n = 75). Forty-five MAEs (11.8%) were potentially harmful. The pharmaceutical forms oral liquid (odds ratio [OR] 3.22, 95% confidence interval [CI] 1.43-7.25), infusion (OR 1.73, CI 1.02-2.94), injection (OR 3.52, CI 2.00-6.21), ointment (OR 10.78, CI 2.10-55.26), suppository/enema (OR 6.39, CI 1.13-36.03) and miscellaneous (OR 6.17, CI 1.90-20.04) were more prone to MAEs compared to oral solid. MAEs were more likely to occur when medication was administered between 10 a.m.-2 p.m. (OR 1.91, CI 1.06-3.46) and 6 p.m.-7 a.m. (OR 1.88, CI 1.00-3.52) compared to 7 a.m.-10 a.m. and when administered by staff with higher professional education compared to staff with secondary vocational education (OR 1.68, CI 1.03-2.74). MAEs were less likely to occur in the teaching hospital (OR 0.17, CI 0.08-0.33). Day of the week, patient-to-nurse ratio, interruptions and other nurse characteristics (degree, experience, employment type) were not associated with MAEs.
Conclusions:
This study identified a high MAE prevalence. Identified determinants suggest that focusing interventions on complex pharmaceutical forms and error-prone administration times may contribute to MAE reduction.
Relevance To Clinical Practice:
The findings of this study can be used to develop targeted interventions to improve patient safety.
Insights
Medication administration errors (MAEs) occurred in 13.7% of administrations, with omissions and handling errors being most common. Interventions targeting complex drug forms and specific times can reduce MAEs and improve patient safety.
Area of Science:
- Pharmacovigilance
- Patient Safety Research
- Clinical Pharmacy Practice
Background:
- Medication administration errors (MAEs) pose a significant threat to patient safety.
- Understanding the factors contributing to MAEs is crucial for developing effective prevention strategies.
Purpose of the Study:
- To determine the prevalence of medication administration errors (MAEs) in hospital settings.
- To identify the key determinants associated with the occurrence of MAEs.
Main Methods:
- A prospective observational study was conducted in two Dutch hospitals.
- Data on medication administrations were collected through direct observation.
- Multivariable mixed-effects logistic regression analysis was employed to identify determinants of MAEs.
Main Results:
- A prevalence of 13.7% for MAEs was observed across 2576 medication administrations.
- Omission errors and incorrect medication handling were the most frequent types of MAEs.
- Complex pharmaceutical forms (e.g., oral liquid, infusion, injection, ointment) and specific administration time windows were significantly associated with higher MAE rates.
Conclusions:
- The study highlights a substantial prevalence of MAEs, emphasizing the need for targeted interventions.
- Focusing on complex medication forms and high-risk administration times can potentially reduce MAEs.
- Findings provide a basis for developing evidence-based strategies to enhance medication safety in clinical practice.
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