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Related Experiment Videos

Relationship between medication errors and adverse drug events

D W Bates1, D L Boyle, M B Vander Vliet

  • 1Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.

Journal of General Internal Medicine
|April 1, 1995
PubMed
Summary
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Medication errors are frequent but rarely lead to adverse drug events (ADEs). Implementing physician computer order entry can prevent many errors and potential ADEs, improving patient safety.

Area of Science:

  • Pharmacology
  • Patient Safety
  • Healthcare Quality Improvement

Background:

  • Medication errors pose a significant risk in healthcare settings.
  • Understanding the frequency and types of medication errors is crucial for developing effective interventions.
  • The association between medication errors and adverse drug events (ADEs) requires thorough investigation.

Purpose of the Study:

  • To quantify the incidence of medication errors using a multidisciplinary approach.
  • To categorize medication errors by their specific type.
  • To determine the frequency of medication errors associated with ADEs and potential ADEs.

Main Methods:

  • A multidisciplinary team utilized self-reporting, chart reviews, and medication sheet reviews to identify medication errors.

Related Experiment Videos

  • Adverse drug events (ADEs) and potential ADEs were identified through spontaneous and solicited reporting, along with daily chart reviews.
  • Two independent reviewers classified all identified incidents as ADEs or potential ADEs.

    • Main Results:

    • A total of 530 medication errors were identified from 10,070 medication orders (5.3 errors per 100 orders).
    • Missing doses constituted the most frequent error type (53%), followed by dose errors (15%).
    • Five ADEs (20% of all ADEs) were linked to medication errors, all deemed preventable; physician computer order entry could have prevented a significant majority of errors.

    Conclusions:

    • Medication errors are prevalent in clinical practice, though a small proportion directly result in ADEs.
    • Preventable medication errors, including those leading to ADEs, can be mitigated through technological solutions like physician computer order entry.
    • Improving medication error detection and prevention strategies is essential for enhancing patient safety.