Medication errors in a public hospital in Brazil

Addressing Critical Mistakes in Administering Intravenous Medications at Omdurman Military Hospital, Khartoum, Sudan

Objective

Errors in the preparation and administration of intravenous medications are significant contributors to morbidity and mortality rates in medical practice. Early reporting and the implementation of preventive measures can mitigate these errors. This study aims to identify patterns and frequencies of errors in IV medication preparation and administration, along with associated factors, at Omdurman Military Hospital in Khartoum, Sudan.

Methods

This observational, descriptive, cross-sectional study was conducted in the emergency department of Omdurman Military Hospital from January to May 2022. We observed 60 nurses responsible for intravenous drug preparation and administration using a pretested questionnaire and checklist on multiple occasions. The data was analyzed by SPSS and the descriptive and inferential statistics were applied.

Results

Our findings reveal that 98% of the nurses reported a lack of formal training in IV drug preparation and administration. The observed preparation area was characterized as untidy in 59.6% of observations, and 52.5% were conducted in crowded environments. We identified six distinct types of errors during drug preparation, with the most common being the absence of aseptic techniques (63.2%) and the failure to check drug expiry dates before administration (99%). In contrast, five types of administration errors were reported, with the most prevalent being incorrect administration rates (68.7%) and the absence of post-administration side-effect assessments (84.8%). Additionally, 83.3% of nurses did not label the unused portion of a drug intended for the next dose.

Conclusion

This study identifies a total of 11 different types of errors in IV drug preparation and administration, some of which are associated with the hospital's work environment. The lack of formal training among 98% of the nurses stands out as a significant contributor to the increasing frequency of these errors.

Assessing the severity of medication administration errors identified in an observational study using a valid and reliable method

BACKGROUND

Epidemiological data on medication errors severity are scarce. The assessment of the prevalence and severity of medication errors may be limited because of several reasons, including a lack of standardization in the method of identifying medication administration errors and little knowledge about the appropriate assessment tools to measure severity. Thus, in this study, we aim to assess the potential severity of errors identified by direct observation in a teaching hospital.

METHODS

We used a validated method for assessing the potential severity of medication administration errors. Responses are scored on a 10-point scale. The 203 errors identified in a previous study were organized per similarity, resulting in 67 errors. This list was assessed by a panel of a physician, a nurse, and two pharmacists. The average score for each of the 67 errors was estimated considering the scores given by the 4 judges. Errors with a severity index < 3, between 3 and 7, and > 7 were considered minor, moderate, and severe, respectively.

RESULTS

Professionals classified the potential clinical significance of the errors as minor, moderate, and severe in 8.8% (18/203), 82.8% (168/203), and 8.4% (17/203) of the cases, respectively. Most errors considered potentially serious (41%, 7/17) were technical errors. Most potentially serious errors involved insulin. Regarding the administration route, nine (53%) potentially serious errors involved medications administered intravenously.

CONCLUSIONS

Most of the errors were considered as potentially moderated by the expert panel; however, the frequency of potentially serious errors was higher than that in previous studies using the same methodology, which highlights the need for strategies to reduce their occurrence.

Observational study on medication administration errors at a University Hospital in Brazil: incidence, nature and associated factors

Background

Medication administration errors are frequent and cause significant harm globally. However, only a few data are available on their prevalence, nature, and severity in developing countries, particularly in Brazil. This study attempts to determine the incidence, nature, and factors associated with medication administration errors observed in a university hospital.

Methods

This was a prospective observational study, conducted in a clinical and surgical unit of a University Hospital in Brazil. Two previously trained professionals directly observed medication preparation and administration for 15 days, 24 h a day, in February 2020. The type of error, the category of the medication involved, according to the anatomical therapeutic chemical classification system, and associated risk factors were analyzed. Multivariate logistic regression was adopted to identify factors associated with errors.

Results

The administration of 561 drug doses was observed. The mean total medication administration error rate was 36.2% (95% confidence interval 32.3–40.2). The main factors associated with time errors were interruptions. Regarding technique errors, the primary factors observed were the route of administration, interruptions, and workload.

Conclusions

Here, we identified a high total medication administration error rate, the most frequent being technique, wrong time, dose, and omission errors. The factors associated with errors were interruptions, route of administration and workload, which agrees well with the results of other national and international studies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40545-022-00443-x.

Drug administration errors in Latin America: A systematic review

PURPOSE

This study systematically reviewed studies to determine the frequency and nature of medication administration errors in Latin American hospitals.

SUMMARY

We systematically searched the medical literature of seven electronic databases to identify studies on medication administration errors in Latin American hospitals using the direct observation method. Studies published in English, Spanish, or Portuguese between 1946 and March 2021 were included. A total of 10 studies conducted at 22 hospitals were included in the review. Nursing professionals were the most frequently observed during medication administration and were observers in four of the ten included studies. Total number of error opportunities was used as a parameter to calculate error rates. The administration error rate had a median of 32% (interquartile range 16%-35.8%) with high variability in the described frequencies (9%-64%). Excluding time errors, the median error rate was 9.7% (interquartile range 7.4%-29.5%). Four different definitions of medication errors were used in these studies. The most frequently observed errors were time, dose, and omission. Only four studies described the therapeutic classes or groups involved in the errors, with systemic anti-infectives being the most reported. None of the studies assessed the severity or outcome of the errors. The assessment of the overall risk bias revealed that one study had low risk, three had moderate risk, and three had high risk. In the assessment of the exploratory, observational, and before-after studies, two were classified as having fair quality and one as having poor quality.

CONCLUSION

The administration error rate in Latin America was high, even when time errors were excluded. The variation observed in the frequencies can be explained by the different contexts in which the study was conducted. Future research using direct observation techniques is necessary to more accurately estimate the nature and severity of medication administration errors.

Hospital medication errors: a cross-sectional study

BACKGROUND

Medication errors (MEs) are among the most common types of incidents reported in Australian and international hospitals. There is no uniform method of reporting and reducing these errors. This study aims to identify the incidence, time trends, types and factors associated with MEs in a large regional hospital in Australia.

METHODS

A 5-year cross-sectional study.

RESULTS

The incidence of MEs was 1.05 per 100 admitted patients. The highest frequency of errors was observed during the colder months of May-August. When distributed by day of the week, Mondays and Tuesdays had the highest frequency of errors. When distributed by hour of the day, time intervals from 7 am to 8 am and from 7 pm to 8 pm showed a sharp increase in the frequency of errors. One thousand and eighty-eight (57.8%) MEs belonged to incidence severity rating (ISR) level 4 and 787 (41.8%) belonged to ISR level 3. There were six incidents of ISR level 2 and only one incident of ISR level 1 reported during the five-year period 2014-2018. Administration-only errors were the most common accounting for 1070 (56.8%) followed by prescribing-only errors (433, 23%). High-risk medications were associated with half the number of errors, the most common of which were narcotics (17.9%) and antimicrobials (13.2%).

CONCLUSIONS

MEs continue to be a problem faced by international hospitals. Inexperience of health professionals and nurse-patient ratios might be the fundamental challenges to overcome. Specific training of junior staff in prescribing and administering medication and nurse workload management could be possible solutions to reducing MEs in hospitals.

Safety Assessment of the Pharmacotherapy Process at the Nurse and Midwife Level - An Observational Study

Purpose

Pharmacological errors are among the most common in the healthcare system. This study aimed to determine the level of safety of the pharmacotherapy process at the stage performed by nurses and midwives by indicating the key risk factors affecting patients’ safety.

Methods

A group of 1276 nurses and 136 midwives in Poland participated in the study. The survey was conducted in the period from May 2019 to August 2019. The original Nursing Risk in Pharmacotherapy (NURIPH) tool was used.

Results

The Cronbach alpha coefficient was 0.832. The low legibility of the medical orders (item 1) was indicated as the highest risk. A mean of 4.50 means that this factor’s significance is assessed between “very significant” and “significant.” The communication between physician, nurse and midwife, time pressure, and work organization were also rated high (Items 2, 3, and 4). The averages for these factors are higher than 4, so their evaluation is more than “significant.”.

Conclusion

Nurses and midwives involved in the pharmacotherapy process are exposed to many ergonomic factors triggering risk. A huge problem is the lack of readability of medical orders, which may be a factor triggering a medical error.

Medication administration – nursing workload and patient safety in clinical wards

ABSTRACT Objective: to analyze the characteristics of the work organization performed by nursing staff regarding medication administration procedures and their implications on the workload of these professionals and on patient safety. Method: the study design is exploratory, with mixed method research and an ecological restorative approach. Data were collected between January 2014 and March 2015, in three inpatient units of a teaching hospital in the south of Brazil, by means of photo walkabout and focus groups, in the qualitative step. In the quantitative phase data were collected from the 162 lists of patients assigned to nursing technicians during their work shifts. Results: the administration of medications has an impact on the professionals' workload and patient safety. Final considerations: there are weaknesses in the process that may contribute to medication administration errors, which are related to the number of doses and the number of patients assigned to each professional.

Interrupções no trabalho da enfermagem como fator de risco para erros de medicação

Objetivo: verificar a associação entre as interrupções e os erros de medicação nas doses preparadas e administradas por profissionais de enfermagem das unidades de internação de clínica médica de dois hospitais públicos localizados no Distrito Federal, Brasil. Método: estudo exploratório, de delineamento transversal e caráter quantitativo realizado em dois hospitais públicos no Distrito Federal, Brasil. A amostra foi de conveniência, sendo 8 profissionais do Hospital 1 e 18 profissionais do Hospital 2. Os dados foram coletados a partir de observação direta e aplicação de questionário e instrumento para identificação dos fatores de risco para erros de medicação. Foram considerados significativos os resultados com valores de p < 0,05 e o índice de confiança estabelecido foi de 95 %.Resultados: em ambos os hospitais verificou-se um perfil majoritariamente de técnicos de enfermagem (H1 = 100 %; H2 = 94,4 %), do sexo feminino (H1 = 75,0 %; H2 = 88,1 %), com idade superior aos 30 anos (H1 = 75,0 %; H2 = 61,0 %). Foram observadas 899 doses no Hospital 1 e Hospital 2, que resultaram em 921 e 648 erros respectivamente, dos quais 464 (53,6 %) no Hospital 1 e 118 (24,4 %) no Hospital 2 estiveram diretamente relacionados à presença de interrupções no trabalho. Cada dose observada sofreu aproximadamente 1,7 erro e percebeu-se uma frequência de aproximadamente 26 (H1) e 16,2 (H2) erros por hora. Conclusões: verifica-se uma forte associação entre as interrupções no trabalho da equipe de enfermagem e os erros de medicação nas unidades de internação estudadas, caracterizando as interrupções como importante fator de risco.

Risk factors for medication errors in the electronic and manual prescription

Objective:

to compare electronic and manual prescriptions of a public hospital of Brasilia, identifying risk factors for the occurrence of medication errors.

Method:

descriptive-exploratory, comparative and retrospective study. Data collection occurred from July 2012 to January 2013, using an instrument for the review of the information contained in medical records related to the medication process. A total of 190 manual and 199 electronic records composed the sample, with 2027 prescriptions each.

Results:

compared to the manual prescription, a significant reduction was observed in the risk factors after implantation of the electronic prescription, in items such as "lack of the form of dilution" (71.1% to 22.3%) and "prescription with brand name" (99.5% to 31.5%). Conversely, the risk factors "no check" and "lack of CRM of the prescriber" increased. The lack of the allergy registration and the occurrences related to medication were the same for both groups.

Conclusion:

generally, the use of the electronic prescription system was associated with a significant reduction in risk factors for medication errors, concerning the following aspects: illegibility, prescription with brand name and presence of essential items that provide a safe and effective prescription.