Prioritising the prevention of medication handling errors |
| |
Authors: | Thilo Bertsche Dorothee Niemann Yvonne Mayer Katrin Ingram Torsten Hoppe-Tichy and Walter E Haefeli |
| |
Institution: | (1) Department of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany;(2) Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany;(3) Pharmacy Department, University Hospital of Heidelberg, Im Neuenheimer Feld 670, 69120 Heidelberg, Germany |
| |
Abstract: | Objective Medication errors are frequent in a hospital setting and often caused by inappropriate drug handling. Systematic strategies
for their prevention however are still lacking. We developed and applied a classification model to categorise medication handling
errors and defined the urgency of correction on the basis of these findings. Setting Nurses on medical wards (including intensive and intermediate care units) of a 1,680-bed teaching hospital. Method In a prospective observational study we evaluated the prevalence of 20 predefined medication handling errors on the ward.
In a concurrent questionnaire survey, we assessed the knowledge of the nurses on medication handling. The severity of errors
observed in individual areas was scored considering prevalence, potential risk of an error, and the involved drug. These scores
and the prevalence of corresponding knowledge deficits were used to define the urgency of preventive strategies according
to a four-field decision matrix. Main outcome measure Prevalence and potential risk of medication handling errors, corresponding knowledge deficits in nurses committing the errors,
and priority of quality improvement. Results In 1,376 observed processes 833 medication handling errors were detected. Errors concerning preparation (mean 0.88 errors
per observed process 95% CI: 0.81–0.96], N = 645) were more frequent than administration errors (0.36 0.32–0.41], N = 701, P < 0.001). Parenteral drugs (1.10 1.00–1.19], N = 492) were more often involved in errors than enteral drugs (0.32 0.28–0.36], N = 794, P < 0.001). Of the 833 observed medication errors 30.9% concerned processes of high risk, 19.0% of moderate risk, and 50.1%
of low risk. Of these errors 11.4% were caused by critical dose drugs, 81.6% by uncomplicated drugs, and 6.9% by nutritional
supplements or diluents without active ingredient. According to the decision matrix that also considered knowledge deficits
two error types concerning enteral drugs (flaws in light protection and prescribing information) were given maximum priority
for quality improvement. For parenteral drugs five errors (incompatibilities, flaws in hygiene, duration of administration,
check for visible abnormalities, and again prescribing information) appeared most important. Conclusion We successfully applied a newly developed classification model to prioritise medication handling errors for prevention strategies. |
| |
Keywords: | Clinical competence Decision making Error detection Germany Knowledge Medication errors Prioritising Questionnaires Risk management Students pharmacy |
本文献已被 SpringerLink 等数据库收录! |
|