Causes of medication administration errors in hospitals 2013,cfg olofmeister 2015,how to treat insulin resistance in cats,glucosamine zwanger - PDF Books


Medication administration errors (MAE) is one of the factors causing death and harm to patients and the most common important challenges threatening healthcare system in all countries worldwide [2]. American Society of Health System Pharmacists (ASHP), (2003) recognises that medication errors can be minimised by assessing the medication use process, identifying inadequacies within systems, and developing interventions to correct the recognised deficiencies.
A possible contributing factor to MAEs in the ED is the unique medication distribution system used. Although the results are mixed, several studies suggest that links exist between medication error and systemic organisational factors. Previous studies have examined important factors in refusal or act as barriers to report medication errors [10-13] or the analysis and improvement medication error reporting practices by emergency department physicians, nurses, and pharmacists [14]. Understanding factors that contribute to medication error is the first step toward preventing it to ensure safety and quality of patient care. This study was carried out in emergency department at teaching Main University Hospital in Alexandria governorate, Egypt which contains 42-bed during the period from June 2013 to the end of august 2013.
All nursing staff (n=84) who were working in the previously mentioned setting and willing to participate in such study were included. Medication Administration Error Survey: It was developed by Wakefield in 1998 [1] included 16 items regarding reasons why medication errors occur.
The Ethics Committee of Faculty of Nursing, Alexandria University has approved the study protocol. Before embarking to data collection, an informed consent was obtained from each participant to share in the study. After data were collected it was revised, coded and fed to statistical software SPSS IBM version 20. Table 1 illustrated the demographic characteristics of nursing staff at emergency department in Main University Hospital. Figure 1 represents the perception of participants for why medication administration errors occur. Table 2 describes the relationship of socio-demographic data with the four reasons of why medication administration errors occur. In this study, results of the factor analysis ranked four categories of factors influencing the occurrence of MAEs in emergency department. The present study factor analysis for MAEs causes ranked pharmacy processing as the third factor influencing the occurrence of MAEs in ED .Ideally, the pharmacist should collaborate with the prescriber in developing, implementing, and monitoring a therapeutic plan to produce defined therapeutic outcomes for the patient.
Based on the nurse perception, the results of the current study showed that regarding demographic characteristics, there was no relation between participants’ age, marital status and their experience in units with nurse staffing and pharmacy processing factors that influencing the occurrence of MAEs. An interesting finding in this section of the study, in relation to nurses’ experience in nursing and hospital, there were statistically significant relationship between nurses experience and medication packing reasons of why MAEs occur, in which nurses who have more working experience highly perceived that medication packaging is factor causing the occurrence of MAEs compared to nurses who have worked less years of experience. This study showed statistically significant correlation between participants’ most frequent shift with medication packaging reasons of why MAEs occur where nurses who are working night shift has highest mean for perception that medication packaging is the most factor causing MAEs. In conclusion, this study determined the factors influencing the occurrence of medication administration errors, as perceived by nurses in emergency department.
In summary, the findings from this study highlight the need to further examination on how hospital management is addressing the problem of MAEs occurrence in ED and the role of the nurse managers in preventing medication errors through participation in quality management processes.
Director, Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust and UCL School of Pharmacy.
Professor Franklin has been involved with medication safety research for nearly twenty years, and has published widely on methods for studying errors, and the frequency and causes of prescribing, dispensing and medication administration errors. This site complies with the HONcode standard for trustworthy health information: verify here. This article was written on 21 Sep 2015, and is filled under Volume 10 2015, Volume 10 No 1 & 2. Purpose: Wrong-time medication administration error (WTMAE) is a high risk to patient safety. Setting: Data was gathered from a private tertiary care university hospital in Karachi, Pakistan.
Implications: Medication administration is a complex process, and WTMAE is a major area to focus for improving the accuracy of medication administration recording. Value: Technology used innovatively in the form of eMAR can significantly help in identifying medication administration errors (MAE). Patient safety issues related to medication administration are critical on a day by day basis. Studies have been conducted to identify MAEs and wrong-time medication administration error (WTMAE) as high risk to patient safety. The purpose of this study was to investigate the prevalence of WTMAE with the help of technology and to explore factors contributing to WTMAE. A literature review was done using different search engines such as Pub-Med, EBSCO host CINAHL Plus and Cochrane Database of Systematic Reviews. The study was conducted at a private tertiary care university hospital in Karachi, Pakistan. A universal sampling technique was used to capture all the medication doses prescribed for the 3-month period from February 10, 2012 to May 9, 2012. Data received from the eMAR was coded for different variables and analyzed in SPSS version 19. The results illustrate that, overall 250,213 doses were prescribed for all of the five selected inpatient locations during the study period of 90 days. Figure 2 summarizes the percentage of on-time and wrong-time medication administration record by locations.
Data was also analyzed to measure WTMAEs in different shifts to identify the impact of shifts on WT errors. The eMAR system was programed to allow nurses to administer a medication dose 60 minutes prior or later to its scheduled time only after giving a short reason. The data on WT medication administration errors illustrates that error identification from electronic system helps to give accurate number of errors and avoid any Hawthorne effects on the study; whereas the literature search revealed that most of the previous studies used observational methods to gather medication administration error data (Bates,.
As a System Analyst, I am involved in the planning, development and implementation of different clinical systems to enhance technology in nurses. A medication error is any preventable event that may cause or lead to inappropriate medication use or harm to a patient. On March 11, 2008, FDA informed health care professionals about adverse events and deaths in children and adults who have taken Tussionex Pennkinetic Extended-Release Suspension (Tussionex). Hydrocodone, the narcotic ingredient in this medicine that controls cough, can cause life-threatening breathing problems when too much medicine is given at one time or when the medicine is given more frequently than recommended. Roughly 7,000 children ages 11 and younger are treated in hospital emergency rooms each year because of overdoses of OTC cough and cold medication, according to a recent study by the Centers for Disease Control and Prevention. OTC cough and cold products can be harmful if more than the recommended amount is used, if they are given too often, or if more than one product containing the same active ingredient is used.
Serious injuries and deaths have resulted from such errors as misunderstanding directions and failing to use the measuring devices that come with the medicine. To avoid accidental overdosing, consumers should not take more than the recommended dose on the label.
FDA has issued warnings about the fentanyl transdermal system, an adhesive patch that delivers an opioid called fentanyl through the skin. The directions on the product label and package insert of the fentanyl transdermal system should be followed exactly in order to avoid overdose.
FDA has issued a public health advisory cautioning practitioners to avoid overdoses when they are prescribing methadone or managing patients taking the drug. Since the 1970s, methadone has been primarily used in treating drug abuse, but it is increasingly being used to treat pain. Both edetate disodium and edetate calcium disodium work by binding with heavy metals or minerals in the body, allowing them to be passed out of the body through the urine. In January 2008, FDA issued a public health advisory, warning that some children and adults have died when they were mistakenly given edetate disodium instead of edetate calcium disodium (calcium disodium versenate), or when edetate disodium was used for chelation therapies and other uses not approved by FDA.
To minimize drug name confusion, FDA reviews about 400 drug names a year that companies submit as proposed brand names.
FDA works with drug companies to reduce the risk of errors that may result from similar-looking labeling and packaging, or from poor product design. In accordance with an FDA rule that went into effect in 2004, bar codes are required on product labels for certain drugs and biologics such as blood.
FDA reviews about 1,400 reports of medication errors per month and analyzes them to determine the cause and type of error.
FDA is working on three new guidances—one on complete submission requirements for anaylsis of trade names, one about the pitfalls of drug labeling, and another on best test practices for naming drugs.
FDA spreads the message about medication error prevention through public health advisories, medication guides, and outreach partnerships with other organizations. Note: If you need help accessing information in different file formats, see Instructions for Downloading Viewers and Players. The definition typically cited in literature that is authored by nurses defines MAE as mistakes associated with drugs and intravenous solutions that are made during the prescription, transcription, dispensing, and administration phases of drug preparation and distribution [1,3]. For example, on-pharmacy profiled automated dispensing cabinet (ADC), unit stock, or refrigerator, as the prescriber’s order may not be reviewed by a pharmacist before the drugs are given (Flynn et al.


These include nurse staffing adequacy, hours worked per week, overtime, staffing mix (professional versus unregulated), and other factors reflecting how the work system is designed [5-7]. However, few studies have focused only on the assessment of the occurrence and reasons of nursing medication errors, these studies recommended further studies to determine and investigate the causes of medication errors [15-18].
Therefore we have conducted this study to explore the most important factors influencing the occurrence of MAEs in ED from nurses’ perspective which can lead to improve medication administration process, diminish the risks of adverse events that impact patient morbidity and mortality, improve patient safety, and lower cost of patient care.
Respondents were asked to how much they believe they affect the occurrence of medication errors in the emergency department using a six points Likert type scale with fix values ranging from 6= strongly agree to 1= strongly disagree. They have determined that this survey does not fall under the committee’s jurisdiction. This study revealed no statistically significant relation between participants’ sex, residence, and educational level and their experience in units with reasons of why MAEs occur.
In descending order of magnitude, these categories included physician communication, followed by medication package, then pharmacy processing and finally nurse staffing. In addition, Peth in 2003 [22] in USA reported that the explosion of new drugs appearing in the marketplace has made it virtually impossible for physicians, nurses, and pharmacists to keep abreast of all of the latest data concerning the indications, contraindications, drug interactions, and adverse effects associated with each new drug. This finding is consistent with Wakefield in 2000 [23], who showed that workload and type of care delivery system, and other factors such as number of consecutive hours worked, rotating shifts, staffing mix and numbers, nurse-to-patient ratios, assignment of floating nurses to unfamiliar units .
This means that all nurses are almost ranking these factors influencing the occurrence of MAEs regardless of their age, marital status or years of experience. Anderson and Townsend in 2010 [20] mentioned that fatigue and sleep deprivation are linked to decreases in vigilance, memory, information processing, reaction time, and decision making. Top management should provide adequate staffing and fair scheduling for all urgent care to provide fair workload between nursing staff that reduce the occurrence of MAEs.
Alternate methods may need to be created for a supportive unit culture that encourages multidisciplinary team from nurse, physician, and pharmacist to prevent medication errors and improve patient safety in the ER hospital setting. Wakefield BJ, Wakefield DS, Uden-Holman T, Blegen MA (1998) Nurses’ perceptions of why medication administration errors occur. Sanghera IS, Franklin BD, Dhillon S (2007) The attitudes and beliefs of healthcare professionals on the causes and reporting of medication errors in a UK Intensive care unit.
Peris-Lopez P, Orfila A, Mitrokotsa A, van der Lubbe JC (2011) A comprehensive RFID solution to enhance inpatient medication safety. Flynn EA, Barker K, Barker B (2010) Medication-administration errors in an emergency department. Rogers AE, Hwang WT, Scott LD, Aiken LH, Dinges DF (2004) The working hours of hospital staff nurses and patient safety.
McGillis Hall L, Doran D, Pink GH (2004) Nurse staffing models, nursing hours, and patient safety outcomes.
Whitman GR, Kim Y, Davidson LJ, Wolf GA, Wang SL (2002) The impact of staffing on patient outcomes across specialty units.
Fairbanks RJ, Hays DP, Webster DF, Spillane LL (2004) Clinical pharmacy services in an emergency department.
Al-Youssif S, Mohamed L, Mohamed N (2013) Nurses’ Experiences toward Perception of Medication Administration Errors Reporting.
Abou Hashish E, El-Bialy G (2013) Nurses’ Perceptions of Safety Climate and Barriers to Report Medication Errors. Baker M, Attala H (2012) Medications errors, causes, and reporting behaviors as perceived by nurses. Lisa D (2009) Medication error reporting by physicians, nurses, and pharmacists in a Level 1 Trauma Center Emergency Department. Kamel S (2008) Studying medication administration errors in Ain –Shams University Hospital. Abo El-Maged N, Gaber E, El-Maghraby M (2002) Relationship between work setting and the occurrence of medication errors among nurses of Assiut University Hospital, Egypt. Mousa S (2000) Assessment of nursing medication errors factors causing them in the critical care unit At El Manial University Hospital, Egypt. Dumo MA (2012) Factors Affecting Medication Errors among Staff Nurses: Basis in the Formulation of Medication Information Guide.
Peth HA (2003) Medication errors in the emergency department: a systems approach to minimizing risk. Wakefield J B, Uden-Holman T, and Wakefield S D (2000) Development and Validation of the Medication Administration Error Reporting Survey, Journal of Advances in Patient Safety 4: 475-89.
Al-Shara M (2011) Factors contributing to medication errors in Jordan: a nursing perspective. Hartel MJ, Staub LP, Röder C, Eggli S (2011) High incidence of medication documentation errors in a Swiss university hospital due to the handwritten prescription process.
She has a particular research interest in methodological issues in patient safety and the evaluation of various technologies designed to reduce errors. The study highlights the frequency of WTMAEs and provides opportunities for improvement in nursing practices by elaborating multiple reasons for WTMAEs. Among all types of clinical errors, medication administration errors (MAEs) are reported as the second most frequent cause of injury. The National Patient Safety Agency (NPSA) News (2007) reported that WTMAE is the second largest category of medication error reported worldwide and has resulted in death or serious harm to patients. This study compared actual versus expected medication administration time, captured from an electronic medication administration recording system (eMAR).
Attempts were made to find the literature from the primary source library and some of the literature was explored through secondary sources (University of Sheffield) library.All electronic databases were searched for references with key terms such as medication error, medication administration error and wrong-time medication administration errors. Data for this study was gathered through the eMAR system, which identified the dose timing (actual verses expected) with reasons for early or late administration. This activity was initiated only after getting approval from hospital departmental heads and the ERC. Additionally Chi-square test was used to analyze data for differences between wrong-time administration verses on-time administration at different locations and shifts, to identify any significance difference. The finding indicates that out of 250,213 prescribed doses 231,380 doses were administered whereas 18,833 doses were not administered (see Table 2). The data showed 17% prevalence of WTMAEs at the tertiary care university hospital in Karachi, Pakistan. This systemic intervention helped us to identify many reasons for early or late medication administration errors. The most important contribution of this study was the focus on wrong-time medication administration errors and their contributing factors.
International studies conducted on wrong time error were reported using observational and chat review methods via manual medication administration record. Currently work as a Lead Analyst Nurse working with EHR Core Committee for selection of suitable software for Electronic Health Record for all the Aga Khan Hospitals in Asia & Africa. Since 2000, the Food and Drug Administration (FDA) has received more than 95,000 reports of medication errors.
For example, miscommunication of drug orders can involve poor handwriting, confusion between drugs with similar names, poor packaging design, and confusion of metric or other dosing units.
Overdose of Tussionex in older children, adolescents, and adults has also been associated with life-threatening and fatal breathing problems. About two-thirds of those incidents occurred when children took medication without a parent's knowledge.
In January 2008, FDA issued a public health advisory recommending that OTC cough and cold products not be used in infants and children under 2. For more information, see OTC Cough and Cold Products: Not for Infants and Children Under 2 Years of Age. The drug is sold under brand names such as Tylenol and Datril, and is also available in many cough and cold products, prescription pain relievers, and sleep aids. Also, acetaminophen should not be taken for more days than recommended, and should not be taken with other drug products that also contain acetaminophen without direction from a health care provider.
For example, the infant drop formula is three times more concentrated than the children's liquid. Fentanyl patches should not be used for short-term acute pain, pain that is not constant, or for pain after an operation.
Recent reports to FDA describe deaths and life-threatening side effects after doctors and other health care professionals inappropriately prescribed the patch to relieve pain after surgery, for headaches, or for occasional or mild pain in patients who were not opioid tolerant. The patients replaced the patch more frequently than directed in the instructions, applied more patches than prescribed, or applied heat to the patch.
FDA issued the advisory because of reports of life-threatening adverse events and death in patients receiving methadone for pain control.
When used with bar code scanner and computerized patient information systems, bar code technology can help ensure that the right dose of the right drug is given to the right patient at the right time. Medication administration errors (MAEs) in the ED are common, with errors occurring most often in the prescribing and administration phase [4]. Evidence of links between stress in the clinical workplace and medication error is also emerging. In addition data were collected on nurses’ sociodemographic data including sex, marital status, age, education level, years of experience, working unit, and the most frequent shift they work.


The Medication Administration Error Survey was translated into Arabic language and accordingly, minor changes were made for a few unclear words. Finding of the current study illustrated that participants perceived physician communication reason as the highest ranked factor influencing the occurrence of MAEs.
Moreover, all medications have side effects, and rare but potentially fatal side effects are unlikely to show up in preliminary clinical trials. Also, the finding of this study showed a significant difference between nurses’ marital status and physician communication as factor influencing occurrence of MAEs, since single nurses had higher ranking for this factor than married ones. This result is consistent with the study of Flor et al in 2012, Zein Eldin and Abd Elaal in 2013 [25,26].This result is in contrast with Al-Youssif et al. A person who works a 12-hour shift and has a long commute may need to stay awake for up to 18 consecutive hours.
Developing and disseminating the patient safety guidelines in all hospital setting especially in nursing and pharmacy departments. A baseline assessment of patient safety culture among nurses at Student University Hospital. Her current post combines research, education and training, and clinical practice as a hospital pharmacist.
Through this study we investigated the prevalence of WTMAEs via electronic medical administration record (eMAR) and explore the contributing factors associated with WTMAEs.
Therefore research needs to be done to identify different types of medication administration errors such as, wrong patient, wrong dose, wrong route, wrong drug, wrong-time and many others.
The study was conducted at a tertiary care hospital in Pakistan where the electronic medication administration record (eMAR) was used at all inpatient locations. These reasons were further grouped to list 35 reasons (Table 3) for late administration and eight reasons (Table 4) for early administration. Our study results showed a total of (n=39,386; 17%) doses in error due to WT administration in a three month period. The study shows that innovative technology and its role in identification of MAE and WTMAE are imperative and well supported by the literature.
The patch is only for moderate-to-severe chronic pain that is expected to last for any number of weeks or longer and that cannot be managed by acetaminophen-opioid combinations, nonsteroidal analgesics, or as-needed dosing with short-acting opioids.
Like other opioids, methadone causes slowed breathing, affects heart rate, and can also interact with other drugs. Edetate disodium was approved as an emergency treatment for certain patients with very high levels of calcium in the blood or certain patients with heart rhythm problems resulting from high amounts of the medication digoxin in the blood.
However, high patient acuity, crowding, and frequent interruptions are pervasive in the ED’s clinical environment.
Also it was tested for content validity by five experts in the same field of the study of nursing at Alexandria Faculty of Nursing.
A pilot study was carried out on 10 nurses who were working in other unit rather than the studied units and the necessary modifications were made. Discrete items concerning nurses responses for each domain were summed together to have the domain total score. In fact, once a medication has been removed from its packaging, it’s hard to identify and can be easily confused with another one [11]. The nursing shortage has increased workloads by increasing the number of patients for which a nurse is responsible.
This could be due to physicians either male or female underestimating nursing as profession which result in poor relationship between younger nurses and physicians however, as new graduated nurses become older and experience nurses receive more respect from them. Moreover, Tully in 2009 and Hartel et al in 2011 [27,28] stated that fatigue and sleep deprivation also may diminish a nurse’s ability to recognise subtle patient changes.
Actually, reducing these errors requires the commitment of everyone with a stake in keeping patients safe. The researchers recommended for provision of on-going education & training on practice of safe medication administration for all nurses especially in urgent care units. Professor Franklin is an associate editor for the journals BMJ Quality and Safety, and BMC Health Services Research. Upon further exploration of WTMAEs multiple reasons for late and early medication administration were identified. Identification and analysis of MAEs are highly important for process improvement and patient safety. The study findings provide an opportunity to decrease patient care risk and assist in development of different strategies for system improvement to ensure safe practices.
Pub-Med search revealed 1642 articles, EBSCO host CINAHL Plus provided 220 and the Cochrane database revealed 1551 full text articles with search term: “medication error”. These units were chosen to cover most of the specialty areas for adult and pediatric patients with medical and surgical conditions.
Figures 4 and 5 depict the top five reasons for late and top three reasons of early administration. The data also displayed how timing errors are not considered a major issue and have been given less attention. Electronic medication administration record systems act as a great tool to capture the administration record in a timely manner and to help to correctly estimate the prevalence of WTMAE and the reasons behind the wrong-time administration. This study’s finding suggest that staff members ought to be sensitized to the importance of on-time medication administration, which requires strong enforcement by management in the form of institutional policy. An overdose can occur because methadone stays in the body longer than the pain relief lasts.
Interruptions in the ED are conservatively estimated to be as frequent as every minute for attending physicians and every 14 minutes for resident physicians. Clearly, adverse drug events that occur in the ED are a significant public health problem and need to be reduced, but this must be accomplished without making the ED less efficient [9]. The questionnaire was hand delivered to each study participant in the morning and afternoon shifts and it was completed through self-report method. Descriptive statistics in the form of frequencies and percent were used to describe the categorical data variables while mean and standard deviation was used to describe domains scores.
Many nurses still feel that physicians don’t understand, respect, or care to listen to nursing perspectives on patient care that lead to misunderstanding and conflict between nurses and physicians.
Also Anderson and Townsend in 2010 [20] reported that, nurses perform many tasks that take them away from the patient’s bedside, such as indirect activities, answering the telephone. As a result, the nurse may not notice an adverse reaction to a drug quickly enough to avoid a devastating outcome. The physician who wrote the prescribed medications, pharmacist who dispensed it and the nurse who received the medications and administered to the patient, all play an important role in preventing MAEs. According to Koppel, Wetterneck, Telles, and Karsh (2008) “The Institute of Medicine (IOM) estimates that, on average, a hospitalized patient is subject to one medication administration error (MAEs) per day… In hospitals, the medication administration stage accounts for 26% to 32% of adult patient’s medication errors” (p.
The search was narrowed to search term “wrong-time medication administration error” which revealed limited full text articles.
Approval for data collection was requested from relevant departmental heads and the hospital Ethical Review cCmmittee (ERC). It has been mentioned by Fitzhenry et al., (2007) that“the effects of timing errors and errors of omission were rarely recognized clinically” (p.
Also regular audits of medication administration records in the eMAR should be done to check for WTMAE. To test for association between sample characteristics and their scores at different domains, independent samples t-test and One Way ANOVA were used. While, Al-Youssif in 2013 [11] illustrated that participants perceived physician-nurse relationship reason as the fourth category of MAEs. When medication errors occur, multifactorial causes in a badly shaped system affect their occurrence, as well as manual prescriptions, lack of bar codes, stress, fatigue, lack of attention and lack of ability. The senior management must also be apprised of the fact that to create a culture of patient safety, correct nurse-patient ratios are important to curtail WTMAE.
To identify the relative importance of each domain at committing error, factor analysis was used to express factor loading which is the correlation between each domain and the overall hidden factor. The third factor was pharmacy processes reason (0.76) for example, pharmacy delivers incorrect doses, and pharmacy does not prepare and label the medication correctly, as well as pharmacists unavailable 24 hours a day. Moreover, poor communication accounts for more than 60% of the root causes of sentinel events reported to the Joint Commission (JC) Anderson and Townsend in 2010 [20]. Allan and Barker (1990) suggested that wrong-time errors were defined as deviations from hospital policy. The last factor was nurse staffing (0.72) was perceived as the least reason of MAEs occurrence.



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