Original Article

Evaluating the Frequency of Errors in Preparation and Administration of Intravenous Medications in the Intensive Care Unit of Shahid-Sadoughi Hospital in Yazd

Abstract

Background: In most Iranian hospitals, the nurses in the wards prepare intravenous (IV) drugs and unfortunately pharmacists are not involved in this process. The severity of the patients in Intensive Care Unit (ICU) heightens the risk of errors. More over the frequency of using IV drugs in this unit is high, so we decided to determine the frequency and types of errors, which occur in the preparation and administration of commonly, used IV medications in an ICU.
Method: A prospective cross sectional study was performed from November 2013 to August 2014, in the intensive care unit in Shahid-Sadoughi hospital in Yazd. Medication errors occurred in the process of preparation and administration of IV drugs, were recorded by a pharmacy student and were evaluated by direct observation, according to the method established by Barker and McConnell.
Results: A total number of 843 intravenous doses were evaluated. The most common type of error (34.26%) was the injection of IV doses faster than the recommended rate followed by preparation (15.69%), administration (9.23%) and compatibility with doctor’s order (6.24%). Amikacin was the most common drug involved in errors (41.67%). Most of errors were occurred at afternoon (8 p.m, 28.36%).
Conclusion:
According to our study the rate of errors in preparation and administration of IV drugs was high in this ICU. Employing more nurses, using developed medical instruments and clinical pharmacists can help to decrease these errors and improve the quality of patient care.

American Society of Health-System Pharmacists. Suggested definitions and relationships among medication misadventures, medication errors, adverse drug events and adverse drug reactions. Am J Health Syst Pharmacists 1998; 55: 165-6.

Ross LM, Wallace J, Paton JY. Medication errors in a pediatric teaching hospital in the UK: five years operational experience. Arch Dis Child 2000; 83: 492-7.

American Society of Health-System Pharmacists. Guidelines on preventing medication errors in hospitals. Am J Hosp Pharm 1993; 50: 305-14.

Allard J, Carthey J, Cope J, Pitt M, Woodward S. Medication errors: causes, prevention and reduction. Br J Haematol 2002;116: 255-65.

Allan E, Barker K. Fundamentals of medication error research. Am J Hosp Pharm 1990; 47: 555-71.

Koren G, Barzilay Z, Greenwald M. Tenfold errors in administration of drug doses: a neglected iatrogenic disease in pediatrics. Pediatrics 1986; 77: 848-9.

Bates D, Cullen D, Laird N, et al. Incidence of adverse drug events and potential adverse drug events. Implication for prevention. JAMA 1995; 274: 29-43.

Raju T, Kecskes S, Thornton J, Perry M, Feldman S. Medication errors in neonatal and pediatric intensive care units. Lancet 1989; 2:374-6.

Koska M. Drug errors: dangerous, costly and avoidable. Hospitals 1989; 63(11): 24.

Jha AK, Prasopa-Plaizier N, Larizgoitia I, et al. Patient safety research: an overview of the global evidence. Qual Saf Health Care 2010; 19: 42-7.

Wilson RM, Michel P, Olsen S, et al. Patient safety in developing countries: retrospective estimation of scale and nature of harm to patients in hospital. BMJ 2012; 344: e832.

Romero CM, Salazar N, Rojas L, et al. Effects of the implementation of a preventive interventions program on the reduction of medication errors in critically ill adult patients. J Crit Care 2013; 28: 451-60.

Shane R. Current status of administration of medicines. Am J Health Syst Pharm 2009; 66(5 Suppl 3): S42-8.

McDowell SE, Mt-Isa S, Ashby D, et al. Where errors occur in the preparation and administration of intravenous medicines: a systematic review and Bayesian analysis. Qual Saf Health Care 2010; 19: 341-5.

Taxis K, Barber N. Causes of intravenous medication errors: an ethnographic study. Qual Saf Health Care 2003; 12: 343-7.

Taxis K, Barber N. Causes of intravenous medication errors—observation of nurses in a German hospital. J Public Health 2004; 12: 132-8.

Stavroudis TA, Shore AD, Morlock L, et al. NICU medication errors: identifying a risk profile for medication errors in the neonatal intensive care unit. J Perinatol 2010; 30: 459-68.

Westbrook JI, Rob MI, Woods A, et al. Errors in the administration of intravenous medications in hospital and the role of correct procedures and nurse experience. BMJ Qual Saf 2011; 20: 1027-34.

Hicks RW, and Becker SC. An overview of intravenous related medication administration errors as reported to MEDMARX, a national medication error-reporting program. J Infus Nurs 2006; 29: 20-7.

Lisby M, Nielsen LP, and Mainz J. Errors in the medication process: frequency, type, and potential clinical consequences. Int J Qual Health Care 2005; 17: 15-22.

Ghaleb MA, Barber N, Franklin BD, Yeung VW, Khaki ZF, Wong IC. Systematic review of medication errors in pediatric patients. Annal Pharmacother 2006; 40: 1766-76.

Taxis N, Barber N. Incidence and severity of intravenous drug errors in a German hospital. Eur J Clin Pharmacol 2004; 59: 815-7.

Abbasinazari M, HajhosseinTalasaz A, Mousavi Z, Zare-Toranposhti S. Evaluating the frequency of errors in preparation and administration of intravenous medications in orthopedic, general surgery and gastroenterology wards of a teaching hospital in Tehran. Iran J Pharm Res 2013;12(1): 229- 34.

Fahimi F, AbbasiNazari M, Abrishami R, et al. Transcription errors observed in a teaching hospital. Arch Iran Med 2009;12(2): 173-5.

Fahimi F, Ariapanah P, Faizi M, Shafaghi B, Namdar R, Ardakani M. Errors in preparation and administration of intravenous medications in the intensive care unit of a teaching hospital: an observational study. Aust Crit Care 2008; 21(2): 110-6.

Khalili H, Farsaei S, Rezaee H, Dashti-Khavidaki S. Role of clinical pharmacists’ interventions in detection and prevention of medication errors in a medical ward. Int J Clin Pharm 2011; 33(2): 281-4.

Vessal G. Detection of prescription errors by a unit-based clinical pharmacist in a nephrology ward. Pharm World Sci 2010; 32(1): 59-65.

Pronovost PJ, Weast B, Holzmueller CG, et al. Evaluation of the culture of safety: survey of clinicians and managers in an academic medical center. Qual Saf Health Care 2003; 12: 405-10.

Cullen DJ, Sweitzer BJ, Bates DW, Burdick E, Edmondson A, Leape LL. Preventable adverse drug events in hospitalized patients: a comparative study of intensive care and general care units. Crit Care Med 1997; 25: 1289-97.

Kane-Gill S, Weber RJ: Principles and practices of medication safety in the ICU. Crit Care Clin 2006; 22: 273-290.

Bracco D, Favre JB, Bissonnette B, et al. Human errors in a multidisciplinary intensive care unit: a 1-year prospective study. Intensive Care Med 2001; 27: 137-45.

Valentin A, Capuzzo M, Guidet B, et al. Errors in administration of parenteral drugs in intensive care units: multinational prospective study. BMJ 2009; 338: b814.

Trissel LA. Handbook on injectable drugs.11th ed. Bethesda, ASHP; 2001.

Lacy CF, Armstrong LL, Goldman MP, Lance LL. Drug information handbook. 13th ed. Hudson, Lexi-Comp; 2005.

Springhouse corporation. Nursing IV Drug Handbook.8th ed. Lippincott Williams and Wilkins; 2003.

Barker KN, and McConnell WE. The problems of detecting medication errors in hospitals. Am J Hosp Pharm. 1962; 19: 360-9.

Allan E, Barker K. Fundamentals of medication error research. Am J Hosp Pharm 1990; 47: 555-71.

Wilmer A, Louie K, Dodek P, Wong H, Ayas N. Incidence of medication errors and adverse drug events in the ICU: a systematic review. Qual Saf Health Care 2010; 19(5): e7

Kaboli PJ, Hoth AB, McClimon BJ, et al. Clinical pharmacists and inpatient medical care: a systematic review. Arch Intern Med 2006; 166: 955-64.

Brown JN, Barnes CL, Beasley B, et al. Effect of pharmacists on medication errors in an emergency department. Am J Health Syst Pharm 2008; 65: 330-3.

Abbasinazari M, Zareh-Toranposhti S, Hassani A, et al. The effect of information provision on reduction of errors in intravenous drug preparation and administration by nurses in ICU and surgical wards. Acta Med Iran 2012; 50: 771-7.

Mueller SK, Sponsler KC, Kripalani S, et al. Hospital-based medication reconciliation practices: a systematic review. Arch Intern Med 2012; 172: 1057-69.

Haig G, Kiser L . Effect of pharmacist participation on a medical team on costs, charges and length of stay Am J Hosp Pharm 1991; 48: 1457-62.

Lobas N, Lepinski P, Abramowitz P .Effects of pharmaceutical care on medication cost and quality of patient care in an ambulatory-care clinic. Am J Hosp Pharm 1992; 49: 1681-8.

Bjornson D, Hiner W, Potyk R, Nelson B, Lombardo F, Morton T, Larson L, Martin B, Sikora R, Cammarata F .Effect of pharmacists on health care outcomes in hospitalized patients. Am J Hosp Pharm 1993; 50: 1875-84.

Taylor J, Kathman M. Documentation of cost savings from decentralized clinical pharmacy services at a community hospital. Am J Hosp Pharm 1991; 48: 1467-70.

Olubunmi Afolabi M, Oyedepo Oyebisi T. Pharmacists’ Perceptions of Barriers to Automation in Selected Hospital Pharmacies in Nigeria. J Pharm

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IssueVol 2, No 3 (Summer 2014) QRcode
SectionOriginal Article(s)
Keywords
Clinical Pharmacist Intravenous Administ ration Medication ErrorsIntensive Care Units

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How to Cite
1.
Sohrevardi SM, Mirjalili MR, Jarrahzadeh MH, Mirjalili M, Mirzaei E. Evaluating the Frequency of Errors in Preparation and Administration of Intravenous Medications in the Intensive Care Unit of Shahid-Sadoughi Hospital in Yazd. J Pharm Care. 2015;2(3):114-119.