Medication error rate

A variety of error rates for different aspects of the medication use process have been reported. Researchers use different methodologies and definitions of medication error, and study different aspects of the medication use process (i.e., prescribing, dispensing, administering). Because there is no national standardization for the denominator used to report medication error rates, the denominator can vary among several, including doses dispensed, doses administered, doses ordered, and patient days. Therefore, the rates reported in the literature are limited in their use for comparative purposes [5]. 

The disadvantages of these phased combinations are fluid retention, poor relief of dysmenorrhoea and the premenstrual syndrome and a relatively high medication error rate. 

It s a promising way to automate aspects of medication administration, says Robert Krawisz, former executive director of the National Patient Safety Foundation. The technology s impact at VA hospitals so far has been amazing. The Department of Veterans Affairs (VA) already uses bar codes nationwide in its hospitals, and the result has been a drastic reduction in medication errors. For example, the VA medical center in Topeka, Kan., has reported that bar coding reduced its medication error rate by 86 percent over a nine-year period. 

Pharmacists and technicians play a major role in medication safety in modern pharmacy practice. After summarizing several studies performed in hospitals and long-term care facilities, Allan and Barker (1990) estimated that medication errors occur at a rate of about 1 per patient per day. In a more recent study performed in ambulatory pharmacies, they found an overall dispensing accuracy rate for prescription medications of 98.3 percent (Allan, Barker, and Carnahan, 2003). While most of these errors probably have minimal clinical relevance and do not affect patients adversely, many experts believe that medication error rates may be higher in the ambulatory care setting because errors may not always be evident to the health professionals who work there. For example, medication errors can occur when a patient purchases nonprescription medications without speaking with the pharmacist about any potential interactions with his or her prescription medications or if patients fail to verify the appropriate dose of the over-the-counter (OTC) medication. 

Practitioners and consumers often want to know the acceptable medication error rate. There is no benchmark. A zero error rate is desired, but unattainable because of human factors. If organizations can determine measuring points and consistently follow them, it might be possible to determine an internal benchmark to be used for quality improvement purposes. However, because the parameters of the measurement are unlikely to be duplicated elsewhere, use of the number for external comparisons is not valid. 

The rate and nature of medication errors has been studied by several authors. Nightingale et al. found a medication error rate of 0.7% in a British National Health Service general hospital (25). Rothschild et al. (26) found 36.2% preventable adverse events plus an additional 149.7 serious errors per 1000 patient days. 

Medication error rates are not always so high. In some settings, perhaps those with more routine use of specific drugs or those where a highly proceduralized approach is possible, rates are lower. For instance, in one study the rate of major errors in 30 000 cytotoxic preparations was only 0.19% (limat etal., 2001). This rate is impressively low, but still might equate to substantial numbers of patients being affected each year across a hospital and still more across a country. 

IHI has produced a full package for improvement with tool kits, follow up measures on all aspects on Medication Reconciliation. Based on different strategies and settings they also report an error rate reduction of at least 50% (IHI MedReconcilliation 2008)... 

We have produced a tool Medication Report in Discharge Information for patients that reduced error rates and health-care contacts based on these errors by 50% in elderly patients (Midlov et al. 2008a,b). 

That medication errors occur frequently in U.S. hospitals has been well-documented [2-4]. In observation studies done between 1962 and 1995 on the rate of administration errors in a variety of in-patient settings, rates ranged from 0 to 59% [5]. Estimates that medication errors occur in almost 7% of hospitalized patients have been reported [6]. One study found that the frequency of medication errors was 1.4 per admission [4]. When approximately 290,000 medication orders were analyzed, Lesar et al. estimated that there were almost two serious errors for every 1,000 orders written. Based on a review of death certificates, it was estimated that almost 8,000 people died from medication errors in 1993, as opposed to almost 3,000 people in 1983 [3]. Researchers foimd an error rate at tv 0 children s hospitals of 4.7 per 1,000 orders [7]. Several... 

It has been shown that computerized physician order entry substantially decreases the rate of non-missed-dose medication errors. 

Compliance is the third patient-related factor contributing to medication errors. One study found a 76 percent difference between medications patients actually are taking when compared with those recorded in their charts as prescribed. Two factors that contribute to this high rate of discrepancy include confusion that may accompany advancing age and the increase in the number of prescribed medications (Bedell et ah, 2000). Another study demonstrated that patient noncompliance played a role in 33 percent of hospital admissions (McDonnell, Jacobs, and McDonnell, 2002). 

That medication errors occur frequently in U.S. hospitals has been well documented.In observation studies carried out between 1962 and 1995 on the rate of administration errors in a variety of inpatient settings. 

Pharmacists have used avoidance of medication errors to justify expanding services. A pediatric critical care satellite was opened to reduce the rate of errors from a total of 17.4% in an intensive care nursery and 38% in a pediatric ICU. A large number of the errors (86.5%) occurred with medications possessing a high potential for serious adverse consequences. 

Avoidance of medication administration errors is another potential contribution of critical care pharmacists. A multicenter analysis of medication errors from five ICUs revealed that medication errors occurred most commonly with vasoactive agents and sedative-analgesics. " Incorrect infusion rate was the most common error. The overall... 

Indicators provide a quantitative measure of an aspect of patient care that can be used in monitoring, evaluating, and improving the quality and appropriateness of healthcare delivery. An indicator may serve as a screen or red flag to identify a potential problem (postoperative infection rate, number of serious medication errors) or measure progress toward an established goal (percent of patients with atrial fibrillation who are anticoagulated). 

The two major types of performance measures are 1) rate-based performance measures, which measure an event for which a certain proportion of the events are expected to occur even with quality care (such as mistimed prescription refills) and 2) sentinel-event performance measures, which measure a serious event that requires an indepth review for each occurrence of the event (such as a medication error).To provide meaningful information, performance measures must be... 

Bates, D.W. Using information technology to reduce rates of medication errors in hospitals. BMJ 2000, 320,... 

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