Prioritising the prevention of medication handling errors.
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.


METHODS
Nurses on medical wards (including intensive and intermediate care units) of a 1,680-bed teaching hospital.


METHODS
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.


METHODS
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.


CONCLUSIONS
We successfully applied a newly developed classification model to prioritise medication handling errors for prevention strategies.
Bertsche
Thilo
T
Department of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany. thilo.bertsche@med.uni-heidelberg.de
Niemann
Dorothee
D
Mayer
Yvonne
Y
Ingram
Katrin
K
Hoppe-Tichy
Torsten
T
Haefeli
Walter E
WE
D000328:Adult; D003657:Decision Making; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005858:Germany; D007722:Health Knowledge, Attitudes, Practice; D006746:Hospital Bed Capacity, 500 and over; D006784:Hospitals, Teaching / Q000458:organization & administration / Q000592:standards; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D008962:Models, Theoretical; D009726:Nurses / Q000458:organization & administration* / Q000592:standards; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D015995:Prevalence; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000379:methods; D011795:Surveys and Questionnaires
D004364:Pharmaceutical Preparations
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