title: Prioritising the prevention of medication handling errors.
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.
  
  
  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.
authors.affiliation: 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
authors.forename: Thilo
authors.initials: T
authors.lastname: Bertsche
authors.forename: Dorothee
authors.initials: D
authors.lastname: Niemann
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Mayer
authors.forename: Katrin
authors.initials: K
authors.lastname: Ingram
authors.forename: Torsten
authors.initials: T
authors.lastname: Hoppe-Tichy
authors.forename: Walter E
authors.initials: WE
authors.lastname: Haefeli
mesh_terms: 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
chemical_list: D004364:Pharmaceutical Preparations
references.citation: Pediatr Infect Dis J. 2003 Jun;22(6):494-9
references.pmid: 12799504
references.citation: JAMA. 1995 Jul 5;274(1):29-34
references.pmid: 7791255
references.citation: Am J Health Syst Pharm. 2007 Jan 15;64(2):166-75
references.pmid: 17215467
references.citation: Pharm World Sci. 2003 Dec;25(6):264-8
references.pmid: 14689814
references.citation: Am J Health Syst Pharm. 1999 Jan 1;56(1):57-62
references.pmid: 10048880
references.citation: Drug Saf. 2006;29(11):1011-22
references.pmid: 17061907
references.citation: Pharm World Sci. 2003 Jun;25(3):112-7
references.pmid: 12840964
references.citation: Am J Health Syst Pharm. 2001 Jan 1;58(1):54-9
references.pmid: 11194136
references.citation: Pharm World Sci. 1998 Aug;20(4):178-82
references.pmid: 9762730
references.citation: Bull Cancer. 2004 Dec;91(12):972-6
references.pmid: 15634638
references.citation: JAMA. 1999 Jul 21;282(3):267-70
references.pmid: 10422996
references.citation: J Healthc Qual. 2004 Nov-Dec;26(6):5-11
references.pmid: 15603088
references.citation: JAMA. 1997 Jan 22-29;277(4):307-11
references.pmid: 9002493
references.citation: JAMA. 1997 Jan 22-29;277(4):301-6
references.pmid: 9002492
references.citation: Lancet. 2000 Mar 18;355(9208):947-8
references.pmid: 10768430
references.citation: Anaesthesist. 2003 May;52(5):409-12
references.pmid: 12750824
references.citation: J Am Med Inform Assoc. 1999 Jul-Aug;6(4):313-21
references.pmid: 10428004
references.citation: BMJ. 1995 Jul 15;311(6998):182-4
references.pmid: 7613435
references.citation: JAMA. 1995 Jul 5;274(1):35-43
references.pmid: 7791256
references.citation: Eur J Clin Pharmacol. 2004 Jan;59(11):815-7
references.pmid: 14586530
references.citation: Am J Health Syst Pharm. 2007 Jul 15;64(14 Suppl 9):S3-9; quiz S24-6
references.pmid: 17617512
references.citation: Intern Med J. 2001 May-Jun;31(4):199-205
references.pmid: 11456032
references.citation: Crit Care Med. 1995 Jul;23(7):1177-83
references.pmid: 7600824
references.citation: BMJ. 2004 Dec 4;329(7478):1321
references.pmid: 15454495
references.citation: Br J Clin Pharmacol. 2007 Feb;63(2):171-6
references.pmid: 17076694
references.citation: Pharm World Sci. 2002 Dec;24(6):236-9
references.pmid: 12512156
references.citation: JAMA. 1998 Apr 15;279(15):1200-5
references.pmid: 9555760
references.citation: JAMA. 1998 Oct 21;280(15):1311-6
references.pmid: 9794308
references.citation: BMJ. 2003 Mar 29;326(7391):684
references.pmid: 12663404
references.citation: Drug Saf. 2007;30(5):379-407
references.pmid: 17472418