Errors in administration of parenteral drugs in intensive care units: multinational prospective study.
OBJECTIVE
To assess on a multinational level the frequency, characteristics, contributing factors, and preventive measures of administration errors in parenteral medication in intensive care units.


METHODS
Observational, prospective, 24 hour cross sectional study with self reporting by staff.


METHODS
113 intensive care units in 27 countries.


METHODS
1328 adults in intensive care.


METHODS
Number of errors; impact of errors; distribution of error characteristics; distribution of contributing and preventive factors.


RESULTS
861 errors affecting 441 patients were reported: 74.5 (95% confidence interval 69.5 to 79.4) events per 100 patient days. Three quarters of the errors were classified as errors of omission. Twelve patients (0.9% of the study population) experienced permanent harm or died because of medication errors at the administration stage. In a multiple logistic regression with patients as the unit of analysis, odds ratios for the occurrence of at least one parenteral medication error were raised for number of organ failures (odds ratio per increase of one organ failure: 1.19, 95% confidence interval 1.05 to 1.34); use of any intravenous medication (yes v no: 2.73, 1.39 to 5.36); number of parenteral administrations (per increase of one parenteral administration: 1.06, 1.04 to 1.08); typical interventions in patients in intensive care (yes v no: 1.50, 1.14 to 1.96); larger intensive care unit (per increase of one bed: 1.01, 1.00 to 1.02); number of patients per nurse (per increase of one patient: 1.30, 1.03 to 1.64); and occupancy rate (per 10% increase: 1.03, 1.00 to 1.05). Odds ratios for the occurrence of parenteral medication errors were decreased for presence of basic monitoring (yes v no: 0.19, 0.07 to 0.49); an existing critical incident reporting system (yes v no: 0.69, 0.53 to 0.90); an established routine of checks at nurses' shift change (yes v no: 0.68, 0.52 to 0.90); and an increased ratio of patient turnover to the size of the unit (per increase of one patient: 0.73, 0.57 to 0.93).


CONCLUSIONS
Parenteral medication errors at the administration stage are common and a serious safety problem in intensive care units. With the increasing complexity of care in critically ill patients, organisational factors such as error reporting systems and routine checks can reduce the risk for such errors.
Valentin
Andreas
A
Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria. andreas.valentin@meduniwien.ac.at
Capuzzo
Maurizia
M
Guidet
Bertrand
B
Moreno
Rui
R
Metnitz
Barbara
B
Bauer
Peter
P
Metnitz
Philipp
P
D003422:Critical Care / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral / Q000009:adverse effects*; D038622:Internationality; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D008875:Middle Aged; D011446:Prospective Studies