title: [Patient safety: use of quality management to prevent medication errors in the hospital medication use cycle].
abstract: OBJECTIVE
  To describe the medication errors in the medication use cycle in a general public hospital, and to identify intervention strategies in relation to the detection and prevention of these errors.
  
  
  METHODS
  Descriptive study with cross-sectional design. General public hospital of 190 beds, in Rosario (Argentina). Daily and systematic data collection of the circuit of use of medicines during May 2009. Once the errors were identified and classified, an interdisciplinary group sequentially applied different quality management tools to recognize and weigh causes, and propose solutions. (Flowchart, Cause Effect Diagram, Brainstorming, Nominal Group and Matrix Decision).
  
  
  RESULTS
  Information on 60 patients was retrieved during the study period, with 506 medication errors detected. The impact indicators showed the following values: 8.4 errors/patient and 88.6 errors/100 patients-day. From the causes identified, two were defined as relevant: "Double prescription" and "Lack of clear policy". Of the various solutions proposed, an intervention strategy was defined to include a differently designed form for "prescription/indication/administration" in the clinical history which could be updated daily, with a duplicate to Pharmacy for the distribution, as well as a Standard Operating Procedure to standardize this new way of working.
  
  
  CONCLUSIONS
  This work achieved, through quality management, the commitment of a team of health professionals to seek and make changes for patient safety, and to improve the quality of services provided by the hospital.
authors: Área Farmacia Asistencial, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina.
authors: M
authors: M
authors: Salamano
authors: V
authors: V
authors: Palchik
authors: C
authors: C
authors: Botta
authors: M
authors: M
authors: Colautti
authors: M
authors: M
authors: Bianchi
authors: M L
authors: ML
authors: Traverso
mesh_terms: D003430:Cross-Sectional Studies; D003663:Decision Trees; D006779:Hospitals, Public; D006801:Humans; D008508:Medication Errors / Q000145:classification / Q000517:prevention & control*; D061214:Patient Safety / Q000592:standards*; D017749:Total Quality Management