A survey of medication error prevalence in a Brazilian health center.
Medication error is a frequent adverse event in health care. In this study, we checked each medication dose in 744 medical orders and identified a prevalence rate of 0.53 medication errors per medical order. The highest prevalence was in the critical care unit (0.98), and the most frequent type was dose omission (53%). The results were published bimonthly for health care professionals, with an improvement recommendation list to minimize medication errors and increase patient safety.
Division of Healthcare Practice, Quality, Safety and Environment, Hospital Israelita Albert Einstein, Sao Paulo, Brazil. cpaixao@einstein.br
Carla F
CF
Paixão Nunes
Paola B A
PB
Andreoli
Fábio T
FT
Ferracini
Claudia G
CG
Barros
D001938:Brazil / Q000453:epidemiology; D019538:Health Care Surveys; D006786:Hospitals, Urban / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008485:Medical Audit / Q000706:statistics & numerical data; D008508:Medication Errors / Q000706:statistics & numerical data*; D009741:Nursing Staff, Hospital / Q000592:standards / Q000706:statistics & numerical data; D015995:Prevalence; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies