Effects of patient-, environment- and medication-related factors on high-alert medication incidents.
OBJECTIVE
To measure the rate of medication incidents associated with the prescription and administration of high-alert medications and to identify patient-, environment- and medication-related factors associated with these incidents.


METHODS
A retrospective chart audit design was conducted of medical records for patient admissions from 1 January 2010 to 31 December 2010.


METHODS
Five practice settings (cardiac care, emergency care, intensive care, oncology care and perioperative care) at a public teaching hospital in Melbourne, Australia.


METHODS
Patients were considered for inclusion if they were prescribed at least one high-alert medication and if they were admitted to one of five practice settings.


METHODS
High-alert prescribing and administering incidents were measured in each of the five practice settings. Generalized linear mixed modeling was used for data analysis.


RESULTS
There were 6984 opportunities for high-alert medication incidents across the five clinical settings. The overall medication incident rate was 1934/6984 (27.69%). There were 1176 prescribing incidents (16.84%) and 758 administering incidents (10.85%). Statistical modeling showed that, in each of the five clinical settings, an increased number of ward transfers was associated with increased odds of prescribing incidents. In addition, statistical modeling demonstrated that an increased number of ward transfers was associated with increased odds of administering incidents in emergency care and perioperative care.


CONCLUSIONS
Complex relationships were found in managing high-alert medications in specialty clinical settings. Employing measures to address patients' movements across ward settings can reduce high-alert medication incidents and improve quality of care.
School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Carlton Victoria e.manias@deakin.edu.au.
Elizabeth
E
Manias
School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia.
Allison
A
Williams
Collaborative Centre for Clinical Epidemiology, Biostatistics and Health Services Research, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Danny
D
Liew
Melbourne School of Health Sciences, The University of Melbourne, Carlton, Victoria, Australia.
Sascha
S
Rixon
Melbourne School of Health Sciences, The University of Melbourne, Carlton, Victoria, Australia.
Sandy
S
Braaf
Statistical Consulting Centre, The University of Melbourne, Carlton, Victoria, Australia.
Sue
S
Finch
D016907:Adverse Drug Reaction Reporting Systems; D000368:Aged; D016903:Drug Monitoring; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology; D008297:Male; D008485:Medical Audit; D008508:Medication Errors / Q000009:adverse effects / Q000517:prevention & control*; D008875:Middle Aged; D061214:Patient Safety; D010818:Practice Patterns, Physicians'; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D012308:Risk Management; D014739:Victoria / Q000453:epidemiology
clinical audit; high-alert medication; hospitals; medication incident; medication therapy management