title: The factors associated with medication errors in adult medical and surgical inpatients: a direct observation approach with medication record reviews.
abstract: BACKGROUND
  Observing real situations in clinical practice can provide undetected information regarding problems in the medication process.
  
  
  OBJECTIVE
  The aims of this study were to describe the frequency, types, and severity of medication errors in medical and surgical inpatients as well as to study the relationship between medication errors and associating factors.
  
  
  METHODS
  A cross-sectional study using direct observations and medication record reviews was conducted to assess how 32 registered nurses administered 1058 medications to 122 inpatients in four medical and surgical wards at a university hospital in Finland between April and May 2012. Observations were recorded using a structured observation form and patients' medication record reviews (n = 122) before and after the observations were conducted. A multiprofessional team analysed and classified all of the detected errors and assessed their severity. A logistic regression was used to analyse the factors (work environment, team, person-specific, patient-specific or medication-related) associated with medication errors.
  
  
  RESULTS
  At least one error was found in 22.2% (235/1058) of administered medications, 63.4% of which were medication administration errors and 18.3% of which were documentation errors. Of the medication administration errors, 59.1% involved an incorrect administration technique. 3.4% of errors caused harm to patients. Statistically significant factors that increased the risk of medication errors included every other weekday, except Sunday; morning shifts; increased rushes; nurses asking for help; and increased number of medications that patients used. Factors that decreased the risk of errors included administering medications through an oral route, double-checking the drugs, and additional people in the medication room at the same time.
  
  
  CONCLUSIONS
  Medication errors in inpatient care are frequent, and improvements to increase safety are vital. More attention to medication administration techniques, administration instructions and attitudes toward safety are needed to prevent problems.
authors.affiliation: Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.|Finnish Doctoral Programme in Nursing Science, Finland.
authors.forename: Marja
authors.initials: M
authors.lastname: Härkänen
authors.affiliation: Pharmacy, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Jouni
authors.initials: J
authors.lastname: Ahonen
authors.affiliation: Department of Medicine, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Marjo
authors.initials: M
authors.lastname: Kervinen
authors.affiliation: Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.|Kuopio University Hospital, Kuopio, Finland.
authors.forename: Hannele
authors.initials: H
authors.lastname: Turunen
authors.affiliation: Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.|Kuopio University Hospital, Kuopio, Finland.
authors.forename: Katri
authors.initials: K
authors.lastname: Vehviläinen-Julkunen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D004282:Documentation; D005260:Female; D005387:Finland; D006785:Hospitals, University / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D008875:Middle Aged; D009726:Nurses / Q000592:standards / Q000706:statistics & numerical data*; D009741:Nursing Staff, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D012307:Risk Factors; D055815:Young Adult
keywords: hospital; medication errors; nurses; observation; patient safety