title: Medication errors in ED: Do patient characteristics and the environment influence the nature and frequency of medication errors?
abstract: BACKGROUND
  Medication safety is of increasing importance and understanding the nature and frequency of medication errors in the Emergency Department (ED) will assist in tailoring interventions which will make patient care safer. The challenge with the literature to date is the wide variability in the frequency of errors reported and the reliance on incident reporting practices of busy ED staff.
  
  
  METHODS
  A prospective, exploratory descriptive design using point prevalence surveys was used to establish the frequency of observed medication errors in the ED. In addition, data related to contextual factors such as ED patients, staffing and workload were also collected during the point prevalence surveys to enable the analysis of relationships between the frequency and nature of specific error types and patient and ED characteristics at the time of data collection.
  
  
  RESULTS
  A total of 172 patients were included in the study: 125 of whom patients had a medication chart. The prevalence of medication errors in the ED studied was 41.2% for failure to apply patient ID bands, 12.2% for failure to document allergy status and 38.4% for errors of omission. The proportion of older patients in the ED did not affect the frequency of medication errors. There was a relationship between high numbers of ATS 1, 2 and 3 patients (indicating high levels of clinical urgency) and increased rates of failure to document allergy status. Medication errors were affected by ED occupancy, when cubicles in the ED were over 50% occupied, medication errors occurred more frequently. ED staffing affects the frequency of medication errors, there was an increase in failure to apply ID bands and errors of omission when there were unfilled nursing deficits and lower levels of senior medical staff were associated with increased errors of omission.
  
  
  CONCLUSIONS
  Medication errors related to patient identification, allergy status and medication omissions occur more frequently in the ED when the ED is busy, has sicker patients and when the staffing is not at the minimum required staffing levels.
authors.affiliation: Northern Health - The Northern Hospital, Emergency Department, 185 Cooper St Epping, Victoria 3076, Australia. Electronic address: belinda.scott@nh.org.au.
authors.forename: Belinda
authors.initials: B
authors.lastname: Mitchell Scott
authors.affiliation: Eastern Health - Deakin University Nursing & Midwifery Research Centre, Australia; School of Nursing and Midwifery, Deakin University, Australia; Centre for Quality and Patient Safety Research, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Considine
authors.affiliation: School of Nursing and Midwifery, Deakin University, Australia; Centre for Quality and Patient Safety Research, Australia; Epworth Deakin Centre for Clinical Nursing Research, Australia.
authors.forename: Mari
authors.initials: M
authors.lastname: Botti
mesh_terms: D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D014739:Victoria / Q000453:epidemiology; D000078329:Workforce
keywords: Emergency medicine; Emergency nursing; Medication errors; Patient safety; Risk management