Intravenous cancer chemotherapy administration errors: An observational study at referral hospital in Jordan

How to get over with medication errors underestimation? Improving indices of medication errors with focus on intravenous medications in hematopoietic stem cell transplantation setting; a direct observation study

BACKGROUND

The administration of intravenous (IV) medications is a technically complicated and error-prone process. Especially, in the hematopoietic stem cell transplantation (HSCT) setting where toxic drugs are frequently used and patients are in critical immunocompromised conditions, medication errors (ME) can have catastrophic reactions and devastating outcomes such as death. Studies on ME are challenging due to poor methodological approaches and complicated interpretations. Here, we tried to resolve this problem using reliable methods and by defining new denominators, as a crucial part of an epidemiological approach.

METHODS

This was an observational, cross-sectional study. A total of 525 episodes of IV medication administration were reviewed by a pharmacist using the disguised direct observation method to evaluate the preparation and administration processes of 32 IV medications in three HSCT wards. We reported errors in 3 ratios; 1) Total Opportunities for Error (TOE; the number of errors/sum of all administered doses observed plus omitted medications), 2) Proportional Error Ratio (the number of errors for each drug or situation/total number of detected errors) and, 3) Corrected Total Opportunities for Errors (CTOE; the number of errors/ Sum of Potential Errors (SPE)).

RESULTS

A total of 1,568 errors were observed out of 5,347 total potential errors. TOE was calculated as 2.98 or 298% and CTOE as 29.3%. Most of the errors occurred at the administration step. The most common potential errors were the use of an incorrect volume of the reconstitution solvent during medication preparation and lack of monitoring in the administration stage.

CONCLUSION

Medication errors frequently occur during the preparation and administration of IV medications in the HSCT setting. Using precise detection methods, denominators, and checklists, we identified the most error-prone steps during this process, for which there is an urgent need to implement effective preventive measures. Our findings can help plan targeted preventive measures and investigate their effectiveness, specifically in HSCT settings.

Prevalence, contributing factors, and interventions to reduce medication errors in outpatient and ambulatory settings: a systematic review

BACKGROUND

Medication errors are common events that compromise patient safety. Outpatient and ambulatory settings enhance access to healthcare which has been linked to favorable outcomes. While medication errors have been extensively researched in inpatient settings, there is dearth of literature from outpatient settings.

AIM

To synthesize the peer-reviewed literature on the prevalence, nature, contributory factors, and interventions to minimize medication errors in outpatient and ambulatory settings.

METHOD

A systematic review was conducted using Medline, Embase, CINAHL, and Google Scholar which were searched from 2011 to November 2021. Quality assessment was conducted using the quality assessment checklist for prevalence studies tool. Data related to contributory factors were synthesized according to Reason's accident causation model.

RESULTS

Twenty-four articles were included in the review. Medication errors were common in outpatient and ambulatory settings (23-92% of prescribed drugs). Prescribing errors were the most common type of errors reported (up to 91% of the prescribed drugs, high variations in the data), with dosing errors being most prevalent (up to 41% of the prescribed drugs). Latent conditions, largely due to inadequate knowledge, were common contributory factors followed by active failures. The seven studies that discussed interventions were of poor quality and none used a randomized design.

CONCLUSION

Medication errors (particularly prescribing errors and dosing errors) in outpatient settings are prevalent, although reported prevalence range is wide. Future research should be informed by behavioral theories and should use high quality designs. These interventions should encompass system-level strategies, multidisciplinary collaborations, effective integration of pharmacists, health information technology, and educational programs.

Detection of medication administration errors at a tertiary hospital using a direct observation approach

Objectives

Medication administration errors (MAEs) are the most common and significant type of medication errors worldwide. This study aims to assess the prevalence, types, and severity of MAEs. Furthermore, this study attempts to determine the factors associated with the occurrence of MAEs.

Method

This cross-sectional study was conducted over a three-month interval in the internal medicine ward of a tertiary teaching hospital in Jordan. During the study period, 13 nurses were observed while they were preparing and administering medications using a direct disguised observation method. All the recorded observations about the preparation and administration were compared with the physician's orders in the medications' records to identify any possible MAEs.

Results

Having observed a total of 1,012 opportunities for errors, 910 MAEs were identified. Among these 910 errors, adherence errors were found to be the most frequent type (n = 364, 35.9%), followed by incorrect drug preparation (n = 247, 24.4%). None of the MAEs revealed any serious harm to patients or contributed to prolonged hospitalization. Antimicrobial drugs (n = 210, 23.0%) was the most common class associated with MAEs, followed by the class of cardiovascular (n = 157, 17.2%) medicines. Results have shown that the occurrence of MAEs was significantly higher in the non-intravenous medications in comparison to the intravenous medications (p-value < 0.001).

Conclusion

While this study revealed a high rate of MAEs, all the identified errors did not cause harm to the patients. Continuous awareness and education campaigns targeting the nurses about the importance of proper and safe drug administration are highly recommended.