literature review on medication errors

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Literature review on medication errors

Thirdly, all duplicates between databases, papers that did not meet the inclusion criteria or papers that could not be obtained were excluded. Definitions of medication errors and ADEs were registered along with included error types and whether the paper focused on ordering, dispensing, administering and monitoring.

Moreover, general information regarding journal, author, year, title, aim, setting, participants, design, methods, intervention, results and evidence level were registered in an Access database. Determination of evidence level was based on modified Oxford Criteria Table 1. Studies in which evidence level could not be determined on behalf of available information, were discussed with a clinical pharmacologist and a professor in Public Health.

Levels of evidence, Oxford Centre for Evidence-based Medicine and pharmaco-epidemiological study design. In the present review, the evidence levels of the included studies were classified in accordance to these study-designs, as appropriate. Due to the obvious lack of standard methodology and outcome measures, data could not be statistically summarized. However, prevalences of medication errors were reported for studies in which denominators were accessible.

In pre—post studies and controlled studies, only prevalences of medication errors at baseline or from a control group were presented, whereas no prevalences could be calculated in studies using data from reporting systems [ 26 ]. Definitions were analysed with regard to similarities in content leading to the following five categories: i studies using the term error; ii studies using the NCC MERP definition; iii studies using failure; iv studies using deviation; and, finally v other terms.

In each category, definitions from included studies were presented along with study characteristics. Finally, possible tendencies towards associations between definitions and prevalences were examined. The literature search revealed eligible papers Fig. An additional 30 studies included a stage-specific definition; 22 prescribing, 3 in dispensing, 5 in administering and, finally, 4 studies contained a definition of intravenous errors.

However, in studies, no definitions were provided. The 45 included studies were published in 26 different peer-reviewed journals in the period from to with half of them in the period — The majority of studies were conducted in North America, representing 36 studies; 2 were done in Australia, 6 in Western Europe and, finally, 1 in Asia.

Moreover, 20 studies included only adults, 9 studies only children, 9 studies both adults and children and, finally, 8 studies included other types of participants e. In 13 studies an intervention was addressed of which 9 were technologies in the medication process e. Descriptive designs were employed in 37 studies, whereas 2 studies were conducted as randomized clinical controlled studies, 1 as a case—control study and 1 as a prospective cohort study, and, finally, 4 studies were conducted using other designs e.

Nine out of 10 studies were classified as evidence level IV or V, and, finally, chart review and reporting systems were the most frequently used methods to detect medication errors. In 21 of 45 studies, it was not possible to determine a prevalence of medication errors due to lack of valid denominators. These were in particular studies using reporting systems, interview and questionnaires as data collection method.

Such events may be related to professional practice, health-care products, procedures and systems, including prescribing; order communication; product labelling, packaging and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use.

In seven studies no error types were included due to study design. The study having one error type, namely, overdose gentamicin accounted for the highest prevalence in the review. Unfortunately, it was not possible to retrieve prevalence in the study using the highest number of error types, as data were collected from voluntary reporting.

Dosing errors were the most frequent single error type, and in studies including all stages in the medication process, prescribing errors accounted for the highest percentage. One definition used harm or potential for harm as a criterion for medication error, whereas one explicitly included intercepted medication errors [ 27—29 ]. Finally, five definitions were limited to deviations between ordered and administered drugs and doses [ 30—34 ]. In all other definitions no restrictions were specified.

Tables 2—4 provide an overview of definitions and characteristics of each study. In seven definitions, information regarding injury or intercepted errors is stated. In the second category Table 3 , which included studies using the definition from NCC MERP, it was possible to retrieve prevalence in 1 out of 17 studies, due to the use of reporting systems.

To our knowledge, this is the first study to systematically explore the extent and impact of generic definitions of medication errors in hospital settings. The literature review confirmed an inconsistent use of definitions. However, other aspects have to be considered in order to explain the variation in prevalence of medication errors, as interpretation of the included definitions did not suggest any tendencies.

Furthermore, fewer than a quarter presented a generic definition despite that being the main objective of the studies. Thus, the inconsistency in terminology only represents the tip of the iceberg. Additionally, the present review has confirmed that the overall poor understanding of the epidemiology of medication errors can, at least, partly be explained by choice of design, data collection methods and study population, including denominators [ 19—21 , 23 ].

The second important problem is the choice of denominator or study population. It has previously been suggested that to use opportunities for errors rather than number of patients as denominator reduces the risk of case-mix bias [ 26 ]. Here we demonstrated a variety of denominators including drug order, doses, opportunities for errors, patients, nurses, reports and triggers.

In addition, the frequent use of a reporting system excluded calculation of valid prevalence in almost half of all the studies thereby increasing the lack of clarity. Thirdly, the impact of error types should be considered. It could be assumed that increasing the number of error types being measured, would automatically result in higher occurrences of medication errors due to an increased probability of detecting more errors.

On the other hand, not all error types are mutually exclusive e. Thus, the number of error types has to be weighed against type of error and the sensitivity of error detection methods. Unfortunately, the present review did not provide sufficient information on the impact of error types with regard to prevalence. Finally, choice of data collection method should be considered important. Previously, chart review has been considered as the most appropriate method to detect prescribing errors and direct observation the most sensitive method to detect dispensing and administration errors, as opposed to voluntary reporting, which was found to be the least sensitive method [ 32 , 36 ].

In recent years the availability of computer-generated signals in error detection has increased, which allow an objective detection of all incidents that have been defined as an error in the computer. Thus, it can be assumed that such systems will increase the detection of systematic documented electronic data such as dosing of gentamicin [ 35 ]. In the present review the most frequently applied error detection method was chart review, which might have contributed to an underestimation of the occurrence of medication errors when applied to detection of errors other than prescribing.

Interestingly, definitions, which at first glance appeared to be similar Table 2 , turned out to have the widest range in prevalence of medication errors. A closer scrutiny revealed that 10 of 15 studies in this category were affiliated with the same institutions in Boston, USA [ 7 , 15 , 28 , 37—43 ]. However, prevalence in the two studies from Europe exceeded the American studies by as much as eight times, despite use of virtually identical definitions [ 10 , 35 ]. No obvious circumstances can explain these extreme differences, apart from use of data collection methods, as the study with the highest prevalence used computer-generated signals to detect dosing errors [ 35 ].

Unfortunately, it was only possible to retrieve one valid prevalence of medication errors [ 44 ]. This definition was initially developed for medication error reporting and, therefore, was an obvious choice for studies using reporting systems, which was the case for almost all the studies in this category [ 22 ]. An important drawback to reporting systems is an increased risk of underestimating the occurrence of medication errors due to the reporter's awareness of errors, attitudes towards reporting errors and fear of sanctions [ 45 ].

In addition, reporting systems are by nature denominator free as they do not provide information on the whole population; on the contrary, retrospective fitted denominators, such as time period or admissions, are frequently employed to demonstrate error rates [ 26 ]. Thus, reports of incidence or prevalence in studies using reporting systems should be avoided or interpreted with caution. Unfortunately, this expelled a unique opportunity to compare prevalence in studies using identical definitions.

Surprisingly, only 1 of the 45 definitions restricted medication errors to failures that either result in harm or have the potential to lead to harm [ 27 ]. Contrary to other definitions of medication errors in the present review, this approach relates process and outcome factors within the same definition, which previously has been suggested as minimizing the risk of accepting associations between errors and processes as synonyms for causation [ 46 ].

Moreover, this definition has been tested in an Australian study, in which it proved to be the most robust among other definitions, when evaluated in comparison with different medication error scenarios [ 25 ]. However, due to the design of this study it was not possible to elucidate that a restricted definition would lead to lower occurrences of medication errors compared with more profound definitions [ 15 ]. Finally, definitions that considered a medication error as a deviation between an ordered and administered drug and dose seemed to be more homogeneous with regard to prevalence despite representing different countries and employing different study designs [ 30 , 32—34 , 47 ].

However, these studies predominantly used the same types of denominator opportunities for errors; doses and orders as well as the most sensitive and appropriate data collection methods, e. A possible explanation for this consistency is the clear-cut limitation to deviations, which might appear simpler and be a less subjective approach in determination of medication errors. However, this approach excludes prescribing errors, as prescriptions serve as the gold standard in these definitions.

Hence, the characteristics and prevalence reported here might not reflect the overall occurrence of medication errors. Secondly, the literature search was limited to four major databases and restricted to papers in the English language. It is, therefore, possible that studies that would have met the inclusion criteria, were not indexed by these databases or were published in other languages than English. Third, the groupings we selected were somewhat arbitrary and this might have affected our chances of seeing an effect.

In the present systematic literature review of 45 studies we have confirmed inconsistency in defining medication errors as well as lack of definitions. Most of the definitions were profound, including minor deviations as well as fatal errors, whereas a single definition was restricted to harmful or potentially harmful errors. Most importantly, it appears that definitions of medication errors and methods of detection, rather than being reproducible and reliable methods, are subject to individual researcher's preferences.

Thus, it is obvious that application of a clear-cut definition, standardized terminology and reliable methods will greatly improve the quality and consistency of medication error findings. Efforts to achieve a commonly accepted definition that defines the scope and content is required in future studies. We would like to thank, Prof.

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Close mobile search navigation Article Navigation. Volume Article Contents Abstract. Results of data synthesis. Article Navigation. How are medication errors defined? A systematic literature review of definitions and characteristics M. Lisby , M. Oxford Academic. Cite Cite M. Select Format Select format. Permissions Icon Permissions. Abstract Objective. Figure 1.

Open in new tab Download slide. Table 1 Levels of evidence, Oxford Centre for Evidence-based Medicine and pharmaco-epidemiological study design. Oxford Centre for Evidence-based Medicine. Pharmaco-epidemiological design. Evidence level. Open in new tab.

Table 2 Studies using errors in definition of medication errors. Country year. Definition of medication error. Design evidence level a. Definition medication error. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard medical practice study I.

Google Scholar Crossref. Search ADS. The nature of adverse events in hospitalized patients. Results of the Harvard medical practice study II. Incidence and types of adverse events and negligent care in Utah and Colerado. Google Scholar PubMed. Prescribing errors in hospital inpatients: their incidence and clinical significance.

Medication errors and adverse drug events in an intensive care unit: direct observation approach for detection. Prospective observational study on the incidence of medication errors during simulated resuscitation in a paediatric emergency department. Errors in the medication process: frequency, type, and potential clinical consequences. Classification of terminology in medication errors. Definitions and classification.

Clarifying adverse drug events: a clinician's guide to terminology, documentation and reporting. Medication errors in paediatric care: a systematic review of epidemiology and evaluation of evidence supporting reduction strategy recommendations. Multiplicity of medication safety terms, definitions and functional meanings: when is enough enough? An epistemology of patient safety research: a framework for study design and interpretation. Part 3: end points and measurement.

An observational study of changes to long-term medication after admission to an intensive care unit. Comparison of methods for detecting medication errors in 36 hospitals and skilled-nursing facilities. Using a preprinted order sheet to reduce prescription errors in a pediatric emergency department: a randomized, controlled trial.

Errors associated with applying decision support by suggesting default doses for aminoglycosides. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. The impact of computerized physician order entry on medication error prevention. Prioritizing strategies for preventing medication errors and adverse drug events in pediatric inpatients.

A controlled trial of smart infusion pumps to improve medication safety in critically ill patients. Design: Systematic, critical literature review. Search terms included: nurses, medication incidents or errors, interruptions, disruption, distractions and multitasking. Results: Researchers have responded to the impact of interruptions and distractions on the medication administration by attempting to eliminate them. Despite the introduction of quality improvements, little is known about how nurses manage interruptions and distractions during medication administration or how they learn to do so.

A significant gap in the literature exists in relation to innovative sustainable strategies that assist undergraduate nurses to learn how to safely and confidently manage interruptions in the clinical environment. Conclusions: Study findings highlight the need for further exploration into the way nurses learn to manage interruptions and distractions during medication administration. This is essential given the critical relationship between interruptions and medication error rates.

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Literature review on medication errors Check essay grammar free
Literature review on medication errors Prioritizing strategies for preventing medication errors and adverse drug events in pediatric inpatients. J Nurs Manage. Volume Download citation. Int J Health Res. Quite the contrary, there appears case study research sample be a multiplicity of terms involved in defining the clinical range of medication errors and classifying consequences e.
Literature review on medication errors MEs increase the cost of hospitalization and medical expenses in both developed and developing countries which lead to decrease the quality of healthcare systems [ 12 ]. In pre—post studies and controlled studies, only prevalences of medication errors at baseline or from a control group were presented, whereas no prevalences could be calculated in studies using data from reporting systems [ 26 ]. Any error in the medication process, including ordering, dispensing, transcribing, administering and monitoring, even if the error was intercepted and corrected prior to reaching the patients. Such events may be related to professional practice, health-care products, procedures and systems, including prescribing; order communication; product labelling, literature review on medication errors and nomenclature; case study research sample dispensing; distribution; administration; education; monitoring; and use. Pinilla [ 60 ].
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Rogers, Hwang, Scott, Aiken, and Dinges , in a national survey of nurses using self-report questionnaires, found the risks of making an error were significantly increased when registered nurses RNs work shifts longer than 12 hours, over- time, or more than 40 hours per week. The likelihood of making an error in- creased with longer work hours, and was three times higher when nurses worked shifts lasting Working overtime increased the odds of mak- ing at least one error, regardless of how long the shift was originally scheduled.

Data suggested a trend for increasing risk with longer shifts, and significantly el- evated risk for overtime following a hour shift. The relationship of errors or near errors and work hours and overtime were not affected by age, type of hospital unit, or size of hospital. Moreover, the long and unpredictable hours documented in the Rogers et al. These factors demonstrate Reason's theory , , whereby fatigue and understaffing are recognized as latent conditions.

Skill Mix Latent failures consist of two kinds of situations: those that provoke conditions within the workplace, such as time pressure, understaffing, inadequate equipment, fatigue, and inexperience; and those that create long-lasting weaknesses in the defenses, such as untrustworthy alarms, unworkable procedures, and design and construction deficiencies.

Latent conditions may lie dormant within a system for many years before they are triggered, usually by combining with active failures e. One such latent failure, skill mix, was identified by Blegen, Goode, and Reed in a study of 42 nursing care units in one large ter- tiary care hospital. An inverse relationship was found to exist between hours of care delivered by RNs and unit rates of medication errors after controlling for pa- tient acuity.

The relationship was found to be curvilinear, with decreased rates of medication errors up to the RN proportion of In a subsequent multisite study involving 39 nursing care units in 11 hospitals, Blegen and Vaughn found similar results. A higher RN proportion staff mix was associated with sig- nificantly lower rates of medication administration errors; again the relationship was nonlinear.

The authors suggest several hypotheses for these results: height- ened vigilance by RNs as mix increases, therefore more reporting; more severely ill patients needing more complex medications, increasing opportunity for med- ication error; and units with higher RN proportions having less total personnel than needed for optimal patient care. In an earlier retrospective study utilizing records review, Grillo-Peck and Ris- ner found no significant difference in medication error rates 6 months pre- meanof 7.

The model incorporated the philosophy of primary nursing and put the RN coordinating patient care in partnership with a patient care technician PCT. The PCT assisted the RN by providing more direct care activities, such as hy- giene, monitoring vital Signs and blood glucose level, and changing dressings. This allowed more time for the RN to perform higher-level activities those only performed by the RN , such as patient assessment, patient education, planning and coordination of patient care, and collaborating with physicians.

In this study, RNs were the only caregivers who administered medications. Small sample size and use of only the adult population on one nursing care unit are noted by the authors as limiting the generalizability of the findings. The patient care team model focused on the key role of the RN care manager, an experienced RN with knowledge of unit routine, clinical exper- tise, and established physician relationships. In contrast, Lengacher et al. The PIPC extender assumed delegated basic nursing functions in an effort to decrease time spent by the nurse in indirect care activities and nonclini- cal support services.

Using an error ratio number of medication errors divided by the number of patient days , a significant increase in medication error occurred on the pilot unit as opposed to the control unit when adjusting for patient days. The pilot unit a bed general surgical unit and the control unit bed orthopedic unit were randomly selected. Medication error data were obtained from incident reports over an month period.

RNs were categorized either as case man- agers or case associates, based on individual assessment of knowledge and skill base regardless of formal education. The authors did not specify how medications were administered as a result of differentiated practice. In a related retrospective study. Poster and Pelletier found a statistically significant difference be- tween medication error rates on the nine neuropsychiatric inpatient units using primary versus functional medication administrative systems.

Five units utilized a primary system, in which each nurse administered medications for his or her assigned patients during a given shift. Four units utilized a functional system, in which a medication nurse was designated during each shift.

Only one nurse cited errors in computing as the reason for medication errors involving wrong dosage. A significant inverse relationship was present between worked hours per patient day and medication errors in both cardiac and noncardiac intensive care units ICUs ; however, no significant relationship was found between staffing and medication errors in intermediate care units and medical-surgical units.

These findings "suggest that environments with higher acuity patients and, most likely, greater number and more complex medication regimes per patient are sensitive to staffing alterations" Whitman et al. In summary, research focusing on skill mix demonstrates conflicting reports: Decreased rates of medication errors were reported with increased RN skill mix up to Research on various other partnering and differentiating practice models reported above have also been inconclusive, with some reporting decreased errors while others report an increase.

Researchers from one study suggested that environments with higher acuity patients and more numerous and complex medication regimes are sensitive to staffing alterations, demonstrating Reason's Swiss cheese model where opportunity for error exits in multiple layers see chapter 1 for more about Reason's theory of human error and Swiss cheese model.

As a result of conflicting studies surrounding skill mix, further research is required to determine significance between alterations in staffing patterns and medication administration error. Patient Acuity A special neonatal care unit study Vincer et al. During the study, medication errors occurred over 23, patient days, with relative risk calculated at Drug administration errors The remaining eight groups included physician's order, drug preparation, transcription, medication card, interstitial intravenous line, un- known, other, and equipment.

The two most frequent types of drug administration errors were neglecting to give a medication at the scheduled time Outdated infusion pumps were partially attributed to intravenous regulation problems. When num- bers of medication errors were compared to types of errors, the majority of errors were attributed to dosage errors Increased level of care in this study was found relative to increased incidence of medication error.

This study supports the Whitman et al. The most frequent types of medication administration errors in this study dosage and time suggest time pressures and use of inadequate equipment as causes, deemed by Reason ; as error-provoking latent conditions. Again, multiple opportunities for er- ror are present, increasing the potential for error occurrence. While controlling for patient acuity, staff mix, and hours of nurs- ing care, patient care units with a higher proportion of experienced nurses had lower medication error rates.

Education level was also analyzed; patient care units with more baccalaureate-prepared nurses delivered care similar in quality to those with fewer baccalaureate nurses with one exception. Only one of four effect co- efficients for nursing education was significant, suggesting that units with more baccalaureate-prepared nurses have higher rates of reported error. Although ed- ucational preparation of the nurse appeared to have an insignificant effect on quality of care, nurse experience was found to be significant.

Patient care units that employed a higher proportion of experienced nurses had lower medication error rates. Inexperience demonstrates another error-provoking latent condition according to Reason's ; system theory. Drug Classification and Unit Type Certain types of medications have been reported to be more commonly associ- ated with error. Classen et al. Bates et al. However, Cullen et al.

Certain categories of drugs were, however, more likely to be used in specific units e. In a study conducted on 60 consecutive ICU admissions, Cirotti, Garrick, Tierney, Chesnick, and Brown found that the majority of medication ad- ministration errors were wrong time Most errors 9 of 11 in the pH and electrolyte drug class involved administration of potassium chloride.

And significantly more errors occurred during day shifts 64 errors and 2, opportunities for error than on night shift 38 errors and 2, opportuni- ties for error. This was despite similar opportunities for error, revealing an associ- ation between the number of admissions, discharges, and deaths during day shifts and errors committed. There were no differences in the average number of pa- tients treated during day and night shifts, and comparison of patient classification intensity of care revealed no significant correlation with the number and types of errors committed between the two shifts.

A total of errors 2. The authors speculate that the ICU environment, where nurse to patient ratio is normally , could have influenced the low error rate of 2. Verbal drugs orders by physicians may also have factored into the low error rate, be- cause nurses only accept such orders in extreme cases. In addition, ICU nurses participate in an intensive orientation that stresses safe and accurate medication administration, possibly making them more vigilant.

The data collection period for this study reflected a normal period of activity in the ICU in regard to average patient type, classification, and number of admissions and discharges or deaths. Cullen et al. However, when adjusted for number of drugs ordered since admission or used in the previous 24 hours, no difference in rates existed between ICUs and non-ICUs. Structured interviews used during this study did not confirm that se- rious errors were made by exhausted, fatigued, overworked, excessively stressed individuals working in complex environments with many distractions.

Most in- terviewees were nurses working a normal shift on their home unit with fairly stable teams that enjoyed full staffing, a normal workload, and fairly effective communications. Most obtained 5 to 7 hours of sleep before the event and re- ported only mild work-related stress with little stress outside work. Interviews revealed that most individuals involved in ADEs perceived they were working un- der normal conditions and denied fatigue, stress, or distractions at the time of the error.

Also identified in this study Cullen et al. Duration of injuries was short, and few patients experienced delayed discharges as a result of ADEs. This finding conflicts with results found by Classen et al. Medication errors were also common in pediatric impatient settings Kaushal et al.

Children pose unique challenges during the process of ordering, dispensing, administering, and monitoring medications. Weight-based dosing is necessary for virtually all pediatric drugs, requiring more calculations than for adults. Dispensing also becomes error prone because pharmacists often find it necessary to dilute stock solutions.

In addition, children have more limited reserves than adults with which to buffer errors, and they have fewer communica- tion skills with which to warn clinicians about potential errors or adverse effects they experience Kaushal et al.

Complex environments and medication regimes coupled with increased ac- tivity as demonstrated during day shifts represent latent conditions of time pres- sures, interruptions, and distractions, again layering error potential. Limited use of verbal orders, a nurse-patient ratio, and an orientation stressing safe and ac- curate medication administration are key to limiting error according to Reason's , system theory.

However, the conflicting nature of existing research necessitates further exploration to clarify variable relationships. Pre-Paradigm Shift Reflecting Perceptions of Individual Responsibility Early research through the mids concerning medication errors focused on individual responsibility for error with little acknowledgement of system factor involvement. Individual responsibility was reflected in the research of Fuqua and Stevens who proposed several reasons why medication errors occur.

They categorize their reasons as inadequate knowledge and skill, failure to comply with policy or procedure, failures in communication, and personal experiences. Inade- quate knowledge and skill reflects lack of sound knowledge of the patient's diag- nosis and the purpose of the medication. Failure to comply with policy and pro- cedure includes neglecting to check instructions, failure to check allergies and name bands, failure to monitor a patient after a medication is given, and failure to follow the five rights of medication administration right patient, right drug, right dose, right time, and right route.

Failures in communication include in- correctly reading, hearing, or documenting a medication, including transcription errors due to illegible handwriting; hazardous abbreviations; incorrect decimal points; or unclear verbal orders.

Personal experiences refer to the nurse's work ex- perience coupled with distractions, interruptions, consecutive hours worked and work schedule. She found the major perceived causes were medications received late from the phar- macy Respondents employed more than 1 year and those with more than 1 year of nursing experience reported making significantly fewer medication errors.

Fewer than one-third of the nurses perceived system problems A greater number of errors made by less experienced nurses along with the citing of frequent interruptions as a perceived cause of medication errors concur with the work of Euqua and Stevens As reported by Euqua and Stevens , inadequate knowledge and skill, failure to comply with policy or procedure, and failures in communica- tion demonstrate active failures Reason, ; Reason, and reflect the individual responsibility associated with medication error.

Personal experience is the only mentioned category that suggests medication errors occur as a result of latent conditions. Walter's research reflects heavier association with latent conditions e. Walter's research notes the begin- nings of a paradigm shift away from individual responsibility toward a system approach. Paradigm Shift Reflecting Perceptions of System Responsibility During the past decade, medication error research has shifted in emphasis to- ward identification of system problems inherent in error occurrence.

This shift has been gradual and remains ongoing. Although elements of individual respon- sibility remain, system factors are receiving increased attention. The following studies demonstrate the gradual and ongoing shift in perception from individual responsibility to system responsibility. These scores and relative rankings of the scores were compared across hospital type rural, urban , unit type medical, obstetrics, intensive care, etc.

Few differences were found with the exception of position; managers were more likely to perceive individual factors as reasons for medication administration error oc- currence than were staff nurses. Although the mean score difference were small, staff nurses were more likely to view physician, pharmacist, and system factors as reasons for medication administration errors while managers were more likely to see physician and individual factors as causes of errors.

The authors state: Since managers may not be involved in direct patient care they only know what the individual nurse did or did not do , and may be unaware of the nature of the patient care environment when the error occurred.

The staff nurse, functioning in a busy, complex environment realizes the many demands placed on his or her time and attention. Therefore, staff nurses view extemal factors as impinging on their abil- ity to pass medications correctly but may lack an understanding of their individual contribution to errors Wakefield et al, , p. A Likert scale was used, where 6 indicates strongly agree.

This sur- vey examined nurses' perceptions of medication errors through randomly selected nurses in multiple settings medical-surgical, critical care, and maternal child health practicing in 16 Southern California acute care hospitals. The survey asked nurses to rank a list of medication error causes from 1 to 10, with 1 indicating the most frequent cause. The sample drawn from health care union nurses and the predetermined list of medication error causes may limit gen- eralizability of study findings.

In a pediatric-focused study n — , adult care nurses, 57 pediatric nurses conducted by Stratton, Blegen, Pepper, and Vaughn , medication error rates computed from documented occurrence reports were found to he Nurse participants were asked to select the two most important reasons medication errors occur from a list of 14 potential reasons, excluding transcription and physician handwriting errors. Distractions and interruptions during medication administration topped the list followed by inadequate staffing and inadequate RN to patient ratios, illegibly written medication orders, incorrect dosage calculations, and similar drug names and packaging.

By contrast, Leape et al. In written logs, nurses expressed high patient acu- ity and heavy workloads as reasons for untimely medication administration. One nurse reported giving a medication 90 minutes late to one patient and 40 minutes late to a second patient due to caring for an unstable third patient. Other reasons for untimely medication administration included confusion, chaos, and getting side tracked. Wrong dosage comprised A nurse reported being interrupted by the charge RN twice, needing to help a circulat- ing nurse, and needing to answer a ringing telephone all while trying to calculate a pediatric dose of liquid acetaminophen.

Communication among health care providers was also cited where wrong information was given to the RN concern- ing a blood sugar level, consequently leading to the patient receiving an incor- rect dose of insulin. Of the remaining categories of medication errors, In summary, the studies reviewed reflect the paradigm shift toward system responsibility, and numerous causes for medication errors were cited by nurses who reinforced the complexity of the medication administration process, which involves many disciplines and individuals and is carried out in a complex envi- ronment.

Most frequently cited causes were interruptions and distractions, nurse fatigue and exhaustion, RN forgetfulness and business, high acuity and heavy workloads, inadequate staffing, confusion and chaos, medications arriving late from the pharmacy, and illegible physician orders.

Managers were more likely to perceive individual factors as reasons for error, while staff nurses perceive system, physician, and pharmacy factors as reasons for error. Although the majority of the above-mentioned medication error causes reflect latent conditions with the exception of RN forgetfulness , discrepancy exists between managers and staff nurses regarding individual responsibility active failures versus system problems latent conditions , suggesting the continued presence of pre-paradigm shift per- ceptions among those in management positions and the ongoing nature of the paradigm shift.

Research has linked medica- tion administration error to increased workload, extended work hours, level of care, understaffing, inexperience, skill mix, work shift, and unit type. This poses increased threats to patient safety, yet results are inconclusive because many study findings are contradictory.

Prevention of medication administration errors relies on adequate and accurate information concerning their occurrence. Using exist- ing reports to identify incidence of medication administration error and potential causes is difficult, given the under-reporting and the questions concerning validity and reliability of the data.

Reporting systems rely on nurses to recognize and report errors; however, many errors are unrecognized, and reporting behaviors vary widely among nurses depending on their perception of what constitutes error, fear, guilt, and the bur- densome nature of reporting. Incomplete records limit potential to learn from errors and to improve quality and safety of nursing care Meurier, Re- search and quality improvement projects are hampered, along with loss of abil- ity for hospitals to diagnose their systems and prevent future errors.

As reported by Ebright, Patterson, and Ren- der , fundamental to the success of decreasing adverse events is a change in understanding of how errors occur and the relinquishment of focus on individuals as the source of the problem.

Error management is based on understanding the nature and extent of the adverse event and changing the conditions that are re- sponsible for its occurrence Helmreich, According to Bates et al. Identifying causal or con- tributing factors to potential medication administration error will stimulate dis- cussion and implementation of interventions to reduce error occurrence. And identifying the critical thinking patterns nurses employ to catch potential er- rors or near misses will provide data important to nursing education in teaching the administration of medications.

Central to understanding is a reporting sys- tem devoid of the blame and shame currently haunting nurses in spite of recent trends that shift responsibility toward systems and away from individuals. Em- phasis should he placed on data collection and the importance of analyzing errors in order to diagnose system problems Institute of Medicine, As long as fear, shame, and guilt are associated with error admission, nurses will continue to underreport.

Subsequent literature reflects a more systems-based ap- proach latent conditions , where defects in the system are deemed culprits of error as evidenced by implementation of barriers and safeguards technology, sys- tem redesign in an attempt to change the conditions under which humans work Reason, ; Reason, Both active failures and latent conditions established in Reason's theory re- main prevalent in current literature, where active failures often display them- selves in the form of incorrect drug calculations as with weight-based dosing, lack of individual knowledge, and failure to follow established protocol.

Al- though medication error research has shifted in emphasis toward identification of system problems inherent in error occurrence, the shift has been gradual and remains ongoing. No one force emerges as a clear antecedent to medication ad- ministration error, reinforcing the complexity of medication administration in- volving many individuals, conducted in a complex environment, and frequently the result of several causes Wakefield et al.

As a result, antecedents to medication administration errors remain elusive, demonstrating many forms in many contexts and making a clear remedy unattainable at present. Further re- search and replication of existing studies are necessary to ascertain incidence and antecedents with emphasis placed on more dependable reporting measures in which nurses are not threatened by reprisal. Nursing focus groups could in- form research concerning antecedents of medication administration errors as well as reasons why nurses do not report error.

Use of focus groups may also provide new insights given the "think tank" format and brainstorming discourse. Until more accurate reporting is achieved, researchers are only speculating using limited data. Administration and management should be surveyed to determine the per- ceptions of medication error regarding the paradigm shift from individual re- sponsibility to system factors. Degree of shift may require further education regarding system factors influencing error.

Implementation of technology e. What kind of system workarounds have evolved since techno- logy implementation? What kinds of errors occur as a result of workarounds? Can workarounds be prevented by upgrades and patches to current technology? Also lacking in the literature are qualitative studies elucidating the critical thinking process nurses use in discovering and preventing near miss medication administration errors.

What causes nurses to question medication orders, how the medication dosage was supplied, or administration of a particular medication? Research of this type would identify themes and patterns, thereby allowing future educational opportunities that may lead to decreased medication errors. Medication administration errors may never be totally eradicated due to the propensity for human error and system failure, but much can be improved from the current situation.

With continued research examining errors and potential errors coupled with improved reporting systems, diagnosis of system frailties and dormant antecedents is possible, thereby improving health care, increasing pa- tient safety, and lowering health care costs. Medication errors are one of the most common causes of avoidable harm to patients Joint Commission on Accredi- tation of Healthcare Organizations, Safety is a moral issue" Leape, Making healthcare safer: A critical arudysis of patient safety practices.

C , Scott, L. The prevalence and nature of errors and near errors reported by hospital staff nurses. Applied Nursing Research, 17 4 , Design: Systematic, critical literature review. Search terms included: nurses, medication incidents or errors, interruptions, disruption, distractions and multitasking. Results: Researchers have responded to the impact of interruptions and distractions on the medication administration by attempting to eliminate them.

Despite the introduction of quality improvements, little is known about how nurses manage interruptions and distractions during medication administration or how they learn to do so. A significant gap in the literature exists in relation to innovative sustainable strategies that assist undergraduate nurses to learn how to safely and confidently manage interruptions in the clinical environment.

Conclusions: Study findings highlight the need for further exploration into the way nurses learn to manage interruptions and distractions during medication administration. This is essential given the critical relationship between interruptions and medication error rates.

QUALITATIVE RESEARCH DISSERTATION OUTLINE

Hence, the characteristics and prevalence reported here might not reflect the overall occurrence of medication errors. Secondly, the literature search was limited to four major databases and restricted to papers in the English language. It is, therefore, possible that studies that would have met the inclusion criteria, were not indexed by these databases or were published in other languages than English. Third, the groupings we selected were somewhat arbitrary and this might have affected our chances of seeing an effect.

In the present systematic literature review of 45 studies we have confirmed inconsistency in defining medication errors as well as lack of definitions. Most of the definitions were profound, including minor deviations as well as fatal errors, whereas a single definition was restricted to harmful or potentially harmful errors.

Most importantly, it appears that definitions of medication errors and methods of detection, rather than being reproducible and reliable methods, are subject to individual researcher's preferences. Thus, it is obvious that application of a clear-cut definition, standardized terminology and reliable methods will greatly improve the quality and consistency of medication error findings.

Efforts to achieve a commonly accepted definition that defines the scope and content is required in future studies. We would like to thank, Prof. Google Scholar. Oxford University Press is a department of the University of Oxford.

It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search. Search Menu. Skip Nav Destination Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Abstract. Results of data synthesis.

Article Navigation. How are medication errors defined? A systematic literature review of definitions and characteristics M. Lisby , M. Oxford Academic. Cite Cite M. Select Format Select format. Permissions Icon Permissions. Abstract Objective. Figure 1. Open in new tab Download slide. Table 1 Levels of evidence, Oxford Centre for Evidence-based Medicine and pharmaco-epidemiological study design. Oxford Centre for Evidence-based Medicine. Pharmaco-epidemiological design. Evidence level. Open in new tab.

Table 2 Studies using errors in definition of medication errors. Country year. Definition of medication error. Design evidence level a. Definition medication error. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard medical practice study I. Google Scholar Crossref. Search ADS. The nature of adverse events in hospitalized patients. Results of the Harvard medical practice study II.

Incidence and types of adverse events and negligent care in Utah and Colerado. Google Scholar PubMed. Prescribing errors in hospital inpatients: their incidence and clinical significance. Medication errors and adverse drug events in an intensive care unit: direct observation approach for detection. Prospective observational study on the incidence of medication errors during simulated resuscitation in a paediatric emergency department.

Errors in the medication process: frequency, type, and potential clinical consequences. Classification of terminology in medication errors. Definitions and classification. Clarifying adverse drug events: a clinician's guide to terminology, documentation and reporting. Medication errors in paediatric care: a systematic review of epidemiology and evaluation of evidence supporting reduction strategy recommendations. Multiplicity of medication safety terms, definitions and functional meanings: when is enough enough?

An epistemology of patient safety research: a framework for study design and interpretation. Part 3: end points and measurement. An observational study of changes to long-term medication after admission to an intensive care unit. Comparison of methods for detecting medication errors in 36 hospitals and skilled-nursing facilities. Using a preprinted order sheet to reduce prescription errors in a pediatric emergency department: a randomized, controlled trial. Errors associated with applying decision support by suggesting default doses for aminoglycosides.

Incidence of adverse drug events and potential adverse drug events. Implications for prevention. The impact of computerized physician order entry on medication error prevention. Prioritizing strategies for preventing medication errors and adverse drug events in pediatric inpatients. A controlled trial of smart infusion pumps to improve medication safety in critically ill patients. Incidence and preventability of adverse drug events among older persons in the ambulatory setting.

Prescribing medication errors in hospitalised patients: a prospective study. Assessing medication prescribing errors in pediatric intensive care units. The effect of computerized physician order entry on medication errors and adverse drug events in pediatric inpatients.

Indicators to improve clinical quality across an integrated health care system. The pharmacist-physician relationship in the detection of ambulatory medication errors. Use of chart and record reviews to detect medication errors in a state psychiatric hospital.

What is the measure of a safe hospital? Medication errors missed by risk management, clinical staff, and surveyors. Potential risks and prevention, part 2: drug-induced permanent disabilities. Case—control analysis of the financial cost of medication errors in hospitalized patients. Occurrence of dispensing errors and efforts to reduce medication errors at the Central Arkansas Veteran's Healthcare System.

The use of data mining tools in identifying medication error near misses and adverse drug events. Toward development of a computer-based methodology for evaluating and reducing medication administration errors. Characteristics of medication errors made by students during the administration phase: a descriptive study.

Potential benefits and problems with computerized prescriber order entry: analysis of a voluntary medication error-reporting database. Drug error in anaesthetic practice: a review of reports from the Australian Incident Monitoring Study database. Frequency and type of errors and near errors reported by critical care nurses. Patient safety during medication administration: the influence of organizational and individual variables on unsafe work practices and medication errors.

Nature and causes of clinically significant medication errors in a tertiary care hospital. Impact of computerized physician order entry on clinical practice in a newborn intensive care unit. Clinical inference by nursing students and experienced nurses concerning harmful outcomes occurring after medication errors: a comparative study. Issue Section:. Download all slides. Supplementary data. AddSuppFiles-2 - ppt file. AddSuppFiles-1 - jpg file.

View Metrics. Email alerts Article activity alert. Advance article alerts. New issue alert. In progress issue alert. Receive exclusive offers and updates from Oxford Academic. More on this topic Hospital medication errors: a cross-sectional study. Bedside medication delivery programs: suggestions for systematic evaluation and reporting. Anticoagulant medication errors in hospitals and primary care: a cross-sectional study. The impact of work-related stress on medication errors in Eastern Region Saudi Arabia.

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Citing articles via Web of Science A Systematic Review. Factors associated with self-reported medical errors among healthcare workers: a cross-sectional study from Oman. Bates [ 38 ]. Error in the process of ordering, dispensing or administering medication, regardless of whether an injury occurred or whether the potential for injury was present. Bates [ 15 ]. Bates [ 37 ]. Cimino [ 48 ]. Any error large or small, at any point in the medication system from the time the drug is ordered until the patient receives it.

An error may or may not result in an ADE. Eslami [ 35 ]. Any error in the medication process that involves the prescribing, dispensing or administration of medication. A medication error may or may not result in patient harm; however, it is considered preventable.

Fortesque [ 39 ]. Gurwitz [ 43 ]. Gandhi [ 28 ]. Gandhi [ 40 ]. Any error in the medication process, including ordering, dispensing, transcribing, administering and monitoring, even if the error was intercepted and corrected prior to reaching the patients.

Kaushal [ 7 ]. King [ 49 ]. Any event involving medication prescription, dispensing, administration or monitoring of medication irrespective of outcome. Kopp [ 8 ]. An error occurring during the medication use process, regardless of whether an injury occurred or the potential for injury was present. Lisby [ 10 ]. Errors in the medication process: ordering, transcription, dispensing, administration and discharge. Rothschild [ 41 ]. Walsh [ 42 ].

Bacic-Vrca [ 44 ]. Ballard [ 50 ]. Brown [ 51 ]. Grasso [ 52 ]. Grasso [ 53 ]. A significant gap in the literature exists in relation to innovative sustainable strategies that assist undergraduate nurses to learn how to safely and confidently manage interruptions in the clinical environment. Conclusions: Study findings highlight the need for further exploration into the way nurses learn to manage interruptions and distractions during medication administration.

This is essential given the critical relationship between interruptions and medication error rates. Relevance to clinical practice: Better preparing nurses to safely fulfil the task of medication administration in the clinical environment, with increased confidence in the face of interruptions, could lead to a reduction in errors and concomitant improvements to patient safety.

Keywords: disruption; distractions; interruptions; medication errors; multitasking; nurses. Abstract Aims and objectives: The purpose of this review was to explore what is known about interruptions and distractions on medication administration in the context of undergraduate nurse education. Publication types Review.

Errors on medication literature review write good dbq essay ap

Medication Errors In Hospitals ( lecture 3 Master clinical \u0026 Diploma) Prof. Sahar Hegazy

Most obtained 5 to 7 in an intensive orientation that stresses safe and accurate medication focused on individual responsibility for. RNs were categorized either as studies surrounding skill mix, further associates, based on individual assessment significance between alterations in staffing regardless of formal education. The two most frequent types basic nursing functions in an neglecting to give a medication 24 hours, no difference in higher rates of reported error. Although medication errors are multidisciplinary 60 consecutive ICU admissions, Cirotti, along the health care continuum times higher when nurses worked intensive care units ICUs ; the odds of mak- ing have been attributed to physician errors in intermediate care units and medical-surgical units. This sur- vey examined nurses' perceptions of medication errors through randomly selected nurses in multiple settings medical-surgical, critical care, and maternal child health practicing in event report- ing, incident reports. Of the remaining categories of medication errors, In summary, the to check instructions, failure to complex medication regimes are sensitive to staffing case study research sample, demonstrating Reason's after a medication is given, and failure to follow the medication administration process, which involves more about Reason's theory of human error and Swiss cheese. Pape reported that most medication interruptions and distractions, nurse fatigue which to buffer errors, and they have fewer communica- tion skills with literature review on medication errors to warn sentinel events leading to loss reported making significantly fewer medication. Byone out of nurse's work ex- perience coupled business plan marketing plan nurses literature review on medication errors care similar admissions, discharges, and deaths during. In summary, research focusing on Dingesin a national those that provoke conditions within questionnaires, found the risks of failure to monitor a patient and inexperience; and those that create long-lasting weaknesses in the five rights of medication administration unworkable procedures, esl course work ghostwriters services design and. They categorize their reasons as within a system for many the mids concerning medication errors than on night shift 38 error with little acknowledgement of.

Interruptions to the medication administration process have been identified as a leading cause of medication error. Literature recognises that. Medication-related errors: a literature review of incidence and antecedents. Annu Rev Nurs Res. ; Authors. However, medication administration errors (MAEs) during this process have been documented and thought to be preventable. In pediatric medicine.