Orientador: Anselmo Gomes de Oliveira / Banca: Maria Jacira Silva Simões / Banca: Julieta Ueta / Resumo: A atenção farmacêutica é uma prática onde o farmacêutico tem a responsabilidade para com o paciente quanto às suas necessidades farmacoterapêuticas, garantindo a eficácia do tratamento e a segurança da farmacoterapia utilizando como instrumento o medicamento. A farmácia hospitalar é um órgão de abrangência assistencial técnico-científico e administrativo onde uma de suas principais funções é estabelecer um sistema racional de distribuição de medicamentos. O objetivo deste estudo foi analisar o sistema de distribuição de medicamentos de uma farmácia hospitalar de um hospital oncológico, bem como identificar os fatores que levam às falhas no processo de distribuição de medicamento. A pesquisa foi realizada na farmácia central de um Hospital Oncológico do Estado de São Paulo em 2007, após aprovação do Comitê de Ética em Pesquisa. A amostra constituiu-se de 3 (12%) farmacêuticos 3 (12%) assistentes de farmácia e 19 (76%) atendentes de farmácia. Todos os profissionais foram consultados quanto a sua disposição para participar do estudo e a seguir, os mesmos assinaram o temo de consentimento livre e esclarecido. Os dados coletados nos mostram que o sistema de distribuição do referido hospital é o sistema por dose individualizada diferenciada, com prescrição eletrônica. Os resultados das observações realizadas durante os 7 dias, indicam o ambiente como principal problema na distribuição de medicamentos (44,77%), pois o local é impróprio, com vários profissionais desenvolvendo atividades diferentes e interrupções freqüentes. Pela observação do ambiente foi possível demonstrar através de fluxogramas todas as ações desenvolvidas pelos profissionais da farmácia desde o momento da chegada da prescrição eletrônica até a entrega dos medicamentos à equipe de enfermagem. As entrevistas... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The pharmaceutical care is a practice where the pharmacist has the responsibility in relation to and with the patient regarding their pharmacotherapeutic needs, guaranteeing the treatment efficiency as well as the pharmacotherapy safety having as its instrument the medicine. The hospital pharmacy is an administrative technical-scientific organ where its main function is to establish a rational system of medicine distribution. The aim of this study was to analyze the medicine distribution system in a hospital pharmacy from an oncologic hospital as well as to identify the factors that lead us to failures related to the medicine distribution process. The survey took place at the central pharmacy from an oncologic hospital in the state of São Paulo after approval of the Committee of the Ethics in Research. The sample includes 3 (12%) pharmacists, 3 (12%) pharmacy assistants and 19 (76%) pharmacy attendants. All the professionals were asked about their willingness to participate in the survey and afterwards they signed on the "Free Will Participation Agreement". The collected data show us that the distribution system from the above mentioned hospital is the individually differential dose system, with electronic prescription. The results based on the 7 days observation show the environment as the main problem in the medicine distribution (44.77%) once the place is improper and have several professionals performing different activities as well as frequent interruptions. From the environment observation was possible to demonstrate, through the fluxograms, all the actions performed by the pharmacy professionals from the electronic prescription's arrival until the medicine delivery to the nursing team. The interviews with the professionals show us that the most frequent errors were related to the medicine dispensing (28.05%) and to the medical... (Complete abstract click electronic access below) / Mestre

Introdução. A terapia medicamentosa é uma intervenção terapêutica realizada com a finalidade de reduzir sofrimento, promover a cura e melhorar a saúde e qualidade de vida, entretanto, não é isenta de riscos. A ocorrência de erros de medicação é comum nas instituições hospitalares e pode afetar a segurança do paciente. A prevenção de erros de medicação tem sido reconhecida como uma prioridade para os serviços de saúde, visto que, esses eventos acarretam repercussões assistenciais, econômicas e sociais e são considerados crescentes problemas de saúde pública. Objetivo. Analisar a literatura sobre erros de prescrição de medicamentos ocorridos em pacientes adultos hospitalizados em unidades de clínica médica e cirúrgica. Método. Pesquisou-se nas bases de dados Medline/PubMed, IPA, Lilacs, Embase, Web of Science e Scopus para seleção de estudos com dados primários publicados em português, inglês e espanhol, entre janeiro de 1999 e dezembro de 2009. Foi utilizada como estratégia de busca os seguintes termos, medication error(s), medication order(s), prescribing error(s), prescription error(s), prescrição, hospital(s), medication system, inpatient(s), adult(s) e os resultados foram filtrados utilizando-se a expressão and. Resultados. Foram selecionadas 51 publicações. A análise revelou que 71% dos artigos não utilizaram nenhuma definição para determinar erro de prescrição, sendo que a definição proposta por DEAN e col. (2000) foi verificada em 22% das publicações. Diversos métodos de coleta de dados foram utilizados, entretanto, a revisão de prescrição/prontuário foi a técnica mais utilizada (51%) e o acompanhamento prospectivo foi empregado em 72% dos estudos. O farmacêutico foi o principal profissional envolvido na coleta de dados, em 41% das publicações e a prescrição manual foi o tipo de prescrição mais analisada, em 39% dos estudos. Os erros de dosagem (frequência, dose e omissão), erros administrativos (ilegibilidade, rasura e prescrição incompleta) e erros terapêuticos (interação medicamentosa, seleção de medicamento) foram considerados os tipos mais comuns de erros de prescrição. Observou-se que os erros de prescrição com gravidade leve e moderada apresentaram expressiva ocorrência, apesar da falta de uma padronização nas escalas de gravidade entre os estudos. A frequência de erros de prescrição variou de 1% a 62% por prescrição; 2,1% a 66,1% por medicamentos prescritos e 0,25 a 2,72 erros por 100 pacientes-dia. O denominador número de prescrições foi o mais utilizado em 41% dos artigos. As principais classes de medicamentos envolvidas foram cardiovasculares, antimicrobianos, analgésicos, psicoativos, gastrointestinais e respiratórios. Múltiplas causas foram associadas a erros de prescrição verificadas em 31% dos estudos, incluindo lapsos de memória e deslizes, excesso de trabalho, falta de comunicação, conhecimento inadequado sobre medicamento. A implantação de prescrição eletrônica com suporte de decisão clínica e introdução de farmacêutico clínico foram as principais estratégias para redução dos erros destacadas em 47% e 27% dos estudos analisados, respectivamente. Conclusão. A literatura apresenta uma diversidade de definições e métodos para detecção de erros de prescrição, o que pode influenciar na variabilidade das taxas de ocorrência de erros de prescrição. Não foi observada diferença na frequência de erro em relação ao tipo de prescrição (manual ou eletrônica). Apesar de algumas publicações referirem que erros de prescrição são os tipos mais graves que ocorrem com a utilização de medicamentos, observou-se nesta revisão, que os erros de gravidade leve e moderada foram relatados com maior frequência. Como os erros de prescrição estão associados a múltiplas causas, faz-se necessária a implantação de intervenções multifatoriais nas diversas etapas do sistema de uso de medicamentos para ajudar na prevenção ou minimização do impacto dos erros. / Introduction. Drug therapy is a therapeutic intervention performed in order to reduce suffering, promote healing and improve health and quality of life, however, is not without risks. The occurrence of medication errors in hospitals is common and can affect patient safety. Prevention of medication errors has been recognized as a priority for health services, since these events cause important impact in terms of hospital stay, social factors and financial costs and is considered public health issue. Objective. Analyze the literature on prescribing errors in adult patients hospitalized in a medical and surgery units. Method. Medline/PubMed, IPA, Lilacs, Embase, Scopus and Web of Science were searched to select studies using primary data published in Portuguese, English and Spanish between January and December 2009. The following terms were used as a strategy to search: \"medication error (s)\", \"medication order (s)\", \"prescribing error (s)\", \"prescription error (s)\", \"prescription\", \"hospital (s ) \",\" medication system; \"inpatient (s), \" adult (s)\" and the results were filtered using the expression \"and\". Results. In total, 51 publications were selected. The analysis revealed that 71% of articles did not use any setting to determine prescribing error, and the definition proposed by Dean et al. (2000) was detected in 22% of publications. Several methods of data collection were used, however, review of prescription or medical record is the most widely used technique (51%) and prospective monitoring was used in 72% of studies. The pharmacist was the primary professional involved in data collection in 41% of publications and prescription manual was the most studied type of prescription in 39% of studies. The dosage errors (frequency, dosage and omission), administrative errors (illegible and incomplete prescription) and therapeutic errors (drug-drug interaction, indication) were considered the most common types of prescription errors. It was observed that the prescribing errors of mild to moderate severity, showed a significant occurrence, despite the lack of standardization in the scales of severity among the studies. The frequency of prescription errors ranged from 1% to 62% per prescription, 2.1% to 66.1% for prescription drugs and from 0.25 to 2.72 errors per 100 patient-days. The denominator number of prescriptions was the most used in 41% of articles. The main drug classes involved were cardiovascular, antibiotics, analgesics, psychoactive drugs, gastrointestinal and respiratory. Multiple causes associated with prescription errors were found in 31% of studies, including memory lapses and slips, overwork, lack of communication, inadequate knowledge about medicine. The implementation of electronic prescribing with clinical decision support and introduction of clinical pharmacist were the main strategies for reducing errors highlighted in 47% and 27% of the studies analyzed, respectively. Conclusion. The literature shows a variety of definitions and methods for detecting prescription errors, which may influence the variability of rates of occurrence of prescription errors. No difference was observed in the frequency error in the type of prescription (manual or electronic). Although some publications refer to prescription errors are the most serious types that occur with medication use, it was observed in this review, that errors of mild and moderate severity were reported more often. Like all prescription errors are associated with multiple causes, it is necessary to implement a multifactorial interventions at different stages of the system of drug use to help prevent or minimize the impact of errors.

Eventos Adversos (EA) são recorrentes nas instituições de saúde e incluem os erros de administração de medicamentos, que podem acontecer nas mais diversas fases do processo dessa administração, da prescrição ao monitoramento do paciente. Atualmente, busca-se pela diminuição de danos desnecessários a um nível mínimo dentro dos limites aceitáveis por meio de ferramentas tecnológicas. Frente ao exposto objetivou-se buscar e analisar as evidências científicas, disponíveis na literatura nacional e internacional, a respeito do uso da tecnologia na segurança dos pacientes hospitalizados, considerando a administração de medicamentos. Utilizou-se a Prática Baseada em Evidências (PBE) como referencial teórico para o presente estudo. Realizou-se a Revisão Integrativa da literatura nas bases de dados CINAHL, LILACS e MEDLINE; a questão norteadora da pesquisa foi: Quais intervenções que utilizam tecnologia têm sido empregadas aos pacientes hospitalizados com o intuito de aumentar a segurança, no que diz respeito a administração de medicamentos? Totalizou-se 10 estudos, publicados no período de janeiro de 2010 a dezembro de 2014, que atendiam aos critérios de inclusão. Após a análise dos dados foi possível identificar que o uso da tecnologia na saúde envolveu: Bomba de Infusão \"Inteligente\"; Sistema de Alertas e Ferramentas de Apoio à Decisão Clínica; Código de Barras e Sistema Eletrônico de Registro de Medicamentos; Prescrição Médica Eletrônica e Bases de Dados Computadorizada. Verificou-se que a segurança do paciente, nos estudos em questão, foi incrementada com a utilização de uma ou mais ferramentas tecnológicas, resultando em diminuição dos erros de administração de medicamentos e favorecendo a segurança aos pacientes / Adverse Events (AE) are recurrent in health institutions and include medication administration errors that can occur in several stages of the process of this administration, since the prescription until the patient monitoring. Currently, they seek the reduction of unnecessary damage to a minimum within acceptable limits through technological tools .Based on this, the objective was to seek and analyze the scientific evidence available in the national and international literature regarding the use of technology in the safety of hospitalized patients considering drug administration. The Evidence-Based Practice (EBP) was used as the theoretical framework for this study. An Integrative Literature Review was performed in CINAHL, LILACS and MEDLINE databases; the guiding research question was: What interventions using technology have been employed to hospitalized patients in order to increase security, as regards the administration of medication? It amounted to 10 studies published from January 2010 to December 2014, which matched to the inclusion criteria. After analyzing the data it was observed that the use of health technology involved: Smart Pump; System Alerts and Clinical Decision Support Tools; Bar Code and Electronic System for Drug Registration; Computerized Physician Order Entry and Computerized Databases. It was found that the safety of the patient, in these studies concerned, was increased with the use of one or more technological tools, resulting in decreased drug administration errors and favoring the safety of the patient

Objetivos: Um dos objetivos deste estudo é avaliar as intervenções farmacêuticas realizadas durante o primeiro ano de atuação de farmacêutico junto a equipe multidisciplinar de uma unidade de terapia intensiva (UTI) de hospital de pronto-socorro, público, localizado em Porto Alegre, RS. O estudo se propôs, ainda, a estabelecer uma metodologia para a priorização do cuidado farmacêutico aos pacientes críticos desse hospital. Métodos: Foi realizado um estudo transversal retrospectivo para avaliar as intervenções farmacêuticas no período de maio de 2013 a abril de 2014, a partir de um banco de dados do Serviço de Farmácia. Para estabelecer uma ordem de prioridade para o acompanhamento farmacoterapêutico foi avaliada, prospectivamente, a complexidade da farmacoterapia dos pacientes, através de uma ferramenta chamada Índice de Complexidade da Farmacoterapia adaptado para paciente crítico (ICFT PC), verificando seu grau de associação com o Escore Fisiológico Agudo Simplificado (SAPS3), utilizado como índice prognóstico pela equipe médica. Resultados: No período avaliado retrospectivamente, 426 pacientes internaram na UTI, sendo que 70,6% deles (301) tiveram pelo menos uma intervenção do farmacêutico na sua terapia medicamentosa. Das 602 intervenções realizadas, 53,5% foram relativas à situações qualificadas como erro de medicação. 77,7% do total de intervenções realizadas foram aceitas, sendo o percentual de aceitação superior para as intervenções realizadas devido à erros de medicação (83,2%). Com relação à complexidade da farmacoterapia, 160 pacientes foram avaliados, dos quais 57% eram homens. O ICFT PC dos pacientes variou de 77 a 499, sendo a mediana igual a 164,5. A correlação entre o SAPS3 e o ICFT PC foi de 0,204. Conclusões: O acompanhamento farmacoterapêutico de pacientes críticos permite não apenas a detecção e correção de potenciais erros de medicação, como também a otimização dos resultados terapêuticos e o uso racional de medicamentos. A utilização de uma metodologia para organização deste cuidado farmacêutico e priorização do atendimento à pacientes com maior risco associado à complexidade da farmacoterapia é uma maneira de proporcionar uma assistência mais efetiva, segura e de qualidade aos pacientes do Sistema Único de Saúde. / Objectives: One of the goals of this study is evaluating pharmaceutical interventions done during the first year of pharmaceutical action together with a multidisciplinary team on an intensive care unit (ICU) inside of a public emergency hospital, located in Porto Alegre, Rio Grande do Sul, Brazil. This study is also proposing to establish a methodology to prioritize the pharmaceutical care for critical patients in that hospital. Methods: It was done a retrospective transversal study to evaluate pharmaceutical interventions from May, 2013 to April, 2014, based on a database offered by the Pharmacy Service. To establish a priority order for the pharmacist monitoring, the complexity of patient’s pharmacotherapy was valued, prospectively, through a tool called Pharmacotherapy Complexity Index, which was adapted for critical patients (Medication Regimen Complexity Index for critical patient – MRCI CP). Thus it was possible to verify its level of association with Simplified Acute Physiologic Score (SAPS3) that is used as prognostic index by medical team. Results: On the period evaluated, 426 patients were hospitalized at ICU, 70.6% of them (301) needed at least one pharmaceutical intervention on their drug therapy. Out of the 602 completed interventions, 53.5% were related to situations of medication error. 77.7% of the interventions were accepted; the acceptance percentage was higher for interventions that were done due to medication errors (83.2%). In relation to complexity of pharmacotherapy, 160 patients were evaluated and 57% of them were men. The patients MRCI CP had a range of 77 to 499, being the median 164.5. The correlation between SAPS3 and MRCI CP was 0.204. Conclusions: The pharmacist monitoring of critical patients allows detection and correction of potential medication errors, besides optimization of therapeutic results and rational use of medicines. The use of a methodology to organize this pharmaceutical care and to prioritize the treatment of patients with increased risk associated to complexity of pharmacotherapy is a way of supply an effective, secure and qualified assistance for patients of Unique Health System.

BACKGROUND: Parent medication errors are exceedingly common, with one child experiencing an outpatient medication error every 8 minutes. In a previous randomized controlled trial where the intervention was carried out under ideal conditions, we examined the efficacy of a pictographic, health literacy-informed medication instruction sheet-based intervention (HELPix) in reducing parent dosing errors. While our intervention was efficacious in reducing errors, reproducing these results in a real world setting, is necessary to examine the true effectiveness of HELPix. OBJECTIVES: 1) To examine the impact of HELPix implementation on parent medication dosing errors. 2) To assess the effect of HELPix implementation on provider use of medication counseling strategies. DESIGN/METHODS: A pre-implementation/post-implementation study design was used in 2 pediatric Emergency Departments (EDs) in New York City, one with planned implementation of the HELPix intervention (HELPix site) and the other a control site within the same hospital network. Subject inclusion criteria included: 1) English or Spanish-speaking parent, 2) child <9 years old, child prescribed a short course (≤14 days) daily liquid medicine, and 3) parent present with the child in the emergency department and received medication counseling. Parents were recruited over the phone; those who enrolled completed a phone interview along with a follow-up in-person assessment (median time to follow-up=15 days). ED providers (residents, fellows, attendings) were also recruited. The HELPix intervention consists of: 1) provider provision of patient- and medicine-specific pictographic instruction sheets, 2) provider use of pictures/drawings as part of counseling to reinforce dosing information, 3) provider demonstration of the dose using an oral syringe, 3) teachback of dose information, 4) parent showback of the dose they plan to give, and 5) provider provision of an oral syringe. At the HELPix site, ED providers were trained in the use of HELPix counseling strategies as well as how to use the electronic medical record (EMR) system to generate the instruction sheets while ordering a prescription. Outcomes assessed were: 1) provider provision of HELPix instruction sheets via web tracking, 2) dosing errors ≥ 20% deviation from prescribed dose, assessed from observation at follow-up visit, 3) provider counseling practices (i.e. use of pictures/drawings, demonstration, teachback, showback, provision of dosing tool) obtained by parent report. RESULTS: A total of 1493 parents were assessed by telephone for eligibility in the pre-/post-implementation phases. 561 parent-child dyads were recruited by phone (284 at HELPix site; 277 at control site). A total of 92% were mothers, 52% were Spanish speakers, 78% were Latino, 16% were Black, and 85% were of low socioeconomic status. Web tracking at the HELPix intervention site indicated that for 58% of the enrolled families in the post-implementation period, providers generated HELPix medication instruction sheets. Compared to the pre-implementation period at the intervention site, parent dosing errors rates were significantly reduced during the post-implementation period (37% versus 16%; AOR=0.3, p<0.001); with an overall Relative Risk Reduction (RRR)=57%, with greatest reductions in errors among those that received HELPix sheets (12% error rate, RRR=68%). Providers at the HELPix implementation site were significantly more likely to use recommended provider counseling strategies post-implementation compared to pre-implementation (pictures/drawings: 37% versus 1%; dosing demonstration: 59% versus 33%; teachback: 24% versus 8%; showback: 33% vs. 13%, and provision of oral syringe 79% versus 25%; p<0.0001 for all strategies). In the non-intervention site, there were no differences in parent dosing error rates, or in provider use of counseling strategies between the pre- and post-implementation periods. CONCLUSION: Implementation of the HELPix intervention resulted in increased provider use of recommended counseling strategies as well as decreased parent medication dosing errors in an urban public hospital setting serving low socioeconomic status families. Use of HELPix supports high quality provider medication counseling and appears to be feasible to incorporate as part of routine Emergency Department discharge practices.

Approximately 43.4% of medication errors occur at the time of administration despite the use of bar code medication administration (BCMA) System. This trend has prompted a national effort to mitigate this problem in the United States. Implementing BCMA in health care settings is one of those efforts. Studies focusing on the approaches employed by nurses when using this system are scant. The purpose of this qualitative case study was to investigate strategies nurses and their leaders use to ensure BCMA is implemented, maximized, and sustained. The technology acceptance model was used to guide the study. The 2 research questions addressed nurses' perceptions regarding the use and optimization of BCMA, and approaches of clinical nurses and their leaders to ensure that BCMA technology is properly used, optimized, and sustained in acute care units. Data collection included semistructured interviews with 8 participants. Thematic data analysis generated themes including ease of use, reduce errors, time saving, old technology, overreliance on technology, paper backups, and hope for future development. Common barriers to system effectiveness were system errors and inadequate training; intragroup and self-monitoring were important strategies to sustain use of the system. Study results may be used by health care leadership to reduce medication errors by adopting easy to use technology, change policies regarding training of BCMA end users in hospitals, increase the culture of patient safety among nurses, and prompt technology redesign within health care settings that meets the national patient safety goals.

The purpose of this body of work was to address medication errors and safe medication administration practices in relation to practicing nurses and nursing students via several different approaches. These different approaches will be presented as three separate papers but interrelated themes. The specific purpose for each paper and the corresponding research questions were addressed individually in each chapter. The approach used in the first paper was a systematic literature search of medication administration errors and the pediatric population; five themes emerged including the incidence rate of medication administration errors, specific medications involved in medication administration errors and classification of the errors, why medication administration errors occur, medication error reporting, and interventions to reduce medication errors. The approach used in the second paper included a systematic literature review and implementation of a survey, both focusing on the assessment strategies for safe medication administration with practicing nurses and nursing students. Results of both the review and the survey indicated a lack of a comprehensive assessment of safe medication administration. The approach used in the third paper was a research study to conduct a psychometric evaluation of the Safe Medication Administration (SAM) Scale with baccalaureate nursing students. Results provided evidence of the validity and reliability of the SAM Scale. This body of work exposed a gap in nursing and demonstrates the importance of having a standardized assessment of safe medication administration with evidence of validity and reliability to demonstrate competency in this area.

Syftet var att genom granskning av vetenskapliga originalartiklar undersöka patientsäkerheten vid generisk läkemedelsanvändning. Det som studerades var den eventuella problematiken, åtgärderna och patienternas egna erfarenheter av generisk användning. Den Metod som användes var en litteraturstudie där artiklar söktes i ett flertal databaser och via manuella sökningar. Sjutton artiklar inkluderades och granskades utifrån en mall för kvalitet- och resultatanalys. I Resultatet framgick att sjuksköterskor anser att osäkerhet, täta läkemedelsbyten, otydlig kommunikation, lika läkemedel till utseende och namn, samt tung arbetsbelastning är riskfaktorer som leder till medicineringsfel i form av under- och överdosering och/ eller utebliven läkemedelsdos. Patientsäkerheten påverkas även då försämrad följsamhet, biverkningar och sämre effekt är konsekvenser av generisk substitution. Åtgärder anses vara kvalificerade patient- och personal utbildningar. Tydligt uttalade ordinationer, minskat antal mediciner med lika namn och utseenden, samt dubbelkontroller och uppdatering av listor var förslag på förbättringar. Patienter hade generellt negativa attityder och erfarenheter av generika. Attityderna grundade sig främst på otrygghet och misstro. Patienter upplevde förvirring, fler eller värre biverkningar samt sämre effekt. Slutsatsen visar att det förekommer att patienter och sjuksköterskor erfar problem vid användning av generiska läkemedel och att detta får konsekvenser för patientsäkerheten. Därför bör fler problemåtgärder fastställas och tillämpas för att förhindra medicineringsfel som äventyrar patientsäkerheten.

Introduction: Medication errors are a major cause of illness and hospitalization of patients throughout the world. This study examines the situation regarding medication errors in the Armed Forces Hospital, Kuwait since no literature exists of any such studies for this country. Several types of potential errors were studied by physicians, nurses and pharmacists. Their attitudes to the commission of errors and possible consequences were surveyed using questionnaires. Additionally, patient medical records were reviewed for possible errors arising from such actions such as the co-administration of interacting drugs. Methods: This study included direct observations of physicians during the prescribing process, pharmacists while they dispensed medications and nurses as they distributed and administered drugs to patients. Data were collected and compiled on Microsoft Excel spreadsheet and analyses were performed using SPSS. Where applicable, results were reported as counts and/ or percentages of error rates. Nurses, pharmacists and physicians survey questionnaires: From the 200 staff sent questionnaires a total of 149 respondents comprising nurses (52.3%), physicians (32.2%) and pharmacists (16.1%) returned the questionnaires a total response rate of 74.5%. All responses were analyzed and compared item-by-item to see if there were any significant differences between the three groups for each questionnaire item. All three groups were most in agreement about their perception of hospital administration as making patient safety a top priority with regard to communicating with staff and taking action when medication errors were reported (all means 3.0 and p > 0.05). Pharmacists were most assured of administration support when an error was reported whereas nurses were least likely to see the administration as being supportive ( p < 0.001), and were more afraid of the negative consequences associated with reporting of medication errors (p = 0.026). Although nurses were generally less likely to perceive themselves as being able to communicate freely regarding reporting of errors compared to pharmacists there was no significant difference between the two groups. Both however were significantly different from physicians (p< 0.001). Physicians had the most favorable response to perceiving new technology as helping to create a safer environment for patients and to the full utilization of such technologies within the institution in order to help prevent medical errors. Scenario response - Responses to two scenarios outlining possible consequences, should a staff member commit a medication error, tended to be very similar among the three groups and followed the same general trend in which the later the error was discovered and the more grievous the patient harm, the more severe would be the consequences to the staff member. Interestingly, physicians saw themselves as less likely to suffer consequences and nurses saw themselves as more likely to suffer consequences should they have committed a medication error. All three groups were more likely to see themselves as facing dismissal from their job if the patient were to die. RESULTS OF ALL THREE OBSERVATIONS: Result of Nursing observations: For 1124 doses studied, 194 resulted in some form of error. The error rate was 17.2% and the accuracy was 82.8%. The commonest errors in a descending order were: wrong time, wrong drug, omission, wrong strength/ dose, wrong route, wrong instruction and wrong technique. No wrong drug form was actually administered in the observational period. These were the total number of errors observed for the entire month period of the study. IV Result of Pharmacist observations: A total of 2472 doses were observed during the one month period. Observations were done for 3 hours per day each day that the study was carried out. The study showed that there were 118 errors detected which were in the following categories respectively: 52 no instructions, 28 wrong drug/unordered, 21 wrong strength/dose, ignored/omission 13, shortage of medication 3 and expired date 1. Result of Prescribers in Chart review for drug-drug interactions: The analysis of the drug-drug interactions showed that out of a total of 1000 prescriptions, 124 had drug-drug interactions. None were found to fall into the highest severity rating i.e. 4 (contraindicated). Only twenty-one interactions were rated 3 (major), 87 interactions were rated moderate and 15 interactions were rated minor according the modified Micromedex scale. Patient education: All health care such as physician, pharmacist, and nurses have a responsibility to educate patient about their medication use and their health conditions to protecting them from any error can occur by wrong using drugs. Conclusion This study has contributed to the field of medication errors by providing data for a Middle Eastern country for the very first time. The views and opinions of the nurses, pharmacists and physicians should be considered to enhance the systems to minimize any errors in the future.

The objectives of this study were to examine the association between patient perceived healthcare quality and self-reported medical, medication, and laboratory errors using cross-sectional and cross-national questionnaire data from eleven countries. In this research, quality of care was measured by a multi-faceted construct, which adopted the patient's perspectives. Five separated quality of care scales were assessed: Access to Care, Continuity of care, Communication of Care, Care Coordination, and Provider's Respect for Patients' Preferences. The findings from this investigation support a number of other published studies suggesting that Coordination of Care is an important predictor of perceived patient safety. After adjusting for potentially important confounding variables, an increase in peoples' perceptions of Coordination of Care decreased the likelihood of self-reporting medical errors (OR =0.605, 95% CI: 0.569 to 0.653), medication errors (OR =0.754, 95% CI: 0.691 to 0.830), and laboratory errors (OR =0.615, 95% CI: 0.555 to 0.681). Finally, results showed that the healthcare system type governing care processes modifies the effect of Coordination of Care on self-reported medication errors.