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.
| Identifer | oai:union.ndltd.org:BRADFORD/oai:bradscholars.brad.ac.uk:10454/4480 |
| Date | January 2010 |
| Creators | Al-Hameli, Fahad M. |
| Contributors | Naylor, Robert J., Naylor, Ian |
| Publisher | University of Bradford, Department of Pharmacy |
| Source Sets | Bradford Scholars |
| Language | English |
| Detected Language | English |
| Type | Thesis, doctoral, PhD |
| Rights | <a rel="license" href="http://creativecommons.org/licenses/by-nc-nd/3.0/"><img alt="Creative Commons License" style="border-width:0" src="http://i.creativecommons.org/l/by-nc-nd/3.0/88x31.png" /></a><br />The University of Bradford theses are licenced under a <a rel="license" href="http://creativecommons.org/licenses/by-nc-nd/3.0/">Creative Commons Licence</a>. |
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