Medication error is an error in prescribing, dispensing or administering of a drug, irrespective of whether such errors lead to adverse consequences or not.1,2
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Parenteral medication errors are a serious safety problem in Intensive Care Units (ICU) and are recognized as a high priority health care issue across national borders, different ICU-settings and health care systems.1,2,5 Errors have been shown to be associated with additional morbidity and mortality in an already critically ill population.3,4
The majority of medication errors do not occur in emergency situations but while performing routine clinical tasks.5 The source of these errors can lie at any stage of the process from the initial prescription of an infusion to its administration.11 This is a complex process12 and can lead to a wide range of different errors.13-18
One of the reasons adverse events are so common is that clinicians are human, and thus prone to error. The seminal study by Wilson et al. found that human error was a significant factor. The majority (81%) of adverse events in their study were associated with one or more human factors, such as lack of knowledge, care or attention.19 Of the events that were considered highly preventable, less than 1% were not associated with human error.19
There are main causes which increase the incidence of Medication Error5:
- nurse’s workload (patient to nurse ratio, occupancy rate, ratio of beds per nurses
- size of unit (complexity of organization)
- look alike / sound alike drug labels and names.
Since the early 70s more and more studies of the quantity of parenteral medication errors have been published.4 The National Patient Safety Agency in the United Kingdom has compiled figures showing the type of medication error incidents that actually occur. More than 14,000 injectable medicine incident reports during 18 months were evaluated.25 It was found that in more than 4,107 cases (28.9% of total) the most frequent medication error was wrong dose, strength or frequency of the prescribed drug.
Errors and irregularities in IV drug preparation can have a broad range of consequences ranging from harmless to serious to fatal. The severity depends on the drug in use and the specific factors of each individual case.
The financial costs of adverse events, in terms of additional treatment and extra days in hospitals, are considerable. For example, in Britain, the cost of preventable adverse events is ￡1 billion per annum in lost bed days alone.22 The wider costs of lost working time, disability benefits and further economic consequences are greater still.
The US Institute of Medicine report estimated that preventable medical errors result in total costs (including the expense of additional care caused by the errors, lost income, household productivity, and disability) of between $ 17 billion and $ 29 billion per year in US hospitals.32
Research in Australia showed that total costs of adverse events represent 15.7% of the total expenditure on direct hospital costs.33
Other significant damages associated with adverse events are the human ones: the harm suffered by the patient. Patients experiencing an adverse event are 4-7 times more likely to die than those who do not.33 Vincent et al. found that 19% of adverse events result in moderate physical impairment, 6% in permanent impairment and 8% in death.22
Potential Risk Associated Cost
A cost evaluation of the risk can be done by assigning costs to their related clinical treatment and resulting extended length of stay. The cost can be calculated using the average daily cost of the expected clinical treatment.30,31 The figure below shows the results of such a calculation for selected examples of complications.
Subsequently, in the case of severe complications which require full ICU treatment for diverse days of hospitalization, a hospital may save between 7,556 € and 56,670 € per single case.28-31
To prevent medication error and effectively ensure safe patient treatment it is important to combine product and organizational measures.
The more successive safety checks that are added, the safer the whole system becomes. Some concrete preventive strategies to implement in clinical routine are described in Figure below.
Moreover, it must be the aim of every employee in the healthcare sector, to ensure the 9 “Rights“.26,27
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6 Institute of Medicine (2007)
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21 Leape LL, Bates DW, Cullen DJ et al. (1995) Systems analysis of adverse drug events. ADE Prevention Study Group. JAMA; 274(1): 35-43.
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25 National Patient Safety Agency (2007)
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