MED ERRORS STDY

• Data for this analysis came from 1276 incident reports involving medication errors by RNs in 5 Southwestern US hospital inpatient settings from November 2011 through July 2014.
• Cardiovascular was the most common drug class associated with medication errors (24.7% overall). In particular, anticoagulants (11.3%) were involved, such as heparin (4.7%), enoxaparin (29.7%), and warfarin (26.9%).
• Cardiovascular was the most common drug class associated with medication errors among all hospital units except for pediatric units.
• The second most common drug class associated with medication errors was antimicrobials (19.1% overall), particularly vancomycin (6.1%).
• Antimicrobials accounted for 38.5% of medication errors in pediatrics, 29.9% in medical-surgical, 20.3% in the emergency department, 17.2% in the ICU, 12.2% in rehabilitation, and 16.4% in the cardiac care unit.
• Other drug classes often associated with medication errors were electrolytes (11.3%), endocrine drugs (8.8%), and analgesics (8.8%).
• Medication errors were statistically significantly most common in medical-surgical units (35.0%), ICUs (14.7%), and intermediate care units (13.3%).
• Effects of medication errors were patient harm in 10% and increased monitoring in 11%, although 65% of errors reached the patients without harm and 14% of errors were identified before the patients were reached.
• Drugs accounting for the highest percentage of medication errors causing patient harm were furosemide (34.6%), enoxaparin (29.7%), insulin (15.2%), and vancomycin (14.1%).
• Penicillins accounted for 37% of errors causing increased patient monitoring.
• On the basis of these findings, the investigators concluded that medication errors involving RNs are common, and that medical-surgical units and ICUs were associated with increased errors. In addition, high-risk drugs (cardiovascular drugs, antimicrobials, and electrolytes) yielded higher medication errors.
• The high risk associated with heparin likely results from complex dosing, use of laboratory tests to calibrate doses, and the need for frequent monitoring of bleeding and clotting parameters.
• The investigators suggest that identifying factors that contribute to medication errors, addressing and eliminating risk for errors across hospital units, and providing education and resources for nurses may help reduce these errors.
• They recommend future research to determine the rate of medication errors with drug classes and individual drugs, the association of these errors in different hospitals across the nation, and the factors associated with errors involving high-risk drugs.
• Potential solutions to reduce medication errors include simulation-based continuing education and training, mandatory continuing pharmacology education highlighting high-risk drugs, ongoing training in anticoagulation administration, use of computerized provider order entry, and nurse training and teaching on computerized provider order entry.
• Study limitations include use of different incident report forms by each hospital; potential underreporting of medication errors; inability to calculate error incidence rates; inability to determine the role of pharmacists, physicians, and other staff regarding medication errors; and possible lack of generalizability to other settings.