Pharmacy World and Science

, Volume 25, Issue 6, pp 264–268

Observational study of potential risk factors of medication administration errors

  • Edgar Tissot
  • Christian Cornette
  • Samuel Limat
  • Jean-Louis Mourand
  • Michèle Becker
  • Joseph-Philippe Etievent
  • Jean-Louis Dupond
  • Micheline Jacquet
  • Marie-Christine Woronoff-Lemsi
Article

DOI: 10.1023/B:PHAR.0000006519.44483.a0

Cite this article as:
Tissot, E., Cornette, C., Limat, S. et al. Pharm World Sci (2003) 25: 264. doi:10.1023/B:PHAR.0000006519.44483.a0

Abstract

Objective: Medication administration errors (MAEs) are the second most frequent type of medication errors, as has been shown in different studies in the literature. The aims of this observational study were to assess the rate and the potential clinical significance of MAEs and to determine the associated risk factors. Design: In two departments, Geriatric Unit (GU) and Cardiovascular-Thoracic Surgery Unit (CTSU) of Besançon University Hospital (France), MAEs were identified using the undisguised observation technique and classified according to the definitions of the American Society of Health-System Pharmacists. Injectable administration, lack of nurses's standardized protocol for the preparation and administration of drugs, incomplete or illegible prescription and nurse's workload were analysed as potential risk factors of MAEs in multivariate logistic regression analysis.Results: During a period of 20 days, opportunities for error concerning 56 patients and 78 MAEs (58 in CTSU and 26 in GU) were observed. The medication administration error rate was 14.9%. Dose errors were the most frequent (41%) errors, followed by wrong time (26%) and wrong rate errors (19%). No potential fatal errors were observed, 8 (10%) were estimated as potentially life-threatening, 20 (26%) potentially significant and 50 (64%) potentially minor. Nurse workload and incomplete or illegible prescriptions were two independent risk factors of MAEs.Conclusion: According to these data, the quality of the medication administration process needs to be optimized in hospitals in order to minimize the incidence of iatrogenic preventable diseases.

AdministrationFranceIatrogenic diseaseMedication errorObservationPharmacyPreventionRisk factor

Copyright information

© Kluwer Academic Publishers 2003

Authors and Affiliations

  • Edgar Tissot
    • 1
  • Christian Cornette
    • 1
  • Samuel Limat
    • 1
  • Jean-Louis Mourand
    • 2
  • Michèle Becker
    • 3
  • Joseph-Philippe Etievent
    • 2
  • Jean-Louis Dupond
    • 3
  • Micheline Jacquet
    • 1
  • Marie-Christine Woronoff-Lemsi
    • 1
  1. 1.Pharmacy DepartmentBesançon University Hospital, Boulevard FlemingBesançon CedexFrance
  2. 2.Cardiovascular-Thoracic Surgery DepartmentBesançon University Hospital, Boulevard FlemingBesançon CedexFrance
  3. 3.Geriatric DepartmentBesançon University Hospital, Boulevard FlemingBesançon CedexFrance