The frequency and nature of medication errors in hospitalized patients with acute coronary syndrome
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Background Cardiovascular medications have been commonly associated with medication errors. Objective The objective of this study was to investigate the incidence and predictors of medication errors in patients with acute coronary syndrome. Setting the coronary care unit of a university teaching hospital. Methods This was a prospective observational study on 150 patients admitted to the coronary care unit between August 2014 and July 2015. Main outcome measure The principal outcome was the number (frequency) of encountered medication errors. Results Of total 5790 prescription items reviewed, 547 (9.4%) potential medication errors were identified of which 523 (9.0%) were prescribing errors and 24 were monitoring errors. The most frequent prescribing errors were dosing errors (231, 42.2%) followed by loading dose omission error (91, 16.6%), omission of essential drugs on 1st day (43, 7.9%), and timing error (40, 7.3%). Errors frequently encountered with drugs such as aspirin, enoxaparin, beta-blockers followed by angiotensin-converting enzyme inhibitors and clopidogrel. Multivariate logistic regression analysis revealed that renal impairment (OR 6.02; 95% CI 1.4–35.4; p = 0.02) and longer duration of hospital stay (OR 4.01; 95% CI 1.5–10.7; p = 0.005) were predictors of the higher incidence of medication errors. Conclusion Prescribing and monitoring errors in coronary care unit are frequent and avoidable, with the majority of errors were ranked to be of mild to moderate severity. Dosing errors, omission of essential drugs and monitoring errors were most common error types encountered. Dosage adjustment based on estimation of the glomerular filtration rate immediately after admission help avoiding dosage-related errors.
KeywordsAcute coronary syndrome Cardiovascular drugs Coronary care unit Egypt Medication errors
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Conflicts of interest
The authors declare no conflict of interest.
- 5.Dornan T, Ashcroft D, Heathfield H, Lewis P, Miles J, Taylor D, et al. An in-depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education: EQUIP study. London: General Medical Council; 2009. pp. 1–215.Google Scholar
- 6.Spinler SA, denus Sd. Cardiovascular disorders. In: Chisholm-Burns MA, Wells BG, Schwinghammer TL, Malone PM, et al. editors. Pharmacotherapy Principles and Practice. 3rd ed. New York: McGraw-Hill; (2013). pp. 133–160.Google Scholar
- 11.Alexander D, Ou F-S, Roe MT, Pollack CV, Ohman EM, Cannon CP, et al. Use of and inhospital outcomes after early clopidogrel therapy in patients not undergoing an early invasive strategy for treatment of non–ST-segment elevation myocardial infarction: results from Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology/American Heart Association guidelines (CRUSADE). Am Heart J. 2008;156(3):606–12.CrossRefPubMedGoogle Scholar
- 12.Freedman JE, Becker RC, Adams JE, Borzak S, Jesse RL, Newby LK, et al. Medication errors in acute cardiac care an american heart association scientific statement from the council on clinical cardiology subcommittee on acute cardiac care, council on cardiopulmonary and critical care, council on cardiovascular nursing, and council on stroke. Circulation. 2002;106(20):2623–9.CrossRefPubMedGoogle Scholar
- 13.Brixey J, Johnson TR, Zhang J. Evaluating a medical error taxonomy. In: Proceedings of the AMIA Symposium. 2002. American Medical Informatics Association.Google Scholar
- 16.Seden K, Kirkham JJ, Kennedy T, Lloyd M, James S, Mcmanus A, et al. Cross-sectional study of prescribing errors in patients admitted to nine hospitals across North West England. BMJ Open. 2013;3(1):e002036. doi: 10.1136/bmjopen-2012-002036.
- 21.Avery T, Barber N, Ghaleb M, Franklin BD, Armstrong S, Crowe S, et al. Investigating the prevalence and causes of prescribing errors in general practice. London: The General Medical Council: PRACtICe Study. 2012.Google Scholar
- 29.Sabry NA, Farid S, Aziz E. Role of the pharmacist in identification of medication related problems in the ICU: a preliminary screening study in an Egyptian teaching hospital. Aust J Basic Appl Sci. 2009;3:995–1003.Google Scholar