ASSESSMENT OF MEDICATION ERRORS AT ZAGAZIG UNIVERSITY HOSPITALS

Abstract

Background: Medication errors are defined as any preventable event that may lead to any inappropriate medication use and or patient harm, or any mistakes associated with the prescription, transcription, dispensing, and administration phases of drug preparation and distribution regardless this mistake led to adverse event or not. Aim of the work: Assessment of medication errors at Zagazig University hospitals through the following objectives: 1- To identify rate and types of medication errors at Zagazig university hospitals. 2- To find out some factors that may be associated with occurrence of errors. 3- To assess the perception of health care providers involved in the medication use process about causes of medication errors. Subjects and methods: An observational descriptive study was carried out at random selected sample of Zagazig University hospital, sample was calculated under two main items. A) Selection of records to assess medication errors: The records were collected by using multistage technique. Zagazig university hospitals were divided into two main branches (internal medicine hospital and surgical hospitals). As there are 3 medical and 4 surgical hospitals, random section of one medical and two surgical hospitals was done (1st stage). The sample calculated by using error rate (11.4%) (1), at 95% CI, with the power of the test 80%, 10% dropout, and total records/ year 39468, the sample was 1774. With putting into consideration the proportional allocation of attendance of internal and surgical hospitals (1.7:1) so the sample was 1117 at internal medicine hospital and 657 at surgical hospital. At each hospital random selection of units was done (2nd stage). B) Selection of health care workers to assess their perception toward medication errors: With perception rate (35%)(2), total number of health care workers (nurses, doctors, and pharmacists) 3158, 95% confidence interval, 80% power of the test, and 10% drop out, the total sample size 547. According to proportional allocation between the stuff number, sample of nurses is 336, doctors 162, and pharmacists 49. Tools: 1- Modified Medication use checklist: to assess medication errors, it contains detailed steps of all the phases of the drug use (Prescription, dispensing, and administration).2- Modified Gladstone questionnaire: directed to doctors, nurses, and pharmacists to assess their perception for errors, risk factors, reporting process, and barriers against it. Ethical consideration: informed verbal consent was obtained from all stuff enrolled in the study; an official permission was obtained from department of public health. A written permission from Zagazig hospitals manager was obtained to perform the study. Results: Rate of medication error at Zagazig university hospitals was 63.7%. The error rate was nearly equal at both internal medicine and surgical hospitals (63.1, 64.7%) without significant difference (p>0.05). The most common type of errors was dispensing (46%), followed by administration (41%), then prescription errors (13%)( Most of prescription errors were of mild and moderate nature, while most of dispensing errors were of moderate type, however most of administration errors were of severe type. There was significant difference at prescription errors, and administration errors with higher frequency at internal medicine more than surgical hospitals (p<0.05). Low number of doctors, nurses, pharmacists, lack of experience of doctors, and pharmacists, in addition to night shift significantly affect error frequency. Stuff members has perceived unreadable hand writing, repeated change of orders, similar drugs (name, shape), change of nurses among units, excess work load, low number of nurses, and dealing with big number of drugs as the most important risk factors of errors. Frequency of reporting among nurses was (44%), compared to (15%) of doctors and (3%) of pharmacists. No clear definition for medication errors, writing a report take a long time, and Focusing on individual punishment more than system improvement were the most important barriers against error reporting as perceived by the staff. . Conclusion and recommendation: Rate of medication errors at Zagazig university hospitals was high, the most common type of errors was dispensing, followed by administration, then prescription errors (Most of prescription errors were of mild and moderate nature, while most of dispensing errors were of moderate type, however most of administration errors were of severe type). Low number of doctors, nurses, and pharmacists, lack of experience of doctors, and pharmacists, night shifts was significant risk factors for error frequency. Based on the finding of the current study the following recommendations can be suggested: 1- Increasing awareness about medication errors, impact and cost. 2- Developing a systematic approach that helps in error monitoring, evaluation, and reporting. 3- Implement hospital policy and procedures for medication errors assessment. 4- Organize a team who is concerned with all items of patient safety including medication errors.5- Changing the format of prescription and introduction of new technology as computerized physician order entry. Key wards: medication errors, risk factors, perception of errors, impact of errors.