Evaluation of Medication Errors in Teaching Hospitals

Document Type : Original Article

Authors

1 Department of Community and Preventive Medicine, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.

2 Department of Community and Preventive Medicine in IAU, Research Centre for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran.

Abstract

Introduction:
Medication errors (MEs) are a common explanation for iatrogenic adverse events. This study appraised the incidence of MEs and identified the error types in the hospitals affiliated to Azad University of Medical Sciences, located in Tehran, Iran.
Materials and Methods:
This cross-sectional descriptive study was conducted on all patients admitted to the hospitals affiliated to Azad University of Medical Sciences. The data were collected by means of a drug safety checklist and then extracted and analyzed in SPSS software (version 22.0). Moreover, drug interaction was assessed based on the World Health Organization guidelines and Medscape application.
Results:
The mean MEs incidence was obtained as 43.38±5.25. Moreover, the mean numbers of errors in prescribing drugs and antibiotics were 4.71±2.93 and 1.02±0.95, respectively. According to the results, drug interactions occurred in 12.3% of the medicines. In addition, ME showed a significant correlation with education status, ward type, admission type, hepatic failure, hepatic enzymes, patient weight (when on antibiotics), antibiotic effect, and patient age (65> years).
Conclusion:
The results were indicative of a high prevalence of prescription errors. Moreover, it was found that most of MEs were made by doctors, mainly due to the lack of an electronic drug registration system. Therefore, physicians need to be educated on how to increase patient safety through drug safety.

Keywords


  1. Sutherland A, Canobbio M, Clarke J, Randall M, Skelland T, Weston E. Incidence and prevalence of intravenous medication errors in the UK: a systematic review. European Journal of Hospital Pharmacy. 2020;27(1):3-8.
  2. Dreijer AR, Diepstraten J, Bukkems VE, Mol PG, Leebeek FW, Kruip MJ, et al. Anticoagulant medication errors in hospitals and primary care: a cross-sectional study. International Journal for Quality in Health Care. 2019;31(5):346-52.
  3. Donaldson LJ, Kelley ET, Dhingra-Kumar N, Kieny M-P, Sheikh A. Medication without harm: WHO's third global patient safety challenge. The Lancet. 2017;389(10080):1680-1.
  4. Chareonkul C, Khun VL, Boonshuyar C. Rational drug use in Cambodia: study of three pilot health centers in Kampong Thom Province. Southeast Asian Journal of Tropical Medicine and Public Health. 2002;33(2):418-24.
  5. Ugur E, Kara S, Yildirim S, Akbal E. Medical errors and patient safety in the operating room. Age. 2016;33(6.53):19-50.
  6. Farha RA, Hammour KA, Al-Jamei S, AlQudah R, Zawiah M. The prevalence and clinical seriousness of medication discrepancies identified upon hospital admission of pediatric patients. BMC health services research. 2018; 18(1):966.
  7. M K, T B, Khaleel MI, P MSaR. a system review on med error. international Journal of drug development. 2015;7(4):1-3.
  8. Leape LL, Bates DW, Cullen DJ, Cooper J, Demonaco HJ, Gallivan T, et al. Systems analysis of adverse drug events. Jama. 1995;274(1):
    35-43.
  9. Aljadhey H, Alhusan A, Alburikan K, Adam M, Murray MD, Bates DW. Medication safety practices in hospitals: A national survey in Saudi Arabia. Saudi Pharmaceutical Journal. 2013; 21(2): 159-64.
  10. Alshahrani SM, Alakhali KM, Al-Worafi YM. Medication errors in a health care facility in southern Saudi Arabia. Tropical Journal of Pharmaceutical Research. 2019;18(5):1119-22.
  11. Schenkel S. Promoting patient safety and preventing medical error in emergency departments. Academic Emergency Medicine. 2000;7(11):1204-22.
  12. System IoMCotFoECitUH. Hospital-based emergency care: at the breaking point. Washington, DC: National Academies Press; 2006.
  13. Caterino JM, Emond JA, Camargo Jr CA. Inappropriate medication administration to the acutely ill elderly: a nationwide emergency department study, 1992–2000. Journal of the American Geriatrics Society. 2004;52(11):
    1847-55.
  14. Chin MH, Wang LC, Jin L, Mulliken R, Walter J, Hayley DC, et al. Appropriateness of medication selection for older persons in an urban academic emergency department. Academic emergency medicine. 1999;6(12):1232-41.
  15. Dabaghzadeh F, Rashidian A, Torkamandi H, Alahyari S, Hanafi S, Farsaei S, et al. Medication errors in an emergency department in a large teaching hospital in Tehran. Iranian journal of pharmaceutical research: IJPR. 2013;12(4):937.
  16. Reis AMM, Cassiani SHDB. Prevalence of potential drug interactions in patients in an intensive care unit of a university hospital in Brazil. Clinics. 2011;66(1):9-15.
  17. Pronovost P, Weast B, Schwarz M, Wyskiel RM, Prow D, Milanovich SN, et al. Medication reconciliation: a practical tool to reduce the risk of medication errors. Journal of critical care. 2003;18(4):201-5.
  18. Yousef N, Yousef F. Using total quality management approach to improve patient safety by preventing medication error incidences. BMC health services research. 2017;17(1):621.
  19. Fahimi F, Nazari MA, Abrishami R, Sistanizad M, Mazidi T, Faghihi T, et al. Transcription errors observed in a teaching hospital. Archives of Iranian Medicine (AIM). 2009;12(2).
  20. Sisay M, Mengistu G, Molla B, Amare F, Gabriel T. Evaluation of rational drug use based on World Health Organization core drug use indicators in selected public hospitals of eastern Ethiopia: a cross sectional study. BMC health services research. 2017;17(1):161.
  21. Ahmadi F, Zarei E. Prescribing patterns of rural family physicians: a study in Kermanshah Province, Iran. BMC public health. 2017; 17(1): 908.
  22. Organization WH. How to investigate drug use in health facilities: selected drug use indicators. Geneva: World Health Organization; 199
  23. Ross L, Wallace J, Paton J. Medication errors in a paediatric teaching hospital in the UK: five years operational experience. Archives of disease in childhood. 2000;83(6):492-7.
  24. Chalasani S, Ramesh M, Gurumurthy P. Pharmacist-Initiated Medication Error-Reporting and Monitoring Programme in a Developing Country Scenario. Pharmacy. 2018; 6(4): 133.
  25. Alsulami Z, Conroy S, Choonara I. Medication errors in the Middle East countries: a systematic review of the literature. European journal of clinical pharmacology. 2013; 69(4): 995-1008.
  26. Vincer MJ, Murray JM, Yuill A, Allen AC, Evans JR, Stinson DA. Drug errors and incidents in a neonatal intensive care unit: a quality assurance activity. American journal of diseases of children. 1989;143(6):737-40.
  27. Maaskant JM, Tio MA, van Hest RM, Vermeulen H, Geukers VG. Medication audit and feedback by a clinical pharmacist decrease medication errors at the PICU: An interrupted time series analysis. Health Science Reports. 2018;1(3):e23.
  28. Masoud A, Hekmat SN, Dehnavieh R, Haj-Akbari N, Poursheikhali A, Abdi Z. An investigation of prescription indicators and trends among general practitioners and specialists from 2005 to 2015 in Kerman, Iran. International journal of health policy and management. 2018;7(9);818-27.
  29. Härkänen M, Vehviläinen-Julkunen K, Murrells T, Rafferty AM, Franklin BD. Medication administration errors and mortality: Incidents reported in England and Wales between 2007 ̶ 2016. Research in Social and Administrative Pharmacy. 2018.
  30. Alshakka M, Abdo Saeed GM, Ali H, Prajapati SK, Ibrahim MI. Adverse Drug Reactions and Medication Errors: A Quantitative Insight in Aden, Yemen. Journal of Young Pharmacists. 2019;11(1).
  31. Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA, et al. The nature of adverse events in hospitalized patients: results of the Harvard Medical Practice Study II. New England journal of medicine. 1991;324(6): 377-84.
  32. Pham JC, Story JL, Hicks RW, Shore AD, Morlock LL, Cheung DS, et al. National study on the frequency, types, causes, and consequences of voluntarily reported emergency department medication errors. The Journal of emergency medicine. 2011;40(5):485-92.
  33. Gashaw T, Sisay M, Mengistu G, Amare F. Investigation of prescribing behavior at outpatient settings of governmental hospitals in eastern Ethiopia: an overall evaluation beyond World Health Organization core prescribing indicators. Journal of pharmaceutical policy and practice. 2018;11(1):26.
  34. Mendes JR, Lopes MCBT, Vancini-Campanharo CR, Okuno MFP, Batista REA. Types and frequency of errors in the preparation and administration of drugs. Einstein (São Paulo). 2018;16(3).
  35. Abdollahiasl A, Kebriaeezadeh A, Nikfar S, Farshchi A, Ghiasi G, Abdollahi M. Patterns of antibiotic consumption in Iran during 2000–2009. International journal of antimicrobial agents. 2011;37(5):489.
  36. Andrajati R, Tilaqza A, Supardi S. Factors related to rational antibiotic prescriptions in community health centers in Depok City, Indonesia. Journal of infection and public health. 2017;10(1):41-8.
  37. Md Rezal RS, Hassali MA, Alrasheedy AA, Saleem F, Md Yusof FA, Godman B. Physicians’ knowledge, perceptions and behaviour towards antibiotic prescribing: a systematic review of the literature. Expert review of anti-infective therapy. 2015;13(5):665-80.
  38. Bian C, Xu S, Wang H, Li N, Wu J, Zhao Y, et al. A study on the application of the information-motivation-behavioral skills (IMB) model on rational drug use behavior among second-level hospital outpatients in Anhui, China. PloS one. 2015;10(8):e0135782.

 

  1. Bates DW, Boyle DL, Vander Vliet MB, Schneider J, Leape L. Relationship between medication errors and adverse drug events. Journal of general internal medicine. 1995; 10(4): 199-205.
  2. Gharekhani A, Kanani N, Khalili H, Dashti-Khavidaki S. Frequency, types, and direct related costs of medication errors in an academic nephrology ward in Iran. Renal failure. 2014; 36(8):1268-72.
  3. Palmero D, Di Paolo ER, Stadelmann C, Pannatier A, Sadeghipour F, Tolsa J-F. Incident reports versus direct observation to identify medication errors and risk factors in hospitalised newborns. European journal of pediatrics. 2018:1-8.
  4. Vessal G. Detection of prescription errors by a unit-based clinical pharmacist in a nephrology ward. Pharmacy world & science. 2010;32(1):
    59-65.
  5. Kopp BJ, Erstad BL, Allen ME, Theodorou AA, Priestley G. Medication errors and adverse drug events in an intensive care unit: direct observation approach for detection. Critical care medicine. 2006;34(2)415-425.
  6. Sankar V, Saaed Y, Joseph RM, Azizi H, Thomas PM. Serious Drug-Drug Interactions in the Prescriptions of Diabetic Patients. Med Sci (Basel). 2015;3(4):93-103.
  7. Salwe KJ, Kalyansundaram D, Bahurupi Y. A study on polypharmacy and potential drug-drug interactions among elderly patients admitted in department of medicine of a tertiary care hospital in Puducherry. Journal of clinical and diagnostic research: JCDR. 2016;10(2):FC06.
  8. Alwhaibi M, Balkhi B, Alhawassi TM, Alkofide H, Alduhaim N, Alabdulali R, et al. Polypharmacy among patients with diabetes: a cross-sectional retrospective study in a tertiary hospital in Saudi Arabia. BMJ open. 2018; 8(5):e020852.
  9. Keers RN, Williams SD, Cooke J, Walsh T, Ashcroft DM. Impact of interventions designed to reduce medication administration errors in hospitals: a systematic review. Drug safety. 2014; 37(5):317-32.