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All authors declared that they have no competing interests: no support from any organization for the submitted work; no financial relationships with any organization that might have an interest in the submitted work in the previous five years; no other relationships or activities that could appear to have influenced the submitted work. SB as PhD student was funded by HMR Expert and a grant from AP-HP (from November 2010 to October 2011) but none of these funds has influenced the submitted work.
SB, BS, FG, TC, PP and PD conceived and planned the work that led to the manuscript. SB made substantial contributions in the acquisition, analysis and interpretation of the data. FG performed data analysis made substantial contributions in the interpretation of the data. BS and PD made substantial contributions in the interpretation of the data.
SB wrote the first draft of the report. All authors were involved in drafting and revising the various drafts of the report with substantive suggestions. All authors read and approved the final manuscript.
Medication errors can occur at any of the three steps of the medication use process: prescribing, dispensing and administration. We aimed to determine the incidence, type and clinical importance of drug administration errors and to identify risk factors.
Prospective study based on disguised observation technique in four wards in a teaching hospital in Paris, France (800 beds). A pharmacist accompanied nurses and witnessed the preparation and administration of drugs to all patients during the three drug rounds on each of six days per ward. Main outcomes were number, type and clinical importance of errors and associated risk factors. Drug administration error rate was calculated with and without wrong time errors. Relationship between the occurrence of errors and potential risk factors were investigated using logistic regression models with random effects.
Twenty-eight nurses caring for 108 patients were observed. Among 1501 opportunities for error, 415 administrations (430 errors) with one or more errors were detected (27.6%). There were 312 wrong time errors, ten simultaneously with another type of error, resulting in an error rate without wrong time error of 7.5% (113/1501). The most frequently administered drugs were the cardiovascular drugs (425/1501, 28.3%). The highest risks of error in a drug administration were for dermatological drugs. No potentially life-threatening errors were witnessed and 6% of errors were classified as having a serious or significant impact on patients (mainly omission). In multivariate analysis, the occurrence of errors was associated with drug administration route, drug classification (ATC) and the number of patient under the nurse's care.
Medication administration errors are frequent. The identification of its determinants helps to undertake designed interventions.