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Incidence and severity of intravenous drug errors in a German hospital.

Abstract：

OBJECTIVE:To determine the incidence of errors in preparing and administering intravenous (i.v.) drugs, identify the stages in the process at which errors occurred and evaluate their clinical importance. METHODS:A prospective ethnographic study using disguised observation was carried out on two wards in one German non-university hospital. RESULTS:We observed 22 nurses administering 122 i.v. drug preparations and administrations. One or more errors occurred in the preparation and administration of 58 of 122 i.v. drug doses (error rate 48%, 95% confidence interval 39-57%). In total, 65 errors were identified. Of doses, 4 had potentially severe errors (3%), 38 (31%) potentially moderate errors and 16 (13%) potentially minor errors. Common errors included multiple step preparations and the co-administration of potentially incompatible drugs as intermittent infusions. CONCLUSION:A high incidence of i.v. drug errors was found in the study hospital. Effective strategies to reduce potentially harmful errors are urgently needed. Measures could include a reduction in the number of ward-based i.v. drug preparations, improvement of staff training and the introduction of ward-based clinical pharmacy services.

journal_name

Eur J Clin Pharmacol

journal_title

European journal of clinical pharmacology

authors

Taxis K,Barber N

doi

10.1007/s00228-003-0689-9

subject

Has Abstract

pub_date

2004-01-01 00:00:00

pages

815-7

issue

11

eissn

0031-6970

issn

1432-1041

journal_volume

59

pub_type

杂志文章

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