International Journal for Quality in Health Care Advance Access originally published online on August 22, 2005
International Journal for Quality in Health Care 2005 17(5):381-389; doi:10.1093/intqhc/mzi066
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Drug administration errors and their determinants in pediatric in-patients
1 Pharmacy, 2 Public Health, 3 Neonatal Intensive Care Unit, 4 Nephrology Unit, 5 Intensive Care Unit, and 6 General Paediatrics Unit, Hôpital Robert Debré AP-HP, Paris, France
Objective. To quantify the type and frequency of drug administration errors to pediatric in-patients and to identify associated factors.
Design. Prospective direct-observation study of drug administration errors from April 2002 to March 2003.
Setting. Four clinical units in a pediatric teaching hospital.
Study participants. Twelve observers accompanied nurses giving medications and witnessed the preparation and administration of all drugs to all patients on all weekday mornings.
Intervention. None
Main outcome measure. Discrepancies between physicians’ orders and actual drug administration.
Results. During the 1719 observed administrations to 336 patients by 485 nurses, 538 administration errors were detected, involving timing (36%), route (19%), dosage (15%), unordered drug (10%), or form (8% form). These errors occurred for 467 (27%) of the 1719 administrations. Intravenous drugs (OR = 0.28; CI = 0.16–0.49; versus miscellaneous) were associated with fewer errors. Error rates were higher for cardiovascular (OR = 3.38; CI = 1.24–9.27; versus miscellaneous) and central nervous system drugs (OR = 2.65; CI = 1.06–6.59; versus miscellaneous); unspecified dispensing system (OR = 2.06; CI = 1.29–3.29; versus store in the unit); nonintravenous nonoral administration (OR = 4.44; CI = 1.81–10.88; versus oral administration); preparation by the pharmacy (OR = 1.66; CI = 1.10–2.51); and administration by a hospital pool nurse, temporary staffing agency nurse, or nurse intern (OR = 1.67; CI = 1.04–2.68; versus registered full-time nurse). Each additional management procedure in the patient increased the risk of error (OR = 1.22; CI = 1.01–1.48).
Conclusions. The risk factors identified in our study should prove useful for designing preventive strategies, thereby improving the quality of care.
Keywords: clinical pharmacy, hospital care, medication errors, nurse clinics, observation, pediatrics,, risk assessment
Address reprint requests to Jean Eudes Fontan, Pharmacie, Hopital Jean Verdier AP-HP, av. 14 Juillet 93143 Bondy cedex, France. E-mail: jean-eudes.fontan{at}jvr.ap-hop-paris.fr
Accepted for publication July 6, 2005.
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