Table 2

Percentages of errors at each stage

Error descriptionStageMedian (95% credible interval)
Error in obtaining drugStage 15.34 (2.59 to 10.3)
Error in obtaining diluentStage 26.78 (3.02 to 14.1)
Error in reconstituting drug and diluentStage 331.0 (11.8 to 49.6)
Error in checking patient's identityStage 40.07 (0.01 to 1.00)
Error in checking for patient allergiesStage 515.1 (0.09 to 57.5)
Error in checking route of drug administrationStage 60.50 (0.12 to 1.19)
Error in checking drug doseStage 74.11 (1.81 to 8.50)
Error in checking patency of cannulaStage 84.51 (0.62 to 40.3)
Error in expelling air from syringeStage 91.00 (0.13 to 7.58)
Error in administering drugStage 1021.7 (6.51 to 48.8)
Error in flushing cannulaStage 115.50 (0.54 to 20.5)
Error in signing prescription chartStage 125.34 (0.55 to 20.2)
Omission error3.45 (0.84 to 10.1)