Elsevier

Journal of Critical Care

Volume 28, Issue 4, August 2013, Pages 451-460
Journal of Critical Care

Administration
Effects of the implementation of a preventive interventions program on the reduction of medication errors in critically ill adult patients,☆☆

https://doi.org/10.1016/j.jcrc.2012.11.011Get rights and content

Abstract

Purpose

Medication errors (MEs) are a major factor limiting the effectiveness and safety of pharmacological therapies in critically ill patients. The purpose was to determine if a preventive interventions program (PIP) is associated with a significant reduction on prevalence of patients with MEs in intensive care unit (ICU).

Methods

A prospective before-after study was conducted in a random sample of adult patients in a medical-surgical ICU. Between 2 observational phases, a PIP (bundle of interventions to reduce MEs) was implemented by a multidisciplinary team. Direct observation was used to detect MEs at baseline and postintervention. Each medication process, that is, prescription, transcription, dispensing, preparation, and administration, was compared with what the prescriber ordered; if there was a difference, the error was described and categorized. Medication errors were defined according to the National Coordinating Council for Medication Error Reporting and Prevention.

Results

A total of 410 medications for 278 patients were evaluated. A 31.7% decrease on the prevalence of patients with MEs (41.9%-28.6%; P < .05) was seen. Main variations occurred in anti-infectives for systemic use and prescription and administration stage.

Conclusions

The implementation of PIP by a multidisciplinary team resulted in a significant reduction on the prevalence of patients with ME at an adult ICU.

Introduction

Medication errors (MEs) are the most common clinical error and account for 78% of serious clinical errors in the ICU [1]. In addition, MEs represent the main factor limiting the effectiveness and safety of pharmacotherapy [2]. Such errors may occur at any stage of the medication use procedure, namely, during prescription, transcription, preparation, dispensing, or administration [3].

It is known that patients in intensive care units (ICUs) experience approximately 1.7 clinical errors every day and many of them are exposed to potentially fatal errors during hospital stay [3].

Patient safety is critical in the ICU, but the complexity of processes and the medical conditions of patients make them more vulnerable to errors [4]. Indeed, ICU patients normally use twice as many medications as those with less complex problems. In addition, medications are administered mainly through parenteral routes and often require complicated mathematical calculations to establish optimal doses, which increase the potential for MEs [5].

Several international studies have assessed MEs prevalence in the ICU, and results vary widely [6], [7], [8], [9], mainly due to differences in methodology, ME definitions, and reporting [8]. Recently, a multinational study reported a 33% of MEs prevalence over parenteral drug administration using voluntary reporting [7].

Availability of ME-related information enables the assessment of processes more prone for generating errors [9], [10]. Only a few studies conducted in Latin American countries allow the identification of part of the processes and causes most responsible for errors. Those studies have been carried out in hospitalized patients in Brazil [11], [12], [13], Mexico [14], Uruguay [15], and Argentina [16], reporting ME rates to a specific stage of medication process and different setting than adult ICU. In addition, medical record review has been the method mainly used for detecting MEs [17]. Direct observation has demonstrated being the best method for detecting and counting the frequency of MEs [18].

In Chile, there are no data published on MEs. In addition, multidisciplinary interventions including pharmacist and related to medication use practices are infrequent due to pharmacists are not included as a permanent staff of the ICU or an active participant in clinical rounds.

Until now, there are no data from Latin American countries estimating the prevalence of patients with MEs and MEs rate in every stage of process of medication use. The purpose of this study was to determine if the implementation of formal, structured preventive intervention program (PIP) by a multidisciplinary team to improve medication use in an ICU is in fact associated with a significant reduction on the prevalence of patients with MEs.

Section snippets

Methods

Hospital Clínico Universidad de Chile is a tertiary care teaching hospital (600 beds) located in Santiago, capital of Chile, a developing country in Latin America. In this hospital, drugs are dispensed from the pharmacy using unit-dose drug distribution system, and once drugs are received by the nursing staff, any additional preparation process is performed by them before administration. The present study was carried out in the medical-surgical adult ICU (12 beds) where approximately 500

Results

A total of 278 patients were assessed, of whom 124 (44.6%) were included in the sample selected at baseline in 2009, and 154 (55.4%) patients at the postintervention assessment in 2011. When comparing the study samples (control and postintervention groups), statistically significant differences were noted with the mean age (51.1 vs 60.9 years, P < .05). There were no significant differences for the other variables. Demographic data concerning morbidity for each assessment year are shown in

Discussion

It has been reported that critical patients have a higher risk of MEs by virtue of (a) usually being under sedation, making it more difficult for the provider to detect possible adverse event due to error; (b) receiving a large numbers of different medications; and (c) receiving mainly parenteral medications, requiring calculations for their administration [26]. Therefore, safe management of medication is particularly challenging because of the complexity of the different stages involved in

Conclusion

The implementation of a formal and structured PIP by a multidisciplinary team was associated with a significantly reduction of the prevalence of patients with ME in an adult medical-surgical ICU.

Acknowledgments

We thank Thomas Einarson, PhD, for his critical appraisal of the manuscript and the staff of ICU at Hospital Clínico Universidad de Chile, for their excellent attitude and willingness to improve healthcare safety and quality at our institution.

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    Disclosure: The authors declare no conflicts of interest.

    ☆☆

    Funding: This study was not funded.

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