How common are errors in the medication process in a psychiatric hospital?
Background and purpose: Medication errors in psychiatric care is a problem in need of attention in Denmark. Studies are sparse and does not investigate all stages of the medication process. There is an urgent need for clarifying studies concerning prevalence and nature of medication errors in psychiatric care, as well as studies concerning associations related to medication errors. This is the basis for quality improving interventions in relation to medication safety in psychiatric care. The aim of this study was to asses frequency, type and potential clinical consequences of errors in all stages of the medication process in an inpatient psychiatric setting.
Methods and materials: A cross-sectional study in two general psychiatric wards and one acute psychiatric ward. Participants were eligible psychiatric in-hospital patients (n=67), physicians prescribing drugs and ward staff (nurses and nurses assistants) dispensing and administering drugs. The study was carried out using 3 methods of investigation – an observational study, an unannounced control visit and an audit of medical records. Medication errors were evaluated in terms of potential, clinical consequences, by two senior clinical pharmacologists. The evaluation was done in a worst-case scenario and did not include discharge summaries.
Results: Main outcome measures were frequency, type and potential severity of errors compared to the total number of opportunities for error. In total, 434 errors were detected in 1333 opportunities for error (33%). The rate of medication errors (with potential to harm patients) was 8% and 0.3% were considered potentially fatal. The frequency of errors was: Prescription: A) Computerized physician order entry (CPOE): 10/267 (4%), B) Electronic medical record (EMR): 245/251 (98%). Dispensing: 18/391 (5%). Administration: 142/340 (42%). Discharge summaries: 19/84 (23%). The most common errors were lack of documentation of informed consent in the EMR, omission of pro re nata (prn) dosing regime in the CPOE, omission of dose, lack of identity control and omission of drug.
Discussion and conclusion: Errors throughout the medication process in a psychiatric setting are common and as prevalent as the rates of errors found in somatic settings. The finding of errors in every third handling in the medication process points toward a continuing need for quality improvement in the psychiatric hospital setting. In this study, the prevalence of clinically important errors was 8% and 0.3% were considered potentially fatal. This indicates that the rate of potentially harmful errors in psychiatric hospitals is similar to the rate of potentially harmful errors found in somatic hospital settings but tends to be less serious. Errors in the administration stage constituted almost a third of all errors detected in the study and it appears that bar-coded medication administration could reduce administration errors. Medical staff needs further education in guidelines related to the medication process. Errors directly related to ward staff constituted 37% of all errors detected and consequently the nurses’ role in improving psychiatric medication safety should be further explored.
|Publikationsdato||6 mar. 2012|
|Status||Udgivet - 6 mar. 2012|
|Begivenhed||2nd Nordic Conference on Research in Patient Safety and Quality in Healthcare - København, Danmark|
Varighed: 6 mar. 2012 → 7 mar. 2012
|Konference||2nd Nordic Conference on Research in Patient Safety and Quality in Healthcare|
|Periode||06/03/12 → 07/03/12|