Evaluation of drug administration errors in a teaching hospital

<p>Abstract</p> <p>Background</p> <p>Medication errors can occur at any of the three steps of the medication use process: prescribing, dispensing and administration. We aimed to determine the incidence, type and clinical importance of drug administration errors and to identify risk factors.</p> <p>Methods</p> <p>Prospective study based on disguised observation technique in four wards in a teaching hospital in Paris, France (800 beds). A pharmacist accompanied nurses and witnessed the preparation and administration of drugs to all patients during the three drug rounds on each of six days per ward. Main outcomes were number, type and clinical importance of errors and associated risk factors. Drug administration error rate was calculated with and without wrong time errors. Relationship between the occurrence of errors and potential risk factors were investigated using logistic regression models with random effects.</p> <p>Results</p> <p>Twenty-eight nurses caring for 108 patients were observed. Among 1501 opportunities for error, 415 administrations (430 errors) with one or more errors were detected (27.6%). There were 312 wrong time errors, ten simultaneously with another type of error, resulting in an error rate without wrong time error of 7.5% (113/1501). The most frequently administered drugs were the cardiovascular drugs (425/1501, 28.3%). The highest risks of error in a drug administration were for dermatological drugs. No potentially life-threatening errors were witnessed and 6% of errors were classified as having a serious or significant impact on patients (mainly omission). In multivariate analysis, the occurrence of errors was associated with drug administration route, drug classification (ATC) and the number of patient under the nurse's care.</p> <p>Conclusion</p> <p>Medication administration errors are frequent. The identification of its determinants helps to undertake designed interventions.</p

Les erreurs d administration des médicaments à l hôpital

Le circuit du médicament implique de nombreux intervenants et est à l origine d erreurs potentielles à chaque étape (prescription médicale, dispensation pharmaceutique et administration par les Infirmiers Diplômés d Etat (IDE)). Dans ce travail, nous nous sommes focalisés sur l étape d administration des médicaments. L objectif final de ce travail était de mettre en place une intervention pour sécuriser l administration des médicaments. Pour ce faire, nous avons d abord réalisé une revue systématique du taux d erreurs d administration détecté par la technique d observation des IDE, afin de quantifier ces erreurs dans la littérature. Elle montre un taux d erreurs variant de 20 à 26% selon le dénominateur utilisé. Dans un deuxième temps, nous avons mené une étude d observation de l administration des médicaments dans notre établissement afin d établir le taux d erreurs d administration. Nos résultats sont comparables à ceux de la littérature avec un taux d erreurs de 28%. Différentes interventions pour réduire ces erreurs ont été décrites. Aux Etats-Unis, Poon a mené une étude d'intervention avant-après utilisant un système de lecture du code à barres de la dose de médicament avant administration au patient pour évaluer son efficacité sur la diminution des erreurs d'administration (Poon NEJM 2010). Les auteurs soulignent l'importance d'évaluations dans d'autres systèmes de santé. Ainsi, nos travaux actuellement en cours consistent en une revue systématique concernant les interventions mises en place pour réduire ces erreurs et une étude d intervention de sécurisation de l administration des médicaments par lecture optique (projet accepté au PREPS 2012).Medication use process involves several healthcare professionals. Medication errors can arise at any stage during the medication use process: from prescription, dispensing to administration to the patient. In this work, we focused on drug administration. Our final goal was to set up an intervention study to secure the administration process. To reach this goal, we divided our work in 3 axes. First, we conducted a systematic review on drug administration errors to evaluate errors rates in the literature. The median errors rates reach 20-26%. Then, we conducted a prospective study in our hospital to evaluate the errors rate. The administration errors rate reached 28%, quite similar to the results of the review. Several interventions to reduce errors were described. Effectiveness of bar-code technology at the patient bedside was evaluated on administration errors reduction in a before and after study (Poon NEJM 2010). Authors mentioned that other evaluations are needed. Finally, the work in progress consists on a systematic review on interventions to reduce administration errors and an intervention study using bar-code technology in our hospital.PARIS-BIUSJ-Biologie recherche (751052107) / SudocSudocFranceF

Erreurs lors de l'administration des médicaments (revue systématique et analyse à l'Hôpital européen Georges Pompidou)

PARIS-BIUP (751062107) / SudocSudocFranceF

Medication errors may be reduced by double-checking method

International audienceNo abstract availabl

Étude qualitative des systèmes automatisés de préparation de doses unitaires traçables informatiquement par lecture optique

CHATENAY M.-PARIS 11-BU Pharma. (920192101) / SudocSudocFranceF

Association Between Exposure to Effervescent Paracetamol and Hospitalization for Acute Heart Failure: A Case-Crossover Study

International audienceWe investigated whether effervescent paracetamol, as an important source of nondietary sodium and fluid load, is associated with a transient increase in the risk of hospitalization for acute heart failure (AHF). We conducted a unidirectional case-crossover study using data from the 1 in 97th representative sample from the French health care database. Subjects aged ≥18 years, hospitalized for AHF during the 2014-2016 period, were included. Exposure to effervescent paracetamol was compared between a risk period (ie, 15 days immediately before admission for AHF) and 3 earlier 15-day control periods, to test a possible trigger effect of effervescent paracetamol intake on AHF. Adjusted odds ratios (aORs) were estimated with a conditional logistic regression. We identified 4301 patients hospitalized for AHF. We found that 5.7% of AHF subjects were exposed to effervescent paracetamol during the risk period, as compared with 4.1% during the control periods (aOR, 1.56 [95% confidence interval [CI], 1.27-1.90]; P < .001). This association was also found in the subgroup of subjects with hypertension (aOR, 1.45 [95%CI, 1.13-1.87]; P = .004, n = 2648) and in the subgroup of subjects aged ≥83 years (aOR, 1.70 [95%CI: 1.28-2.24], P < .001, n = 2238). A similar analysis, considering exposure to noneffervescent paracetamol, did not support the existence of an indication bias likely to explain the association observed for effervescent paracetamol. This study suggests an association between effervescent paracetamol and admission for AHF and should be confirmed with other complementary study designs

Effects of a multifaceted intervention to promote the use of intravenous iron sucrose complex instead of ferric carboxymaltose in patients admitted for more than 24 h

International audiencePurposeAlthough more practical for use, the impact of ferric carboxymaltose (FCM) on the hospital budget is considerable, and intravenous iron sucrose complex (ISC) represents a cost-saving alternative for the management of iron deficiency anemia in patients during hospitalization. The Drug Committee decided to reserve FCM for day hospitalizations and contraindications to ISC, especially allergy. ISC was available for prescription for all other situations.MethodsThe impact of a multifaceted intervention promoting a switch from FCM to ISC was evaluated using an interrupted time series model with segmented regression analysis. The standardized rate of the dispensing of FCM, ISC, and oral iron by the hospital pharmacy, as well as the rate of the dispensing of packed red blood cells and the number of biological iron status measurements, was analyzed before and after the intervention.ResultsThere was an immediate decrease in FCM consumption following the intervention, with a reduction of 88% (RR: 0.12 [CI95% 0.10 to 0.15]). Conversely, there was a large increase in ISC use (RR: 5.1 [CI95% 4.4 to 5.9]). We did not observe a prescription shift to packed red blood cells or oral iron after the intervention. The time series analysis showed the frequency of iron status testing to remain stable before and after. The direct savings for intravenous iron for 8 months were 187,417.54 €.ConclusionOur intervention to lower the impact of intravenous iron therapy on the hospital budget was effective

Impact of drug storage systems: a quasi-experimental study with and without an automated-drug dispensing cabinet

International audienc