Transcript Evaluation of medication administration process in a paediatric ward

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MEDICATION ADMINISTRATION ERRORS
IN PAEDIATRIC WARD: OBSERVATIONAL
STUDY
Dr Zayed Alsulami
Paediatric Clinical Pharmacologist
Alkharj Military Hospital,
Alkharj, Saudi Arabia
22– 24 August, 2016
INTRODUCTION

Patient and medication safety is a concern of the
health professional and health care systems.

Medication safety issues are an important aspect of
the medication use process in hospitals.

Medication treatment process is a complicated
process.
INTRODUCTION

No one heads to work wanting to make an errors BUT
we are HUMAN.

Mistakes happen and human mistakes are a source of
medication errors.
MEDICATION TREATMENT PROCESS
Figure 1: Medication treatment stages
MEDICATION ERRORS DEFINITION

“ Any preventable event that may cause or lead to
inappropriate medication use or patient harm while the
medication is in the control of the health care professional,
patient or consumer. Such events may be related to
professional
practice,
healthcare
products,
communications,
product,
labelling,
packaging,
compounding, dispensing, distribution, administration,
education, monitoring and use” (DoH, 2004).
MEDICATION ERROR INCIDENCE RATE
Table 1: Medication Errors incidence rate in Europe
Medication stages
Error rates
Comments
Prescribing
0.3 – 9.1%
% of medication orders
Dispensing
1.6 – 2.1%
Administration
2.4 - 49.3%
Direct observation studies
Council of Europe, 2009
 Types of errors:
• Wrong dose.
• Wrong frequency of administration.
MIDDLE EAST COUNTRIES
Figure 2: Middle East countries
MEDICATION ERRORS IN THE MIDDLE EAST COUNTRIES
MEDICATION ERRORS IN THE MIDDLE EAST

Countries with data:
MEs studies in the Middle East countries
Number of studies
14
12
10
13
10
9
8
6
4
2
4
3
2
1
0
1
1
1
0
0
Country
Figure 3: Graph illustrating country origin of included studies
0
0
0
MEDICATION ERRORS IN THE MIDDLE EAST

Types of studies
27%
42%
Prescribing
Transcribing
Administration
Interventions
29%
2%
Figure 4: Studies classification by stage of medication
MEDICATION ERRORS IN THE MIDDLE EAST
Table 2: MEs incidence rate in Middle East
Medication stages
Error rates
Prescribing
7.1 – 90.5%
Dispensing
NAD
Administration
9.4 - 80%
Documentation
NAD
Comments
No Available Data
No Available Data
Alsulami, et al, 2012
MEDICATION ERRORS IN THE MIDDLE EAST



Studies related to MEs in the Middle East countries were few in
number.
There was a widely variation between studies in the incidence error
rates reported.
Most of the studies on MEs were conducted on adult patients, while
very few studies have been performed in paediatric patients.
MEDICATION ERRORS IN CHILDREN
Medication Administration Errors in Paediatric
Ward: Observational study
INTRODUCTION

Medication administration stage is the last stage in
the medication treatment process.

Nurses spend up to 40% of their time administering
medications.
STUDY OBJECTIVES

To evaluate how the paediatric nurses adhere
to the medication administration policy.

To identify any medication preparation and
administration errors.

Also, to identify any contributory factors that
may affect the administration process.
METHODS

Prospective, direct observational study of paediatric
nurses administering medication during their routine
practice.

16 steps were evaluated according to the hospital
medication administration policy.

Observation process was conducted during weekdays
only.
RESULTS
Table 1: Demographic information
Characteristic
Number of patients
Ward
90
Age (months), median (range)
27.6 (0.2 - 126)
Weight (in kg), median (range)
11 (2.3 - 51)
Number of oral drugs (% total)
145 (31.7%)
Number of IV drugs (% total)
193 (42.3%)
Number of inhaler drugs (% total)
118 (26%)
Total number of drugs administered
456 (100%)
%of each drug class`observed
RESULTS
45
40
35
30
25
20
15
10
5
0
41
26
6
5.3
Type of drug classes
1
0.4
RESULTS
Table 2: Adherence rate to policy steps
Policy step
Adherence rate n = 456
Adherence rate %
Two nurses
448
99.1
Vital signs
10
26.4
Drug name
446
98.7
Correct drug
456
100
Correct dosage form
456
100
Drug dose calculated
161
35
Expiry date
283
62.7
Correct volume
358
78.5
Correct IV rate
185
41.2
RESULTS
Table 2: Adherence rate to policy steps (Contd.)
Policy step
Adherence rate n = 456
Adherence rate %
Correct time
425
94.2
Correct label
416
91.2
Correct route
440
96.4
Patient ID
439
96.2
7
1.6
Admin to the patient
398
87.2
Sign to the drug chart
428
93.8
Allergy
RESULTS
Table 3: Medication administration errors reported
Type of error
Drug drops out
Wrong time
Drug given to
mothers
Preparation errors
Wrong doses
Example
No. of errors
Nurses drop out few drops of Vancomycin IV
dose
19
Augmentin IV dose was given 2:18 hr late from
prescribed time.
18
Domperidone dose was given to the mother
without observing at administration
15
Predinosolone tablet was crushed to be
prepared as solution, nurses did not add enough
quantity of water and also did not mix the
content properly.
5
Ceftriaxon IV 300 mg dose was given by nurses
instead to 150 mg in drug chart (dose reduced
by doctor in drug chart)
2
RESULTS

Antibacterial drugs were the most common drug class administered and
observed (41%).

Out of 16 steps observed, 7 steps were reported to have lower adherence
rate.

In total, 63 medication administration errors were detected during the study
period.

The incidence error rate is 13.8%

The most common error reported was involved nurses drop out few drops of
IV medication before administration, followed by wrong time of
administration.
RESULTS

Risk factors affect nurses’ adherence to policy:

Medication administration policy steps need to be more clarified for the
nurses.

Some of the logistics and administrative issues affects on the nurses
adherence to the policy.

Shortage in some of instruments that used in drug administration process.

Shortage in the number of paediatric nurses in the ward ( 1 nurse to each 5
patients).
CONCLUSION
X
The medication administration policy and procedure need an urgent revision
to be more applicable for nurses in practice.
X
Paediatric nurses knowledge and skills regarding to drug information and
administration process should be improved.
We can’t change the human condition, but we
can change conditions under which humans
work.
Thank you!
Dr Zayed Alsulami
[email protected]
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