Definition and classification of medication errors according to Bates et al_ (1999)
| Process | Definition | Error types (Examples) |
|---|---|---|
| Ordering (handwritten) | Unambiguous prescription according to the five rights (right patient, medication, dose, application, time) | Illegible or incomplete prescription; omission of an order; wrong order such as wrong patient, wrong drug name, wrong drug formulation, wrong route, wrong dose regime and wrong application time |
| Ordering (by CPOE) | Unambiguous prescription according to the five rights (right patient, medication, dose, application, time) | Discrepancy in: the right medication such as drug name, right time, right dose, right patient, right route, and omissions of medications |
| Transcription (into the CPOE) | Identical transcription from the anaesthesia order to an EPR by an RN | Discrepancy in: the right medication such as drug name, right time, right dose, right patient, right route, and omissions of medications |
| Dispensing | Dispensing of medication according to a physician’s order | Unordered drug (wrong drug); unordered time, unordered dose, wrong patient, unordered route, and omission of medications |
| Administration | The right medication in the right dose to the right patient in the right application form and at the right time | Wrong medication; wrong administration time (± 30, 60 and 120 min); wrong dose; wrong patient; wrong route; omission of a dose and unordered drug or dose |
Frequency and type of medication errors
| Medication administration 371 (43.0%) N (%) | Physician ordering (CPOE) 198 (23.0%) N (%) | Medication dispensing 292 (34.0%) N (%) | |
|---|---|---|---|
| Wrong medication | 30 (8.1) | 19 (9.6) | 19 (6.5) |
| Wrong time | 291 (78.4) | 58 (29.3) | 48 (16.4) |
| Wrong dose | 10 (2.7) | 61 (30.8) | 34 (11.6) |
| Wrong patient | 7 (1.9) | 1 (0.5) | 3 (1.0) |
| Wrong route | 4 (1.1) | 19 (9.6) | 2 (0.7) |
| Omission | 29 (7.8) | 40 (20.2) | 186 (63.7) |
Sample characteristics
| Characteristics | |
|---|---|
| Registered Nurses | |
| Total number (%) | 88 (100) |
| Female (N, %) | 81 (92) |
| Male (N, %) | 7 (8) |
| Age (years) | M = 31.8; SD = 9.5 |
| Bachelor’s degree(N, %) | 7 (8) |
| Diploma (N, %) | 81 (92) |
| Overall work experience (years) Work experience on current ward (years) | M = 7.7; SD = 8.3 M = .8; SD = 5.0 |
| Patients | |
| Total number (%) | 1,087 (100) |
| Undergone surgery (N, %) | 768 (70.7) |
| Female (N, %) | 627 (57.7) |
| Male (N, %) | 460 (42.3) |
| Age (years) | M = 62.0; SD = 18.4 |
| Surgical disciplines (N, %) | |
| Orthopaedic | 387 (35.6) |
| Visceral surgery | 335 (30.8) |
| Spinal surgery | 158 (14.5) |
| Urological | 107 (9.8) |
| Gynaecological | 94 (8.6) |
| Ear-nose-throat | 6 (0.6) |
Medication Error Self Reporting Tool (adapted from Küng et al_, 2013)
| During my shift, one of the following medication-error-related events occurred (please mark with a cross) | ||||||
| Medication administration | □ | 1. I administered a wrong medication to a patient | ||||
2. I administered a medication at the wrong time:
| ||||||
| □ | 3. I administered a medication in a wrong dosage | |||||
| □ | 4. I administered a medication to the wrong patient | |||||
| □ | 5. I administered a medication in the wrong route | |||||
| □ | 6. I forgot to administer a medication | |||||
| Physician ordering with CPOE | □ | 7. A wrong medication was prescribed | ||||
| □ | 8. A medication prescription was ordered at the wrong time | |||||
| □ | 9. A medication prescription was ordered in a wrong dosage | |||||
| □ | 10. A medication prescription was ordered to the wrong patient | |||||
| □ | 11. A medication prescription was ordered the wrong route | |||||
| □ | 12. A medication was forgotten to prescribe | |||||
| Medication dispensing | □ | 13. At the medication control a prescribed medication was not dispensed | ||||
14. At the medication control I have found the following error:
| ||||||
| Anaesthesia ordering | 15. Have you controlled a prescription by anaesthesia during your shift pre-or postoperatively?
| |||||
| □ | 16. A medication prescription by anaesthesia was illegible | |||||
| □ | 17. A medication prescription by anaesthesia was incomplete | |||||
| □ | 18. A medication prescription by anaesthesia was wrong | |||||
| □ | 19. A medication prescription by anaesthesia was transcribed wrong | |||||
| Patient consequences | □ | 20. The medication error event had no consequences for the patient | ||||
| □ | 21. The medication error event had consequences for the patient. If yes, what are the consequences? (use the space below) | |||||
| Workload | 22. Please evaluate your workload of the present shift: | |||||
| 23. If the workload was high or very high, please write down the reason: | ||||||
| Shift | □ | 24. No medication error-related event happened to me during my shift | ||||
| 25. Please mark your shift: | ||||||
| Morning shift | Evening shift | Night shift | ||||