Izadpanah Fatemeh, Nikfar Shekoufeh, Bakhshi Imcheh Freshteh, Amini Mina, Zargaran Marzieh
Food and Drug Administration of Iran, Tehran, Iran.
Iran Council for Review and Formulation of Drugs, Tehran, Iran.
J Med Life. 2018 Oct-Dec;11(4):299-305. doi: 10.25122/jml-2018-0046.
Medical errors and adverse events are among the major causes of avoidable deaths and costs incurred on health systems all over the world. Medical errors are among the main challenges threatening the safety of patients in all countries and one of the most common types of medical errors is medication errors. This study aimed to determine the frequency, type, and causes of medication errors in the emergency and pediatric wards of hospitals affiliated to Tehran University of Medical Sciences in 2017. This study was a cross-sectional descriptive study which was conducted on 423 nurses working in teaching hospitals affiliated to Tehran University of Medical Sciences in 2017. The subjects were selected using the stratified sampling method. A total of 49 teaching hospitals in Tehran are affiliated to Tehran University of Medical Sciences and they are divided into two groups of general and specialized hospitals. Of all, 10 general hospitals and 14 specialized hospitals were randomly selected. The required data was collected using a three-part questionnaire. Using the SPSS software (version 18), the collected data was analyzed by means of ANOVA, Pearson Correlation Coefficient, and t-test and the results were reported as frequency, percentage, mean, and standard deviation. According to the results of this study, the mean total number of medication errors that occurred within one month in the pediatric and emergency wards was roughly 41.9 cases, as stated by the nurses. The mean number of medication errors was higher in men than in women. Also, the two variables of gender and the type of shift work were related to medication errors; specifically, it was higher first in the evening and night shifts and then in the morning and evening shifts, respectively. Also, the number was higher in night shifts than in the morning shifts. The most common types of medication errors were: administration of the drugs at the wrong time, using a wrong technique of administration, wrong dosage, forgetting the dosage of the drug, administrating additional doses, administrating the drug to a wrong patient, and following the oral orders of physicians. On the other hand, the most common causes of medication errors in clinical wards were the following: illegible physician orders, shortage of manpower and high workload, incomplete physician orders, the use of lookalike and sound-alike drugs, absence of pharmacist/pharmaceutical expert in the ward, lack of dosage forms appropriate for children, and lack of adequate training regarding drug therapy. Considering the results of this study, it is necessary to reduce the workload and working hours of nurses, increase medical staff's awareness of the significance of medication errors, revise the existing techniques of drug prescription, and update the indices of human resource in hospitals. It is also necessary to correct the process of naming and selecting the dosage forms of drugs by the industry.
医疗差错和不良事件是全球可避免死亡及卫生系统成本增加的主要原因之一。医疗差错是威胁各国患者安全的主要挑战之一，而用药差错是最常见的医疗差错类型之一。本研究旨在确定2017年德黑兰医科大学附属医院急诊科和儿科病房用药差错的发生率、类型及原因。 本研究为横断面描述性研究，于2017年对德黑兰医科大学附属医院的423名护士进行。采用分层抽样方法选取研究对象。德黑兰共有49家隶属于德黑兰医科大学的教学医院，分为综合医院和专科医院两组。其中，随机选取10家综合医院和14家专科医院。所需数据通过一份由三部分组成的问卷收集。使用SPSS软件（版本18），通过方差分析、Pearson相关系数和t检验对收集到的数据进行分析，并将结果以频数、百分比、均值和标准差的形式报告。 根据本研究结果，护士表示儿科和急诊科病房一个月内发生的用药差错总数平均约为41.9例。男性的用药差错平均数高于女性。此外，性别和轮班工作类型这两个变量与用药差错有关；具体而言，用药差错数首先在晚班和夜班较高，然后分别在早班和中班较高。而且，夜班的用药差错数高于早班。最常见的用药差错类型有：给药时间错误、给药技术错误、剂量错误、忘记给药剂量、重复给药、给错患者用药以及执行医生口头医嘱。另一方面，临床病房用药差错最常见的原因如下：医生医嘱字迹不清、人力短缺和工作量大、医生医嘱不完整、使用外观相似和发音相似的药物、病房缺乏药剂师/药学专家、缺乏适合儿童的剂型以及缺乏关于药物治疗的充分培训。 考虑到本研究结果，有必要减少护士的工作量和工作时间，提高医务人员对用药差错重要性的认识，修订现有的药物处方技术，并更新医院的人力资源指标。还需要纠正制药行业药品剂型命名和选择的流程。
