Tan Shirlyn, Teh Lih Jiuan, Mohd Mokhtaruddin Safura, Henry Basil Josephine
Department of Pharmacy, Hospital Tengku Ampuan Rahimah, Ministry of Health Malaysia, Jalan Langat, Klang, Selangor 41200, Malaysia.
Department of Pharmacy, Hospital Banting, Ministry of Health Malaysia, Jalan Sultan Alam Shah, Banting, Selangor 42700, Malaysia.
Int J Qual Health Care. 2025 Feb 18;37(1). doi: 10.1093/intqhc/mzaf012.
Medication administration in busy emergency departments (EDs) presents significant challenges due to the high-pressure environment and complexity of processes. Medication administration errors (MAEs) are a critical concern as they can severely impact patient safety and increase healthcare costs. Understanding the prevalence and underlying factors contributing to intravenous MAEs is essential for enhancing patient care and improving hospital services. This study aims to explore and measure the frequency of intravenous MAEs in EDs and identify factors contributing to these errors during their preparation and administration.
This prospective study utilized the direct observation technique where the preparation and administration of 222 intravenous medications were observed in the EDs of two hospitals in Malaysia. Information on medication preparation, administration, and other procedures was recorded. Error rates were calculated, and multivariable logistic regression was conducted to identify factors contributing to intravenous MAEs.
MAEs were detected in 83.3% (185/222) of the observed medications affecting 86.7% (124/143) patients. Among these, a total of 240 MAEs were identified, with the most common being wrong rate of administration (55.8%), wrong preparation technique (20.8%), and omission error (11.7%). Alimentary tract and metabolism medications accounted for the highest proportion of MAEs (52.0%), followed by anti-infective medications (21.7%) and nervous system medications (15.4%). Excluding wrong time errors reduced the error rate to 80.2% (178/222). Nonverbal orders and inadequate or absence of labelling were significantly associated with MAEs, while factors such as the complexity of preparations, working shift, experience, and high-alert medications showed no significant associations.
The study highlighted a high prevalence of intravenous MAEs in EDs. Nonverbal orders and inadequacy in labelling of medications were significant contributing factors to MAEs in the ED. Implementing an admixture labelling policy, comprehensive training programmes, strict enforcement of existing guidelines and protocols through regular audits, establishing nonpunitive error reporting system, and technological solutions where financially feasible are crucial for mitigating these errors to promote patient safety.
由于急诊部门工作环境压力大且流程复杂，繁忙的急诊科给药面临重大挑战。给药错误是一个关键问题，因为它们会严重影响患者安全并增加医疗成本。了解静脉给药错误的发生率及其潜在因素对于提高患者护理质量和改善医院服务至关重要。本研究旨在探索和测量急诊科静脉给药错误的发生率，并确定在药物准备和给药过程中导致这些错误的因素。
这项前瞻性研究采用直接观察技术，在马来西亚两家医院的急诊科观察了222例静脉用药的准备和给药情况。记录了有关药物准备、给药及其他程序的信息。计算错误率，并进行多变量逻辑回归分析以确定导致静脉给药错误的因素。
在观察的药物中，83.3%（185/222）检测到给药错误，影响了86.7%（124/143）的患者。其中，共识别出240例给药错误，最常见的是给药速度错误（55.8%）、准备技术错误（20.8%）和遗漏错误（11.7%）。消化道和代谢药物的给药错误占比最高（52.0%），其次是抗感染药物（21.7%）和神经系统药物（15.4%）。排除给药时间错误后，错误率降至80.2%（178/222）。口头医嘱以及标签不足或缺失与给药错误显著相关，而诸如准备工作的复杂性、工作班次、经验和高警示药物等因素未显示出显著关联。
该研究突出了急诊科静脉给药错误的高发生率。口头医嘱和药物标签不足是急诊科给药错误的重要促成因素。实施混合标签政策、全面的培训计划、通过定期审核严格执行现有指南和规程、建立无惩罚性的错误报告系统以及在经济可行的情况下采用技术解决方案对于减少这些错误以促进患者安全至关重要。
