Assessment of inpatients omission errors made by nurses throughout the medication administration process

Abstract

Omission error defined as, failure to administer an ordered dose to a patientaccording to the American Society of HealthSystem Pharmacists.1 Medication errors (prescribing, transcribing, dispensing and administration errors) are an important cause of patient morbidity and mortality.2 Medication administration errors are a common sub-type of medication errors and accounted for 34% of errors in one large USA study conducted in medical and surgical units A recent report of the Institute of Medicine suggests that at least 44,000 and perhaps as many as 98,000 Americans die each year in hospitals as a result of medical errors.3 Over half of these errors were medication errors, defined as 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 or patient.4 Observational studies in general hospitals have yielded error rates varying between 3.5 and 27% of doses.5–8 Direct observation detects medication administration errors at a much higher rate than chart review or incident report review.8 The observational method has been demonstrated to be valid and reliable.9 A review of drug administration errors detected by the observation technique10 revealed methodological limitations in studies evaluating the administration process: no standardized definition of error types and error rate, lack of information about the selection method of nurses observed and number of nurses observed, the level of experience of nurses, the number of patients or information on the observation technique.5,8,11–23 Nurses may spend up to one third Pepper24 of their time on medicationrelated activities, and because of the relative lack of safeguards to prevent MEs, both nurses and patients are placed at high risk during this stage of the medication use process (Elliott and Liu 2010).25 The observation technique has been described as one of the better methods for the detection of MAEs.26,27 In March 2017, we published the first observation, pre and post intervention based study of medication administration errors carried out in a pediatric ward.28 It is the first study in Pakistan which conducted in the pediatric inpatients by the way of assessment of omission errors. The objective of this study was to evaluate the omission errors in pediatric medicine ward.