AN INVESTIGATION OF ERRORS: THE PREPARATION AND ADMINISTRATION OF PARENTERAL MEDICATIONS IN AN INTENSIVE CARE UNIT OF A TERTIARY TEACHING HOSPITAL IN MALAYSIA
Objective: This study was carried out to investigate the incidence, types, and factors associated with parenteral medication preparation/administration errors. The study also investigates the concentration accuracy of prepared drug infusions and the adherence to good practices by the nurses.
Methods: This was a prospective study conducted in a general intensive care unit (GICU) of a tertiary teaching hospital in Malaysia, using an observation method. The preparation and administration of the parenteral medications by the nurses were observed, and the details were recorded using a standard checklist. The drug infusions (noradrenaline) prepared by the nurses were collected for a concentration analysis using a high-performance liquid chromatography (HPLC).
Results: This study found that 79% of the parenteral medications prepared and administered had one or more error. There were 33% doses with 2 or more errors while 6% doses contained 3 errors. The most common errors involved incorrect drug preparation (57%), followed by incorrect administration rate (33%). There was no double-checking performed in the preparation/administration of all (100%) parenteral doses. In terms of concentration accuracy, 48% of the prepared drug infusions contained errors. Failure to label syringe properly was found to result in more errors per dose (P<0.001).
Conclusion: Error during preparation and administration of parenteral medications is common in Malaysiaâ€™s intensive care unit setting. Incorrect drug preparation and wrong administration rate were both error â€˜hot spotsâ€™ identified in this study, and must be targeted for intervention. Some of the recommendations to improve parenteral medication safety include providing education, centralised admixture services, and interdisciplinary collaboration.
Keywords: Medication error, Nurses, Parenteral medication, Intensive care unit, Observation
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