A Prospective Observational Study of Medication Errors in a Tertiary Care Emergency Department
Received 23 October 2009; received in revised form 18 November 2009; accepted 11 December 2009. published online 15 January 2010. Corrected Proof
Study objective
We determine the rate and severity of medication errors, as well as factors associated with error occurrence in the emergency department (ED).
Methods
This was a prospective observational study conducted between May 1, 2008, and February 1, 2009. The pharmacist observer was present in the ED for 28 shifts (12 hours each). Information was collected on the medication use process by observing the activities of nurses caring for the patients. Errors were categorized by severity. Logistic regression was used to analyze factors associated with a risk of medication error.
Results
The observer identified 178 medication errors in 192 patients during the data collection period. At least 1 error occurred in 59.4% of patients, and 37% of patients overall had an error that reached them. No errors in the study resulted in permanent harm to the patient or contributed to initial or prolonged hospitalization; however, interventions were performed to prevent patient harm that likely influenced the severity of error. Errors categorized according to stage were prescribing (53.9%), transcribing (10.7%), dispensing (0.6%), and administering (34.8%). Variables predictive of medication errors were boarded patient status (odds ratio [OR] 2.15; 95% confidence interval [CI] 1.03 to 4.5), number of medication orders (OR 1.25; 95% CI 1.12 to 1.39), number of medications administered (OR 1.22; 95% CI 1.07 to 1.38), and nursing employment status (less error if full time) (OR 0.37; 95% CI 0.16 to 0.86).
Conclusion
Medication errors in the ED are common, and most errors occur in the prescribing and administering phases. Boarded patient status, increasing number of medications orders, increasing number of medications administered, and part-time nursing status are associated with an increased risk of medication error.
aDepartment of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ
bDepartment of Emergency Medicine, University of Arizona, Tucson, AZ
Address for correspondence: Brian L. Erstad, PharmD, Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, 1295 N Martin, PO Box 210202, Tucson, AZ 85721-0207; 520-694-5600, fax 520-626-7355
Please see page XX for the Editor's Capsule Summary of this article.
Supervising editor: Robert L. Wears, MD, MS
Author contributions: AEP, TLW, ABS, and BLE conceived and designed the study. AEP performed all data collection. AEP and BLE conducted data analysis and drafted the article. TLW and ABS contributed substantially to its revision. AEP takes responsibility for the paper as a whole.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This research was supported by a junior investigator grant from the American Society of Health-System Pharmacists Foundation.
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