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 Malaysia's intensive care unit setting. Incorrect drug preparation and wrong administration rate were both error â€˜hot spots' 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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