Elena Bohomol, Lais Helena Ramos

¶ … Elena Bohomol, Lais Helena Ramos and Maria D'Innocenzo entitled "Medication errors in an intensive care unit" (Bohomol, Ramos, & D'Innocenzo, 2009). This article represents a quantitative survey that looks at rates of medication errors in an intensive care setting that studies 44 patients for 30 days. The actual exploratory survey was conducted in 2006 in Brazil.

Medication errors are common in nearly all patient care environments across the world (Kliger, 2010). When judgments are left up to human decision alone, then some level of error is nearly inevitable (Drach-Zahavy & Pud, 2010). When medication orders are given orally then this creates another dimension of potential errors (Lambert et al., 2010). The greater the amount of various medications that a patient consumes leads to the greater the potential for error in administration. Therefore the elderly patients are in a particularly high risk category (Verrue et al., 2010)

The question that arises is frequency of occurrences in which errors take place and also designing systems to minimize the prevalence of occurrences. The nursing profession will undoubtedly adopt increasingly rigorous system implementation in the future to avoid as many instances of medication error as humanly possible.

Research Question

Medication error is defined as the any error in the process which begins at the prescription phase and follows all the way through the administration of the drug itself. The definition does not require that any adverse effects result from the error; just that an error in itself did occur. Though medication errors rarely result in death or serious injury there is still an overwhelming cause for concern. The data from previous studies that the authors present in this study contains a staggering amount of damages incurred by patients and consequently resulting in enormous monetary damages to the institutions that were responsible for the error. Medication errors from omissions have been found to represent a cause for concern (Warne et al., 2010).

Though most of the data provided referenced studies conducted in the United States, it is safe to assume that Brazil, the location of the study, faces similar or even greater challenges since the Brazilian medical field is rapidly advancing. The specific aim of this paper was to investigate the types of incidence as well as the underlying cause which lead to the fruition of such errors. The paper also considers the consequences of the errors to the patients.

Shedding light on the relevant factors that lead to errors in medication practices might enable preventative measures to be properly developed and implemented into the practitioners' standard operating procedures. Any development of such procedures will be most effective when based on research that provides relevant data that illustrates correlations between the effective causes and the undesired outcomes, in this case medication error. Papers such as this and also others that are of similar scope will provide the future of the industry insights into ways in which they can improve medical practices.

Research Design

The research was conducted as an exploratory survey that collected quantitative data. The participants of the study were patients of an ICU division of a hospital. These patients were observed for thirty days to determine the frequency of medication error. Observation is a method of data collection that is utilized in similar studies (Siew et al., 2010). However, three separate types of data collection were utilized to quantify frequencies of these errors in an attempt to mitigate potential errors associated with only one method data collection method.

The first was to provide the nursing staff an anonymous self-report mechanism which was composed of a box in which the nurses could report instances of medication error without out any fear of reprimand by their supervisors. Another collection method utilized the nurse-investigator who conducted interviews with the staff to attempt to reveal cases of medication error. The final collection method used was the inspection of the patients' medical charts to check for deviations to the prescribed medication schedules.

To determine classifications for medication errors the authors employed the Delphi technique which basically acts as a survey given to the "experts" in the field. The experts provide their analysis of the subject under question then the results from the entire panel are compiled. This compilation represents a theoretical best practices knowledge base provided by industry experts. Usually the resulting agreements that are produced with this method are subject to the group's consensus. This study used eighteen such experts to determine what specific actions would be considered to be a medication error.

The sample population was split into two different groups; one was representative of the population that was in the ICU treatment for less than one week while the other was representative to all the patients who under ICU care for over one week. These two groups were subjects of the three different data collection methods previously mentioned. The primary groups of instances of medication error were composed of these eight different categories:

1. Omission

2. Wrong time

3. Prescribing

4. Improper Dose

5. Wrong dose form

6. Unauthorized Drug Form

7. Monitoring

8. Other

These categories are important to note because these are representative of the types of medication errors that are occurring in hospital settings.

Results

The study produces the standard demographic data associated with the sample; most notable was the average patient stay in ICU which was twelve point six days. Also, there was an average of a twenty five percent mortality rate of patients in the ICU. Of the forty four patients involved in this study there were three hundred five cases of medication error which equates to a mean average of six point nine occurrences per patient. Furthermore, only four patients in the study had no medication error what so ever. Through extrapolation, less than ten percent of the patient population received their medication without error during their stay in the hospitals ICU department. Another interesting finding is that the length of stay was correlated with the frequency of daily medication errors in which the patients with the longest tenure in the ICU were more prone to these errors.

Criticisms

This study provides many valuable insights to the occurrences of medication error. It offers an expanded insight into the frequencies of these occurrences by intending to study the length of stay and its correlations with the indices of these events. However, there are some questions about the study that remain unanswered. For example, it is evident that medication error does occur, however this study does little to distinguish the levels of errors. For instance, if a drug prescription was provided twenty minutes late would that be equal, by the study design, to the wrong drug being administered.

In reality these separate transgressions would cause greatly different implications for the patient however these errors are categorized into a very broad category that encompasses all procedural indiscretions. Another related potential cause for concern in this study is that there is little to develop what constitutes an actual medical error. For instance, does missing a dosing schedule by five minutes, twenty minutes, or an hour equal a medication error? This might explain the extraordinarily high rate of medication error if the tolerances for the errors were set relatively low.