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Study: Major Problem with ICU-Injected Medications

Mar 16, 2009 | Parker Waichman LLP Injected medications administered in hospital intensive care units (ICUs) are being linked to a significant safety issue involving errors with medication dosing, medications administered, and medication timing, HealthDay News is reporting, citing a new Austrian study.

The research team, led by Dr. Andreas Valentin of the Rudolfstiftung Hospital in Vienna, looked at errors in 1,328 patients in 113 ICUs in 27 countries over a 24-hour period in January 2007, said HealthDay News.  Two U.S. cities with 50 patients were included in the research.  

The team found 861 injected medication errors involving 441 patients, which broke down as follows:  250 (19 percent) of the patients experienced one error and 14 percent (191 patients) experienced at least two errors, said HealthDay News.  Fifteen errors—or 0.9 percent—involving 12 patients resulted in permanent harm or a fatality, said HealthDay News.  Of those, five died.  Eight errors involved medical trainees, said HealthDay News.

The most frequent errors involved medication timing, dosing, and administration, as well as the medication itself.  According to HealthDay, the mistakes broke down as follows: Administering medication at the wrong time (386), missing the dosing altogether (259), administering either a wrong dose (188) or drug (61), and utilizing the wrong medication route (37).

The ICU staffs reviewed said that “workload/stress/fatigue” was a contributing factor in about one-third of the cases, with confusion over a recently changed drug name (18 percent), written communication (14 percent) or oral communication problems (10 percent), and violation of standard protocol (nine percent), as other contributing factors, said HealthDay News.  The vast majority—69 percent—of the errors occurred during routine care, noted the BBC.

As patient illness levels increased, increased care, often involving increased injections, were needed, which heightened the potential for error. Risks lowered when a “critical incident reporting system” or an established routine for checking at nursing shift changes was implemented, said HealthDay News.

"It is a really serious problem. The administration of injected medication is a weak point in patient safety," Dr. Valentin told the BBC. "With the increasing complexity of care in critically ill patients, organizational factors such as error reporting systems and routine checks at shift changes can reduce the risk of such errors."  

Dr. Valentin pointed out that only one in five units reported no adverse events in the study period, and the problems identified were applicable to all of the health systems studied, reported the BBC.

Medical News Today noted that an earlier study concluded that medication errors occurred most frequently at the administration phase.  This finding prompted Dr. Valentin and his colleagues to initiate an international review of the problem, noting that the 24-hour period studied in 2007 took place on either January 17 or January 24.  Key medical staff—doctors and nurses—were asked to record errors on a questionnaire provided at each patient’s beside, said Medical News.

The researchers also calculated for occupancy rate, relative turnover, patient-to-nurse and patient-to physician ratios per ICU shift, also assessing for severity of patient illness and nursing workload, reported Medical News.

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