Drug administration errors and their determinants in pediatric in-patients.

OBJECTIVE

. To quantify the type and frequency of drug administration errors to pediatric in-patients and to identify associated factors.

DESIGN

Prospective direct-observation study of drug administration errors from April 2002 to March 2003.

SETTING

Four clinical units in a pediatric teaching hospital.

STUDY

PARTICIPANTS

Twelve observers accompanied nurses giving medications and witnessed the preparation and administration of all drugs to all patients on all weekday mornings.

INTERVENTION: None.

MAIN OUTCOME MEASURE: Discrepancies between physicians' orders and actual drug administration.

RESULTS

During the 1719 observed administrations to 336 patients by 485 nurses, 538 administration errors were detected, involving timing (36%), route (19%), dosage (15%), unordered drug (10%), or form (8% form). These errors occurred for 467 (27%) of the 1719 administrations. Intravenous drugs (OR = 0.28; CI = 0.16-0.49; versus miscellaneous) were associated with fewer errors. Error rates were higher for cardiovascular (OR = 3.38; CI = 1.24-9.27; versus miscellaneous) and central nervous system drugs (OR = 2.65; CI = 1.06-6.59; versus miscellaneous); unspecified dispensing system (OR = 2.06; CI = 1.29-3.29; versus store in the unit); non-intravenous non-oral administration (OR = 4.44; CI = 1.81-10.88; versus oral administration); preparation by the pharmacy (OR = 1.66; CI = 1.10-2.51); and administration by a hospital pool nurse, temporary staffing agency nurse, or nurse intern (OR = 1.67; CI = 1.04-2.68; versus registered full-time nurse). Each additional management procedure in the patient increased the risk of error (OR = 1.22; CI = 1.01-1.48).

CONCLUSIONS

The risk factors identified in our study should prove useful for designing preventive strategies, thereby improving the quality of care.