Published 12 March 2009, doi:10.1136/bmj.b814
Cite this as: BMJ 2009;338:b814

Research

Errors in administration of parenteral drugs in intensive care units: multinational prospective study

¹ Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria, ² Rudolfstiftung Hospital, Medical Department II, Juchgasse 25, A-1030 Vienna, ³ Department of Anaesthesia and Intensive Care, University Hospital of Ferrara, Ferrara, Italy, ⁴ INSERM, Unité de Recherche en Epidemiologié, Systemes d’Information, et Modelisation, Paris, France, ⁵ Faculty of Medicine, University Pierre et Marie Curie, Paris, ⁶ Assistance Publique, Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, ⁷ Department of Intensive Care, Hospital de St António dos Capuchos, Centro Hospitalar de Lisboa (central, e.p.e), Lisbon, Portugal, ⁸ Section of Medical Statistics, Medical University of Vienna, Vienna, ⁹ Department of Anaesthesiology and General Intensive Care, Medical University of Vienna, Vienna

Objective To assess on a multinational level the frequency, characteristics, contributing factors, and preventive measures of administration errors in parenteral medication in intensive care units.

Design Observational, prospective, 24 hour cross sectional study with self reporting by staff.

Setting 113 intensive care units in 27 countries.

Participants 1328 adults in intensive care.

Main outcome measures Number of errors; impact of errors; distribution of error characteristics; distribution of contributing and preventive factors.

Results 861 errors affecting 441 patients were reported: 74.5 (95% confidence interval 69.5 to 79.4) events per 100 patient days. Three quarters of the errors were classified as errors of omission. Twelve patients (0.9% of the study population) experienced permanent harm or died because of medication errors at the administration stage. In a multiple logistic regression with patients as the unit of analysis, odds ratios for the occurrence of at least one parenteral medication error were raised for number of organ failures (odds ratio per increase of one organ failure: 1.19, 95% confidence interval 1.05 to 1.34); use of any intravenous medication (yes v no: 2.73, 1.39 to 5.36); number of parenteral administrations (per increase of one parenteral administration: 1.06, 1.04 to 1.08); typical interventions in patients in intensive care (yes v no: 1.50, 1.14 to 1.96); larger intensive care unit (per increase of one bed: 1.01, 1.00 to 1.02); number of patients per nurse (per increase of one patient: 1.30, 1.03 to 1.64); and occupancy rate (per 10% increase: 1.03, 1.00 to 1.05). Odds ratios for the occurrence of parenteral medication errors were decreased for presence of basic monitoring (yes v no: 0.19, 0.07 to 0.49); an existing critical incident reporting system (yes v no: 0.69, 0.53 to 0.90); an established routine of checks at nurses’ shift change (yes v no: 0.68, 0.52 to 0.90); and an increased ratio of patient turnover to the size of the unit (per increase of one patient: 0.73, 0.57 to 0.93).

Conclusions Parenteral medication errors at the administration stage are common and a serious safety problem in intensive care units. With the increasing complexity of care in critically ill patients, organisational factors such as error reporting systems and routine checks can reduce the risk for such errors.

© Valentin et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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