Medication Preparation And Calculation Skills Studies

A nonconcurrent cohort study on hospital reported medication errors were conducted on premature neonates in Washington. It revealed that 1.2% of the neonatal discharges reported medication errors. There was a significant linear increase in the error rate based on birth weight. It was concluded that 1.2% of error rate in neonates is lower than that reported errors in both pediatric and adult population.

A study was conducted on medication errors among the hospitalized patients of 54 hospitals in the Vermont Oxford Network. In this study 739 Health professionals received access to a secure internet site for anonymous reporting of errors, near-miss errors and adverse drug events. It is a descriptive study in which a voluntary, anonymous, internet based reporting system was developed for medication errors in NICU (Neonatal ICU) and evaluated its feasibility and identified errors that affect high-risk neonates and their families. Reports used free-text entry in phase 1 (17 months) and a structured form in phase 2 (10 months). The number and types of reported events and factors that contributed to the events were measured. It was found that out of 1230 reports--522 in phase 1 (17 months) and 708 in phase 2 (10 months) – the most frequent event categories were wrong medication, dose, schedule, or infusion rate (including nutritional agents and blood products; 47%); error in administration or method of using a treatment (14%); patient misidentification (11%); other system failure (9%); error or delay in diagnosis (7%); and error in the performance of an operation, procedure, or test (4%). The most frequent contributory factors were failure to follow policy or protocol (47%), inattention (27%), communications problem (22%), error in charting or documentation (13%), distraction (12%), inexperience (10%), labeling error (10%), and poor teamwork (9%). In 24 reports, family members assisted in discovery, contributed to the cause, or themselves were victims of the error. Serious patient harm was reported in 2% and minor harm in 25% of phase 2 events. It was concluded that Specialty-based, voluntary, anonymous Internet reporting by health care professionals identified a broad range of medical errors in neonatal intensive care and promoted multidisciplinary collaborative learning.In the above study, it was found that about half (47%) of the medication errors involved a lack of knowledge on the drugs administration as well as deficiency in the calculation of doses.

A prospective quality assurance study was conducted where 315 iatrogenic medication errors were reported among the 2147 neonatal and paediatric intensive-care admissions, with an error rate of 1 per 6.8 admissions (14.7%). The frequency of iatrogenic injury of any sort due to a medication error was 66/2147 (3.1%)--1 injury for each 33 intensive-care admissions. 33 (10.5%) errors were potentially serious, 32 (10.2%) caused mild patient injuries, and 1 patient had acute aminophylline poisoning after receiving five intravenous doses of the drug at a dosage ten times higher than prescribed, owing to a calculation error during dilution. A longitudinal monitoring system helps to identify iatrogenic complications due to medication errors and may help in implementing preventive measures.This study highlights the significance of knowledge on the drugs administered and the calculation skills for the estimation of the right dose. Dilution of drugs is a small part of drug administration yet it plays a major role in the administration of the correct dose and prevention of medication errors of varying degrees.A study was undertaken to initiate investigation into the medication errors that occur in a pediatric emergency department. They conducted a retrospective chart review of all medication and intravenous fluid errors identified in a pediatric emergency department through incident reports filed over a 5-year period. An attempt was made to determine who was involved with the errors and what caused the errors. The patient outcomes were noted and classified according to clinical significance. Thirty-three incident reports involving medication or intravenous fluid errors were analyzed. It was found that most errors occurred on the evening and night shifts. Nurses were involved in 39% of reported errors; the nurse and emergency physician were jointly involved in 36%. The most common error was an incorrect dose of medication (35%) or incorrect medication given (30%). In one third of the cases, the family was not made aware of the error. In 12%, patients required additional treatment, and one was admitted to the hospital because of the error. There were no deaths. It was concluded that incorrect recording of patient weights leading to an incorrect medication dose and failure to note drug allergy are common causes for medication errors in the pediatric emergency department. Incorrect drugs and I.V. fluids are given because of similar names and packaging. These errors have the potential for significant morbidity and mortality, as well as costly litigation.

Many of the errors in the Emergency Department seem to be preventable.In this study all (100%) of the medication errors could have been prevented if the nurses who administered these drugs had adequate knowledge on the drugs and the calculation of drug doses administered by them.A study on Opportunities for performance improvement in relation to medication administration during pediatric stabilization was conducted in Durham. Out of a total of 150 medications given by the physicians, only 55% of the orders were verbally repeated back by the nurses. Of the 120 orders in which the doses were converted from milligrams to milliliters by nurses, 17 (14.2%) were converted incorrectly and the maximum dose deviation reached 400%. Selection of the wrong medication occurred in 11 of the 150 orders. Dextrose (which requires dilution before being administered to children) was not diluted in 17% of the medication orders and in 12% it was diluted improperly. About 40% of the orders for ceftriaxone (which requires reconstitution) were not properly reconstituted. In 49 (32.7%) of the 150 medication orders that were drawn up in a syringe, the amount measured was not consistent with the stated dose. For some medications, a prolonged time was required by nurses to convert the doses and draw up the medications.A study was conducted on Role of Incident Reports by Physicians and Nurses to Document Errors in Pediatric Patients in Washington. Out of a total of 140 surveys which consists of 64 nurses and 74 physicians, nurses were significantly more to report more than 80% of their own medical errors than physicians. It is evident that nurses lack in the realm of knowledge of the drugs rather than the mathematics involved in the calculation of drug doses. More emphasis has to be placed for up gradation of nurse’s knowledge of the drugs administered by them in order to reduce medication errors.

A descriptive research to assess the medication calculation skills of graduating nursing students in Finland among 204 nursing students using convenience sampling technique and a structured questionnaire. The response rate was 88%. It was concluded that the overall student’s mathematical skills were inadequate as the calculation of drug doses is not accepted when the accuracy is less that 100%.This emphasizes that skills in calculation of drug doses is as significant as the knowledge of the drugs in the provision of comprehensive and safe nursing care.