Medication Errors V.S Bar Coding - Essay Example

In an analysis of 334 medication errors from II acute care wards, 39 % of the problems were judged to occur during physician ordering, 12% during transcription and verification, 11% during pharmacy dispensing and 38% during nursing administration (Patterson 2002). The intravenous (IV) administration of drug is a complex process and errors frequently occur. For example, in a recent study on 10 wards in the two UK hospitals it was found that errors occurred in almost half the IV drug preparations and administrations, 1% of which were severe and 58% moderate.

The main findings of the study are as follows: An error rate of 73% occurred when giving bolus doses (172 errors in 235 observed administrations). An error rate of 14% occurred when preparing drugs that required multiple steps (50 errors in 345 observed multiple step preparations). An ethnographic study was conducted to investigate IV drug errors in two UK hospitals. This research method offers the advantage that the context can be explored at the time of the error and many of the conditions, which contribute to errors, as outlined by human error theory, can be identified in this context.

A purposive sampling strategy was used to collect data in different hospital settings. A trained and experienced observer accompanied nurses during IV drug rounds on 10 wards in two hospitals (one University teaching hospital and one non-teaching hospital) in the UK. Information came from observation and talking informally to staff. Human error theory was used to analyze the causes of IV error. Both hospitals operated a typical ward pharmacy service in which doctors wrote prescriptions on formatted inpatient drug charts and nurses used the charts to determine the doses to be given and to record the administration of drugs.

IV medication in general was prepared and administered on the wards by nursing staff, with the exception of cytotoxic medication, which was prepared centrally by the pharmacy department. This disguised, observation method has been shown to be valid for identification of medication errors. Each case of IV medications error was analyzed to identity the main active failure and the factors contributing to this error. Medication was omitted because of failures in communication in 14 errors (16%).

This occurred when patients were transferred between wards and information on drug administration was not communicated. Communication problems between doctors and nurses included ambiguous hand written prescriptions. These cases also indicated failures in adequately using and checking patient's drug charts. High workload and distractions when carrying out several tasks at the same time were observed in 13 errors ( Taxis 2003)) A prospective audit was carried out by Cousins D.H (2005) by direct