• Title/Summary/Keyword: Medication Errors

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The Mediating and Moderating Roles of Safety-specific Transformational Leadership on the Relationship between Barrier to and Intention of Reporting Medication Errors (투약오류보고장애요인과 투약오류보고의도의 관계에서 수간호사의 안전 관련 변혁적 리더십의 매개, 완충효과)

  • Kim, Myoung Soo
    • Korean Journal of Adult Nursing
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    • v.27 no.6
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    • pp.673-683
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    • 2015
  • Purpose: This study was aimed to identify the mediating and moderating effects of safety-specific transformational leadership on the relationship between barrier to and intention of reporting medication errors. Methods: Two hundred thirty seven nurses from seven different hospitals participated in the study. Safety-specific transformational leadership was measured by an instrument with 10 items, barrier to reporting medication errors with 16 items, and intention of reporting medication errors with 3 items. The data was collected from September to October 2012. Descriptive statistics, factor analysis, t-test, ANOVA, Pearson correlation coefficient and a hierarchial regression analysis were used. Results: There were significant negative correlations between the subcategories of barrier to reporting medication errors and intention of reporting medication errors (r=-.16~-.27, p<.001), and a positive correlation between the intention and safety-specific transformational leadership (r=.25, p<001). Transformational leadership was a mediator between barrier to and intention of reporting medication errors. Conclusion: Safety-specific transformational leadership mediated the relationships between barrier to and intention of reporting medication errors. Enhancing safety-specific transformational leadership of nursing unit managers is necessary to increase the intention to reporting medication errors.

Analysis of Medication Errors of Nurses by Patient Safety Accident Reports (환자안전사고 보고서를 통한 간호사 투약오류 분석)

  • Koo, Mi Jee
    • Journal of Korean Clinical Nursing Research
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    • v.27 no.1
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    • pp.109-119
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    • 2021
  • Purpose: The purpose of this study was to identify and analyze the characteristics of nurses' medication errors during three years. Methods: Retrospective survey study design was used to analyze medication errors by nurses among patient safety accidents. Data were collected for three years from January, 2017 to December, 2019. Data were analyzed using frequency, percentage, 𝑥2-test, and logistic regression with SPSS 26.0 program. Results: Of a total 677 medication errors, 40.6% were caused by nurses. Among the medication errors, near miss (n=154, 56.0%), intravenous bolus injection (n=170, 61.8%), wrong dose (n=102, 37.1%) and carelessness for repetitive work (n=98, 35.6%) were the most common. Medication errors differed by department, and nurses' career, and patient safety accident type. The results of the logistic regression analysis showed that the risk factors of adverse events were medication of fluids (OR=3.93, 95% CI: 1.26~12.27), insulin subcutaneous injection (OR=39.06, 95% CI: 4.58~333.18), and occurrence of extravasation/infiltration (OR=7.26, 95% CI: 1.85~28.53). Conclusion: The simplest and most effective way to prevent medication errors is to keep 5 right, and a differentiated education program according to department and nurse career is needed rather than general education programs. Hospital-level integrated interventions such as a medication barcode system or a team nursing method are also necessary.

DICS Behavior Pattern and Medication Errors by Nurses (간호사의 DICS 행동유형과 투약오류)

  • Kim, Eun-Kyung;Lee, Soon-Young;Eom, Mi Ran
    • Journal of Korean Academy of Nursing Administration
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    • v.19 no.1
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    • pp.28-38
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    • 2013
  • Purpose: Human factor is one of the major causes of medication errors. The purpose of this study was to identify nurses' perception and experience of medication errors, examine the relationship of Dominance, Influence, Steadiness, Conscientiousness (DISC) behavior patterns and medication errors by nurses. Methods: A descriptive survey design with a convenience sampling was used. Data collection was done using self-report questionnaires answered by 308 nurses from one university hospital and two general hospitals. Results: The most frequent DISC behavioral style of nurses was influence style (41.9%), followed by steadiness style (23.7%), conscientiousness style (20.4%), and dominance style (14.0%). Differences in the perception and experience level of medication errors by nurses' behavioral pattern were not statistically significant. However, nurses with conscientiousness style had the lowest scores for in experience of medication errors and the highest scores for perception of medication errors. Conclusion: The results of this study show that identification of the behavior pattern of nurses and application of this education program can prevent medication errors by nurses in hospitals.

Prescription, Transcription and Administration Errors in Out-Patient Day Care Unit of a Regional Cancer Centre in South India

  • Mathaiyan, Jayanthi;Jain, Tanvi;Dubashi, Biswajit;Batmanabane, Gitanjali
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.5
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    • pp.2611-2617
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    • 2016
  • Background: Medication errors are common but most often preventable events in any health care setup. Studies on medication errors involving chemotherapeutic drugs are limited. Objective: We studied three aspects of medication errors - prescription, transcription and administration errors in 500 cancer patients who received ambulatory cancer chemotherapy at a resource limited setting government hospital attached cancer centre in South India. The frequency of medication errors, their types and the possible reasons for their occurrence were analysed. Design and Methods: Cross-sectional study using direct observation and chart review in anmbulatory day care unit of a Regional Cancer Centre in South India. Prescription charts of 500 patients during a three month time period were studied and errors analysed. Transcription errors were estimated from the nurses records for these 500 patients who were prescribed anticancer medications or premedication to be administered in the day care centre, direct observations were made during drug administration and administration errors analysed. Medical oncologists prescribing anticancer medications and nurses administering medications also participated. Results: A total of 500 patient observations were made and 41.6% medication errors were detected. Among the total observed errors, 114 (54.8%) were prescription errors, 51(24.5%) were transcribing errors and 43 (20.7%) were administration errors. The majority of the prescription errors were due to missing information (45.5%) and administration errors were mainly due to errors in drug reconstitution (55.8%). There were no life threatening events during the observation period since most of the errors were either intercepted before reaching the patient or were trivial. Conclusions: A high rate of potentially harmful medication errors were intercepted at the ambulatory day care unit of our regional cancer centre. Suggestions have been made to reduce errors in the future by adoption of computerised prescriptions and periodic sensitisation of the responsible health personnel.

Perception and Experience of Medication Errors in Nurses with tess than One Year Job Experience (신규 간호사의 투약오류 인지 및 경험에 대한 조사 연구)

  • Oh, Choon-Ae;Yoon, Hae-Sang
    • Journal of Korean Academy of Fundamentals of Nursing
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    • v.14 no.1
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    • pp.6-17
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    • 2007
  • Purpose: This study was carried out to investigate perception and experience of medication errors by nurses. Method: Data collection through a survey was performed using structured questionnaires over the period of September 1 to October 15, 2004. Questionnaire were delivered to 222 nurses from 15 hospitals; thereafter, 205 questionnaires were responded (i.e., 92% response rate). The subject in the study was a nurse who had been working in the hospital for less than one year. Results: The average perception rate was 87.5%. The perception rates of subjects in medication errors from four areas are 62% in wrong dosage form for drug administration, 61.5% in air into an IV set, 63% in crystals in an IV lines, and 83.5% in wrong time. The experience rates of subjects in medication errors from four areas are 85.5% in wrong time, 39.5% in wrong injection site, 34.5% in omission error, and 28% in wrong patient. Conclusion: The average perception rate and experience rates of medication errors were 87.5% and 23.5%, respectively. Education about the Five right in medication and knowledges about drugs would improve the perception of medication errors of nurses whose work experience is less than one year, and prevent them from medication errors.

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Factors Affecting Medication Errors and Medication-related Educational Needs of Community dwelling Older Adults (지역사회 거주 노인의 약물오용 영향요인: 약물지식 및 복약관리 교육요구를 중심으로)

  • Jeong, Hye Sun
    • Journal of Home Health Care Nursing
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    • v.24 no.1
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    • pp.87-98
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    • 2017
  • Purpose: The purpose of this study was to investigate the factors affecting medication errors and the medication management educational needs of community-dwelling older adults. Methods: From February 20 to February 23, 2017, 150 elderly people aged 65 or older were surveyed using a structured questionnaire. Results: A total of 85.7% of the older adults were taking medication, but their drug knowledge was found to be low. The medication error rate was 24.9%, and the score for medication management education requirement was 3.61 out of a possible 5points. Factors affecting medication errors were perceived health status and knowledge of medication, and their explanatory power was 43% in total. Conclusion: It was concluded that nursing intervention is needed to reduce older adults' medication errors and to increase their knowledge of medication. Additionally, groups of older adults with high medication errors should be intensively educated, and when developing a medication management education program, the contents of the sub-areas and items in which the participants' needs were high should be reinforced.

Factors Influencing Clinical Nurses' Intention to Report Medication Administration Errors (임상간호사의 투약오류보고 의도에 영향을 미치는 요인)

  • Lee, Seul Hee;Seo, Eun Ji
    • Journal of Korean Critical Care Nursing
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    • v.14 no.3
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    • pp.62-72
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    • 2021
  • Purpose : This study aimed to identify factors influencing clinical nurses' intention to report medication administration errors. Methods : This cross-sectional study collected data from 121 nurses in charge of administering medication at a university hospital in Korea using structured questionnaires. Data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Pearson's correlation coefficient, and multiple linear regression. Results : Participants' mean age was 26.90±3.99 years, and 89.3% were women. Their mean clinical career duration was 3.88±4.26 years. The average levels of patient safety culture, attitude toward reporting medication administration errors, and intention to report medication administration errors were 7.51 out of 10, 3.36 out of 5, and 4.85 out of 6, respectively. The multiple regression analysis results indicated that the statistically significant influencing factors were patient safety culture (𝛽=.21, p =.018) and attitude toward reporting medication administration errors (𝛽=.22, p =.015). Conclusion : To improve the intention to report medication administration errors among clinical nurses, a patient safety culture must be established, along with an education provision for improving their attitudes toward reporting such administration errors.

Impact of Psychosocial Factors on Occurrence of Medication Errors among Tehran Public Hospitals Nurses by Evaluating the Balance between Effort and Reward

  • Zaree, Tahere Yeke;Nazari, Jalil;Jafarabadi, Mohhamad Asghary;Alinia, Tahereh
    • Safety and Health at Work
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    • v.9 no.4
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    • pp.447-453
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    • 2018
  • Background: Patient safety and accurate implementation of medication orders are among the essential requirements of par nursing profession. In this regard, it is necessary to determine and prevent factors influencing medications errors. Although many studies have investigated this issue, the effects of psychosocial factors have not been examined thoroughly. Methods: The present study aimed at investigating the impact of psychosocial factors on nurses' medication errors by evaluating the balance between effort and reward. This cross-sectional descriptive study was conducted in public hospitals of Tehran in 2015. The population of this work consisted of 379 nurses. A multisection questionnaire was used for data collection. Results: In this research, 29% of participating nurses reported medication errors in 2015. Most frequent errors were related to wrong dosage, drug, and patient. There were significant relationships between medications errors and the stress of imbalance between effort and reward (p < 0.02) and job commitment and stress (p < 0.027). Conclusion: It seems that several factors play a role in the occurrence of medication errors, and psychosocial factors play a crucial and major role in this regard. Therefore, it is necessary to investigate these factors in more detail and take them into account in the hospital management.

The influence of new nurses' knowledge, nursing performance, and educational needs of chemotherapy medication on chemotherapy medication errors (신규간호사의 항암 투약 간호 지식, 수행도 및 교육 요구도가 항암 투약 오류에 미치는 영향)

  • Song, Eon Jeong; Lee, Gyu Young
    • The Journal of Korean Academic Society of Nursing Education
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    • v.29 no.2
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    • pp.115-123
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    • 2023
  • Purpose: This study aimed to identify the factors affecting the chemotherapy medication errors made by new nurses and to use the results as basic data for the development of a chemotherapy medication nursing education program for new nurses. Methods: This cross-sectional study was conducted with 189 new nurses working at a general hospital and a tertiary general hospital in Korea. The data collection period was from January 11 to February 7, 2021. The data collected during this study were analyzed using the IBM SPSS statistics version 25.0 program. Data analysis included descriptive statistics, independent t-test, ANOVA, and logistic regression analysis. Results: One factor influencing chemotherapy medication errors was new nurses' educational needs (odds ratio=.18, p=.005). As educational needs increased, the probability of making errors in medication was reduced by .18. Conclusion: It is necessary to develop a chemotherapy medication education program tailored to the educational needs of new nurses by considering the education period, method, and content, with a focus on the content with high demand from new nurses.

Guideline of Improvement and Evaluation of Prescribing Errors in Colorectal Chemotherapy (대장암 항암 화학요법의 처방 오류 평가 및 개선안 제시)

  • Lim, Hyun-Soo;Lim, Sung Cil
    • Korean Journal of Clinical Pharmacy
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    • v.23 no.2
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    • pp.158-166
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    • 2013
  • Background: Colorectal cancer shows a significant increase in South Korea due to westernization of diet, lack of dietary fiber, drinking and smoking, irregular defecation. There are surgery, chemotherapy, radiation therapy in treatment of colorectal cancer. There may be a medication errors in the process of chemotherapy because of its high toxicity, narrow therapeutic index and the health status of cancer patients. Consequently medication errors can cause increasing the risk of death, prolonging hospital stay and increasing the cost. Among medication errors on medication use process, prescribing errors are of particular concern due to higher risk of serious consequences. It is important for pharmacist to prevent the prescribing errors before reaching patient. Therefore we analyzed the prescriptions of colorectal cancer, classified prescribing errors, suggested guideline to reduce prescribing errors and verified the importance of pharmacist's role in prevention of medication errors activity. Methods: We collected the numbers of prescriptions of colorectal cancer(n=2,373) through anti cancer management program and EMR and analyzed the errors of prescriptions by categories from Oct 1st 2011 to Sep 30th 2012 at Chungbuk National University Hospital. We reviewed the prescriptions as follows - patients' characteristics, the result of test, previous prescriptions, characteristics of antineoplastic agents and patients' allergy, drug sensitivity, adverse events. Prescriptions are classified into inpatient and outpatient and analyzed the errors of prescriptions by categories (dosage form, dose, input, diluents, regimen, product). Results: Total prescription number of inpatient and outpatient of colorectal cancer was 1,193 and 1,180 and that of errors was 107(9%) and 22(1.9%), respectively. In case of errors of categories, the number of errors of dosage form is 69 and 8, errors of dose is 15 and 5, errors of input is 9 and 9 in inpatient and outpatient prescriptions, respectively. Errors of diluents is 8, errors of regimen is 3, errors of product is 3 in only inpatient prescriptions. In case of errors of categories by inpatient department, the number of errors of dosage form is 34 and 35, errors of dose is 7 and 8, errors of input is 6 and 3, errors of diluents is 4 and 4, errors of regimen is 2 and 1, errors of product is 2 and 1 in SG and HO, respectively. In case of outpatient department, the number of errors of dosage form is 8 in HO, errors of dose is 5 in HO, errors of input is 5 and 4 in SG and HO, respectively. Conclusions: The rate of errors of inpatient is higher than that of outpatient. Junior doctors are engaged in prescriptions of inpatient and pharmacist need to pay attention to review all prescriptions. If prescribing errors are discovered, pharmacist should contact the prescriber and correct the errors without delay. The guideline to reduce prescribing errors might be upgrading software of anti cancer management program, education for physicians as well as pharmacists and calling prescriber's attention to preventing recurrence of errors.