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Preventing Medication Errors
TABLE 3-2 Error Rates in Nursing Homes
Per 100 opportunities/doses
6 (Cooper et al., 1994)
12.2 (Barker et al., 1982)
14.7 (Barker et al., 2002)
20 (Baldwin, 1992)
the hospital receives 10 doses of medication per day,5 a typical patient would be subject to one administration medication error per day. These data, taken together with the results of the above studies, which identified 0.1 prescribing error per patient per day (Kaushal et al., 2001) and 0.3 prescribing error per patient per day (Bates et al., 1995a), as well as plus the fact that medication errors occur in other stages of the medication-use process (e.g., errors in the prescribing and administration stages accounted for 77 percent of medication errors [Leape et al., 1995]), suggest to the committee that about one medication error occurs per patient per day in hospital care.
There is little information on rates of dispensing errors in nursing homes, since this function generally is outsourced. According to the available data (see Table 3-2), medication administration errors appear to occur in nursing homes at a rate of 6–20 per 100 doses (Barker et al., 1982, 2002; Baldwin, 1992; Cooper et al., 1994). The two main studies in this area, published 20 years apart, both used the same error detection method (direct observation) and reported similar error rates—12 errors per 100 doses (Barker et al., 1982), and 15 errors per 100 doses (Barker et al., 2002) (in both cases excluding doses administered at the wrong time). Excluding wrong-time errors, omission of an ordered medication is generally the most common type of drug administration error in nursing homes. Given that administration error rates are higher in nursing homes than in hospitals, it
Rates of doses dispensed in hospital are rarely quoted in the literature. At MountainView Hospital, Las Vegas, Nevada, dose rates increased steadily at about 10 percent per year over the period 2002–2006 (Wood and Nam, 2005). During this period, the average numbers of doses dispensed per patient per day were 13.6 (January 2002), 13.3 (July 2002), 15.8 (January 2003), 15.1 (July 2003), 16.8 (January 2004), 16.3 (July 2004), 19.5 (January 2005), 18.0 (July 2005), and 22.1 (January 2006). The committee also carried out a small survey of eight community and teaching hospitals in Pennsylvania, Michigan, Ohio, and Minnesota. Based on 2005 or 2006 data, for the three community hospitals, the results were 24.4, 20.6, and 12.2 doses per patient per day; and for the teaching hospitals, the results were 25.8, 29.7, 32.8, 22.3, and 20.9 doses per patient per day. These data suggest that the assumption of 10 doses per patient per day is a conservative one.