The incidence, severity and causes of intravenous medication errors in hospitals

Little is known about intravenous (IV) medication errors in hospitals, even though reports indicate error rates between 13 and over 100%. Therefore, this study investigated the incidence, severity and causes of IV drug preparation and administration errors in hospitals in the UK and Germany. The nature of errors was explored by interviews and textual analysis. Qualitative interviews with a convenience sample of 15 health care professionals were carried out to explore nurses and pharmacists roles in IV therapy and their views about IV medication errors. A framework of human error theory was used to identify causes of IV medication errors by analysing documents about IV drug errors from three different data sources. Incidence, severity and causes of IV medication errors were also investigated by observing actual practice of IV drug preparation and administration in two hospitals in the UK and one in Germany. An existing valid and reliable method to assess the severity of medication errors was validated for use in Germany. Observations on ten wards in two UK hospitals identified that 49% out of 430 observed preparations and administration were erroneous, including 0.7% potentially severe cases. Frequent errors were the fast administration of bolus doses, found to be due to deliberate violations of guidelines. This was due to lack of practical training, complex design of technology and other organisational issues. Observations in one German hospital identified 48% erroneous cases out of 122 observed, including 3% of potentially severe cases. The administration of potentially incompatible medication occurred frequently. This was due to lack of training and guidelines, possibly due to an ambiguous legal framework and a lack of pharmaceutical involvement on the wards. Intravenous therapy is a complex health care technology associated with a high drug preparation and administration error rate, potentially harming patients unnecessarily. Suggested changes include improved training of nurses and increased involvement of pharmacists in IV therapy. More complex health care interventions should also be considered and their implementation carefully assessed.