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medpundit |
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Monday, September 09, 2002In the 36 institutions, 19% of the doses (605/3216) were in error. The most frequent errors by category were wrong time (43%), omission (30%), wrong dose (17%), and unauthorized drug (4%). Seven percent of the errors were judged potential adverse drug events. There was no significant difference between error rates in the 3 settings (P = .82) or by size (P = .39). Error rates were higher in Colorado than in Georgia (P = .04) The newspaper story says that translates into 40 medication errors a day per hospital. But wait a minute, are all of those really errors? It’s not really an error to give a medication one hour later than scheduled because the nurse was attending to another patient who was in a medical crisis. It would be a grave error to ignore a patient in crisis while making sure everyone else's medication is exactly on time. Missing a dose could be an error, but as errors go it isn’t likely to be harmful. The wrong dose and the wrong drug, however, are defintely errors, but those only made up 21% of the cases. That means that only 8 serious errors occured per day per hospital. That’s still eight errors too many, but addressing those sorts of errors would be a better use of resources than lumping them all together. As an article last week in the Annals of Internal Medicine pointed out, not all “errors” are mistakes. posted by Sydney on 9/09/2002 06:40:00 AM 0 comments 0 Comments: |
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