Parenteral drug administration errors by nursing staff on an acute medicaladmissions ward during day duty

Background: Parenteral therapy is a route of administration for drugs which are poorly absorbed via the oral route and it can provide a rapid response during an emergency. However, poorly prepared and/or administered parenter al therapy can cause potential harm to patients such as thrombus formation, severe hypersensitivity reactions and infection. Very few studies have inv estigated the incidence of medication errors associated with parenteral dru g administration. Objectives: To determine the error rate during preparation and administrati on of parenteral medications by nursing staff and to propose strategies to reduce the error rate during parenteral administration. Methods: A direct, disguised observation technique was used. The first auth or (JB) observed and recorded errors that occurred during the preparation a nd administration of parenteral medications on an admissions ward between 8 .00am and 4.30pm from Monday to Friday for a 4-week period during December 1998. The staff were told that the observer was timing the administration; therefore they were not aware of the true nature of the study. This study w as approved by the hospital audit committee. Results: Drug administration was witnessed for a 4-week period providing 10 7 opportunities for error. 27 errors were observed which equated to an erro r rate of 25.2% [95% confidence interval (CI) 17.0 to 33.5%] including wron g time errors. Excluding wrong time errors, the most frequently occurring t ype of error, reduced the error rate to 10.3% (95% CI 3.8 to 14.9%). Discussion: The error rate was lower than reported in the literature, this may be due to different methodologies, small sample size or effective nursi ng training and operating procedures. In the observed hospital, only nursin g staff who have completed a training package are allowed to administer par enteral medications. Conclusion: Based on our small study, and 2 previous small studies, we can conclude that parenteral medication administration errors are common in the UK; however, these studies are too small-scale to detect rare and serious errors.