Assessment of Medication Errors Among Anesthesia Clinicians in Saudi Arabia: A Cross-Sectional Survey Study

ABSTRACT Introduction Anesthetic drugs are prepared and administrated without referral to the pharmacy or other medical departments. We aimed to assess the occurrence of anesthetic drug errors in Saudi Arabia. We also determined the contributing factors, reporting strategies, and clinicians' opinions of the preventive measures. Methods We conducted a cross-sectional web-based survey study using a validated tool. A total of 300 anesthesia clinicians completed the survey (146 anesthesiologists and 154 anesthesia technology specialists). We measured descriptive statistics to describe the demographic characteristics and performed inferential statistics to examine associations and differences. Results Sixty-nine percent of respondents had experienced an anesthetic drug error at least once in their career. The two primary factors that caused drug errors were haste (60.3%) and heavy workload (60.3%). On syringe labeling, 56.3% withdrew the drug then labeled the syringe, and 43.7% labeled the syringe then withdrew the drug. The chi-square test revealed that clinicians who labeled the syringe first then withdrew the drug made errors more frequently (p = 0.036). The test also showed that clinicians with less experience had committed more errors (p = 0.015). On reporting drug errors, 77.7% of respondents identified the fear of medicolegal issues as the most common barrier to reporting errors. Respondents believed that double-checking the medication and color-coded syringe labels were the most effective strategies to reduce errors (82% and 64%, respectively). The Mann-Whiney U test revealed significant differences between the two specialties about their opinions of the preventive measures. Conclusions There was a high occurrence rate of anesthetic drug errors in Saudi Arabia. Policymakers need to unify the syringe-labeling practice, and future research needs to focus on what makes a nonpunitive culture to encourage reporting errors.

Providing A Technical Solution to Improve Nurses' Performance in Drug Delivery : A qualitative study

Background and Purpose: Providing services in the nursing profession is very wide. In the field of clinical services, one of the most important is to provide care related to medication, which in fact is one of the ways to assess the quality of nursing care, so this study aims to provide a solution. Technical measures were taken to improve the performance of nurses in the drug delivery process in hospitals affiliated to Zahedan University of Medical Sciences in Iran Materials and Methods: This study was conducted with a qualitative approach and contractual content analysis method in 2017-18. Participants were 16 nurses and a physician working in different wards of the hospital who were included in the study by purposive sampling. The method of data collection was semi-structured interviews. All interviews were conducted and reviewed and analyzed by contractual content analysis. Results: In the present study, "steps to prevent drug error" as the main category and "acting professionally" and "providing technical solutions" as two subcategories were extracted from the data. Conclusion: The results showed that the use of nurses 'experience and knowledge as technical solutions to prevent drug errors can play an important role in improving nurses' performance and increasing patient safety

Drug errors related to self-medication in Morocco

Introduction: Self-medication refers to the act of obtaining a drug without a prescription in order to use it for treatment. The objective of this study is to describe the epidemiological characteristics of drug errors related to self-medication in Morocco. Method: This is a retrospective study of drug errors related to self-medication, reported to the Moroccan Poison Control Center between 2014 and 2018. Results: During the study period, 99 medication errors were recorded, of which 31.6% concerned children under the age of 15 years. The average age of the patients was 26.6 years. The sex ratio was balanced, with 4 breastfeeding women. Almost all of cases (94.9%) occurred at home. Drugs acting on the nervous system accounted for 39.4% of notifications. This was a medicine error in 47.5% of cases. The patient himself was responsible for the error in 57.6% of cases. Drug administration was oral in 84.5% of cases. Of all error cases, 32.7% were symptomatic. Conclusion: The dangers of self-medication are multiple. Sometimes, self-medication can lead to severe complications. It therefore strongly recommended to follow the medical prescription and the pharmacist’s instructions as well as to educate the public about the risks associated with self-medication.

Results of decision support system implementation for prescribing anticoagulants to patients with atrial fibrillation in hospital

Background. In 819% of patients with atrial fibrillation (AF) with anticoagulant therapy (ACT), hemorrhagic complications occur, including due to excess doses of AC. At the same time, ACT is necessary for patients with AF, since anticoagulants effectively reduces the risk of ischemic stroke. To make a decision on the appointment of ACT, it is necessary to correlate the risks of ischemic stroke and bleeding, this requires knowledge of current clinical using ACT recommendations and instructions. Among patients admitted to hospital, 30% receive ACT, so increasing adherence to clinical recommendations for prescribing AC to patients with AF by doctors of various profiles is an urgent task. Aim. To analyze the adherence of physicians to recommendations for prescribing ACT before and after the introduction of decision support system (DSS) in patients with AF in a multi-specialty hospital. Materials and methods. A single-center non-randomized study with historical control to assess adherence to recommendations based on the analysis of medical prescriptions and the structure of drug errors in patients with AF in a multi-specialty hospital in Moscow before and after the introduction of DSS. Compliance with the recommendations of physicians was evaluated in the sections indications /contraindications to AC and dosage regimen of AC. The presence of deviations from the clinical recommendations /instructions for medical use of AC was regarded as management of the patient with non-compliance with recommendations. Physicians adherence level to recommendations was calculated as the ratio of cases of compliance with recommendations to the total number of cases. Results. In the control and experimental groups, there was a significant increase in the proportion of POAC at discharge in comparison with admission to hospital: from 54.5 to 76.8% (p=0.0005) and from 63 to 85.7% (p=0.0002), respectively. However, only in the experimental group it was possible to significantly reduce the number of patients without a prescribed ACT (if there are indications) from 7.6 to 1% (p=0.04) in comparison with admission. During the study, it was possible to significantly increase physicians adherence level to the recommendations for the AC dosage regimen in patients with AF from 59% (44 discrepancies for 107 prescriptions) to 84.6% (16 discrepancies for 104 prescriptions); p0.005. Before the introduction of the DSS, the analysis of drug prescriptions revealed 56 drug errors (0.5 errors per patient), after the introduction of the DSS, the number of drug errors significantly decreased to 21 (0.2 errors per patient); p0.05. After the introduction of DSS, the number of sub-therapeutic doses of AC was reduced from 31 (27.7%) to 8 (7.6%); p0.05. Conclusion. The level of adherence to the recommendations for prescribing ACT to patients with AF in the hospital is high. The use of DSS increases the level of adherence to the recommendations on the AC dosage regimen in patients with AF, as well as eliminates errors in calculating the risk of ischemic stroke and systemic thromboembolic complications, and contributes to reducing the frequency of prescribing sub-therapeutic doses of AC.