Types, prevalence, and potential clinical significance of medication administration errors in assisted living

被引：52

作者：

Young, Heather M. ^{[1
]}

Gray, Shelly L. ^{[3
]}

McCormick, Wayne C. ^{[2
]}

Sikma, Suzanne K. ^{[4
]}

Reinhard, Susan ^{[5
]}

Trippett, Linda Johnson ^{[4
]}

Christlieb, Carol ^{[1
]}

Allen, Tiffany ^{[1
]}

机构：

[1] Oregon Hlth & Sci Univ, Sch Nursing, Ashland, OR 97520 USA

[2] Univ Washington, Sch Med, Seattle, WA USA

[3] Univ Washington, Sch Pharm, Seattle, WA USA

[4] Univ Washington, Nursing Program, Bothell, WA USA

[5] AARP Publ Policy Inst, Washington, DC USA

来源：

JOURNAL OF THE AMERICAN GERIATRICS SOCIETY | 2008年 / 56卷 / 07期

关键词：

assisted living; medication administration; unlicensed assistive personnel; quality; medication errors;

D O I：

10.1111/j.1532-5415.2008.01754.x

中图分类号：

R592 [老年病学]; C [社会科学总论];

学科分类号：

03 ; 0303 ; 100203 ;

摘要：

OBJECTIVES: To describe the types and potential clinical significance of medication administration errors in assisted living (AL). DESIGN: Cross-sectional observational study. SETTING: This study was conducted in 12 AL settings in three states (Oregon, Washington, and New Jersey). PARTICIPANTS: Participants included 29 unlicensed assistive personnel and 510 AL residents. MEASUREMENTS: Medication administration observations, chart review, and determination of rates, types, and potential clinical significance of errors using standardized methodology. RESULTS: Of 4,866 observations, 1,373 errors were observed (28.2% error rate). Of these, 70.8% were wrong time, 12.9% wrong dose, 11.1% omitted dose, 3.5% extra dose, 1.5% unauthorized drug, and 0.2% wrong drug. Excluding wrong time, the overall error rate dropped to 8.2%. Of the 1,373 errors, three were rated as having potential clinical significance. CONCLUSION: A high number of daily medications are given in AL. Wrong time accounted for the majority of the errors. The bulk of the medications are low risk and routine; to promote optimal care delivery, clinicians need to focus on high-risk medications and residents with complex health problems.

引用

页码：1199 / 1205

页数：7

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