Medication Errors in Emergency Department Settings

Rodney W. Hicks, MSN, RN, ARNP, BC, MPA and Susan Camp, PharmD for U. S. Pharmacopeia, Rockville, MD

Purpose

Medication errors are pervasive in today's healthcare settings with little research focusing on errors originating in Emergency Departments (EDs). Medication errors are the largest component of all medical errors and are often preventable.

Design

MEDMARX® is the largest national medication error reporting program that has more than 500,000 medication error records. This descriptive study involved a secondary data analysis of medication error reports that identified EDs as the location where the errors originated as reported during calendar year (CY) 2002. Also included in the analysis were reports for the Medication Errors Reporting (MER) Program.

Methods

Structured queries indicating EDs as location of error were performed. Error outcome category, node, type of error, cause of error, contributing factor, level of staff involved, product reported, and patient outcome fields were included in the analyses. Case reports were analyzed for common themes and medication use related problems.

Results

EDs were ranked as the 5th leading location of medication error in CY 2002. More than 300 unique facilities collectively reported over 3,440 medication errors. The majority (94.8%) of errors did not result in patient harm. However, 5.2% did result in various levels of harm with two fatalities being reported. The Administering node was the most often reported (49%) point in the medication use process where the error originated. Improper dose/quantity and prescribing errors (27% and 22%) were the most common types of error. Performance deficit was cited as the leading cause of error. Distractions were frequently reported. There were nearly 400 unique products reported and Heparin was the most common drug reported in a medication error. Patients appeared to receive medications for which they had previously reported allergies.

Implications

The goal of reducing the risk of a medication error must be addressed through multidisciplinary and systems-related changes. Using a national database to identify trends in the nature and type of medication errors can assist members in the healthcare team to identify risk situations and implement appropriate preventative strategies.

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