Medication Errors in Ready-to-Administer Injectable Admixtures Compounded by Pharmacy Personnel: A Study of Hospitals in Northern Thailand

Abstract

OBJECTIVE To determine the number, types, and severity of medication errors in ready-to-administer injectable admixtures compounded by pharmacy personnel in northern Thai hospitals.
METHODS This retrospective descriptive study was conducted in six hospitals in northern Thailand. Data were gathered from hospital incidence reports over the three-year period 2017-2019. The following data were extracted from each report: stage of error, medication involved, care setting, and severity of error. The National Coordinating Council for Medication Error Reporting and Prevention index was used to categorize the severity of the medication errors. Results are presented as number and percentage.
RESULTS The total number of medication error events in the six hospitals was 405, classified as transcribing (n=59, 14.5%), pre-dispensing (n=217, 53.6%) and dispensing errors (n=129, 31.9%). The most frequent type of pre-dispensing errors was inappropriate techniques in medication compounding (n= 54, 13.3%). Almost all the medication errors were of severity level B (errors resulting in no harm to patients) (n=398, 98.3%). The most frequent errors were reported in antineoplastic agents (n=373, 92.1%).
CONCLUSIONS The great majority of medication errors were pre-dispensing errors with a low level of severity. The provision of strategies to prevent medication errors is necessary for patient safety.