Development of Guidelines to Prevent Medication Errors in the Anesthesia Department at Nongkhai Hospital

Abstract

This action research aimed to develop and evaluate the implementation of practice guidelines for preventing medication errors in the anesthesia department at Nongkhai Hospital. The study was divided into three phases: 1) preparation; 2) action, consisting of four steps-planning, acting, observing, and reflecting-across two cycles; and 3) evaluation. Purposive sampling was applied. The participants included 16 anesthesiologists and nurse anesthetists and 4,110 patients undergoing anesthesia, divided into pre-implementation (n = 2,020) and post-implementation (n = 2,090) groups.  Research instruments included the developed practice guidelines, which had a content validity index (CVI) of 0.88; a feasibility assessment form (validity = 0.83, reliability = 0.83); a satisfaction questionnaire (validity = 0.90, reliability = 0.71); and forms for recording the incidence and severity of medication errors. Qualitative data were analyzed by summarization and presented descriptively. Quantitative data analysis included descriptive statistics, comparisons of the proportion of medication error incidence and severity before and after guideline implementation using Z-tests, and comparison of satisfaction pre- and post-implementation satisfaction scores using Wilcoxon signed rank tests.

The results showed that: 1) the developed guidelines covered six processes-prescribing, preparation, administration, monitoring, documentation, and storage of medications; and 2) the feasibility of implementing the guidelines was rated at the highest level. The satisfaction scores after implementation were significantly higher than before implementation (p< .001). Both the incidence and severity of medication errors were significantly lower after guideline implementation compared to before implementation (p< .001). In conclusion, the developed guidelines, which comprehensively cover all processes of medication use, were effective in reducing both the incidence and severity of medication errors.