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Integrated Pharmacy Research and Practice 2017:6 47–51
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O R I G I N A L R E S E A R C H
open access to scientific and medical research
Open Access Full Text Article
http://dx.doi.org/10.2147/IPRP.S125085
Prevalence of intravenous medication administration errors: a cross-sectional study
Tezeta Fekadu1
Mebrahtu Teweldemedhin2
Eyerusalem Esrael1
Solomon Weldegebreal Asgedom1
1School of Pharmacy, Department of Clinical Pharmacy, College of Health Sciences, Mekelle University, Mekelle, 2Unit of Biomedical Science, School of Medicine, College of Health Sciences and Referral Hospital, Aksum University, Aksum, Ethiopia
Background: Intravenous medication administration errors (MAEs) may be accompanied by
avoidable undesirable effects, which might result in clinical complications.
Objective: The aim of the study was to determine the prevalence of MAEs and to identify the
factors associated with such errors.
Methods: A hospital-based cross-sectional study was conducted from March to April 2015.
Data were collected by direct observation using a pretested data collection tool. Simple random
sampling was used, and bivariate logistic regression model was used to identify the factors
associated with MAEs. P value <0.05 was considered statistically significant.
Results: A total of 134 patients were found to be eligible for the study. More than half of the
study participants were males (76 [56.7%]). The rate of MAE was 46.1%, with the missed
dose (n=162, 95.8%) being reported as the most common error. The age groups of 60–79 years
(adjusted odds ratio = 2.166, confidence interval = 1.532–8.799) and 80–101 years (adjusted
odds ratio = 1.52, confidence interval = 1.198–5.584) were the determinants of MAEs.
Conclusion: A high prevalence of MAEs was found. Enhancing the knowledge and practical
skills of clinical nurses might minimize such errors.
Keywords: prevalence, medication, administration, error
Background Preparation and intravenous (IV) administration of medications is a crucial clinical
activity in provision of health care for hospitalized patients.1,2 In health care systems, the
medication administration processes represent an advanced technology and a complex
process.3,4 Infusion therapy is one of the medication administration processes used in
the treatment of many hospitalized patients; however, it is associated with high risk of
causing harm for patients.5,6 Administration of medications may be accompanied by
avoidable undesirable effects which sometimes are life threatening, especially when
administered in error.7,8
Medication errors are among the major clinical issues in the health care settings.9–11
Although IV therapy benefits patients, it also represents a source of risks. The complex-
ity of the procedures, multiplicity of professionals and services involved, rapid intro-
duction of new drugs, and diagnostic and therapeutic technologies frequently provoke
errors, jeopardizing care security and quality and generating an increase in cost.3,12
Medication errors are the eighth leading cause of death in the US, and they rep-
resent the single largest cause of errors in the hospital setting, accounting for >7000
deaths annually.13,14 In the US, 60% of serious and life-threatening medication errors
that occur in patients involved IV drugs; in the UK approximately 56% of the errors
Correspondence: Solomon Weldegebreal Asgedom School of Pharmacy, Department of Clinical Pharmacy, College of Health Sciences, Mekelle University, Mekelle 1871, Ethiopia Tel +251 9 2087 1964 Email [email protected]
Journal name: Integrated Pharmacy Research and Practice Article Designation: ORIGINAL RESEARCH Year: 2017 Volume: 6 Running head verso: Fekadu et al Running head recto: Medication administration errors DOI: http://dx.doi.org/10.2147/IPRP.S125085
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Fekadu et al
administered with IV drugs. Although only a few medica-
tions are administered IV in the hospital setting, the IV
drugs account for the majority of medication errors.15,16 A
high incidence of medication errors related to IV therapy
was found in Germany, where 23% of the total medication
errors occur during IV administration.16,17 In Ethiopia, the
prevalence of medication administration errors (MAEs) was
reported to be 55%.18
MAEs can affect patient morbidity and mortality. They
can also influence patients, familiesm, and health care provid-
ers indirectly by cost implication, prolonged hospital stays
and psychological impact.11 Although medication errors are
well investigated in many developed countries, research on
the issue has rarely been conducted in developing countries,
including Ethiopia. Therefore, the aims of this study, which
was conducted at Ayder Referral Hospital (ARH), are to
determine the prevalence of MAEs and identify the factors
associated with them.
Methods and participants The study was conducted at ARH, which is located in Mekelle
city, Tigray, Ethiopia. The hospital is affiliated to Mekelle
University and is the only referral hospital in the region.
It has a total capacity of 500 inpatient beds and serves
250–400 cases per day. We conducted an institutional-based
cross-sectional study. The sample size needed was deter-
mined using single mean population proportion formula.
Considering 1.96 for the standard normal variable with 5%
level of significance (α-value), 95% confidence interval, 5%
margin of error and 10% contingency for loss, the sample
size was calculated to be 384. Because the hospital has 206
beds in the three wards (medical, surgical, and gynecologi-
cal), the minimum sample size needed was estimated to be
134. Simple random sampling was used to select the study
participants. The study included patients aged 18 years and
above; patients administered with two or more IV medica-
tions during their stay in the ward; and patients admitted to
the three wards during the study period. Patients treated with
oral or topical medications were excluded from the study.
Data were collected by directly observing medication
administrations, and the medical records were reviewed using
the pretested data collection format, which was developed
by reviewing reputable literatures. All relevant data were
collected prospectively from patients’ medical records and
by direct observation. Demographic information about the
patients was obtained from their medical cards and medica-
tion administration records. Data on medication administra-
tion were collected by directly observing all day-time (6:00
am to 6:00 pm) medication administration. Along with the
day time observations, medication chart review was carried
out to collect data on the off duty (7:00 pm to 6:00 am) drug
administration. The observations and the information recorded
in the medication charts were documented during the data
collection, including all details about the patient’s medica-
tion regimen. The data were collected by two undergraduate
pharmacists employed outside of ARH. Pretest was done on
ten patients who were randomly selected from the hospital.
These were then excluded from the analysis and amendment
was done in the data abstraction format. MAEs were identi-
fied by comparing medication administration observed/found
as per the order of prescribers. The primary outcome of the
study was presence of MAE; age, comorbidity, number of
medications per patient, regimen complexity, sex, diagnosis,
and dose and frequency of medications were the independent
variables studied.
The data were coded, cleaned and checked for complete-
ness. They were entered in Epidata version 3.1 and analyzed
using Statistical Package for Social Sciences version 20.
Bivariate logistic regression analysis was used to find the
association between MAE and independent variables. Vari-
ables with P<0.05 in the binary logistic regression were
reanalyzed using multivariate logistic regression analysis
to identify the determinants of MAE. A P value <0.05 was
considered to be statistically significant. Ethical clearance
was obtained from the Institutional Review Board of College
of Health Sciences, Mekelle University. Oral consent were
obtained from the patients before the data were collected.
Operational definitions MAE is a deviation from the physician’s medication order
as written on the patient’s chart. It includes poor medica-
tion administration record on the patient chart and failure
to comply with the prescription order (drug, dose, dosage
regimen, dosage form and length of therapy).19
Complex regimen is the prescription of three or more drugs
to one patient at the same time.19
Results Demographic characteristics In our study, 134 patients were included, making up a 100%
response rate. More than half of the study participants were
males 76 (56.7%) and 58 (43.3%) were in the age group of
40–59 years. The mean age of the participants was 35±15.5
years (Table 1).
IV medication usage information More than half of the patients (64.2%) were admitted to the
emergency department before they were transferred to one
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Medication administration errors
of the three wards, and 73 (54.5%) patients were admitted
to the medical ward. Concerning the number of drugs per
prescription, 67 (50%), 43 (32.1%) and 17 (12.7%) patients
received two, three and four drugs per prescription, respec-
tively (Table 2). An average of 2.73 (2.73±1.34: mean ± stan-
dard deviation [SD]) drugs were prescribed at the same time
and 37 (27.6%) patients were diagnosed with comorbidities
including infection and abscess (Table 3).
MAE A total of 366 medication administration interventions had
occurred in the studied wards of ARH. Out of the 366 medi-
cation administration interventions, 169 (46.1%) medica-
tions administered were labeled as MAE. Among all MAEs,
missed dose and wrong dose contributed to 162 (95.8%) and
7 (4.2%) errors, respectively. The MAEs were observed in
each study site: 89 (52.6%) in the medical ward, 51 (30.1%)
in the surgical ward and 29 (17.1%) in the gynecology ward.
Factors associated with IV MAE Binary logistic regression analyses showed that age groups
60–79 years (crude odds ratio [COR] = 1.31, 95% confidence
interval [CI] = 0.47–3.68) and 80–101 years (COR = 1.13, 95%
CI = 1.02–4.03) were significantly associated with MAEs. Mul-
tivariate binary logistic analyses of factors showed that patients
in the age group of 60–79 years (adjusted odds ratio [AOR] =
2.17, CI = 1.532–8.78) and 80–101 years (AOR = 1.52, CI =
1.198–5.58) were determinants of MAE (Table 4). Patients in
the age group of 60–79 years were two times more likely to have
MAE than those in the age group of 18–39 years. Moreover,
patients in the age group of 80–101 years were 1.5 times more
likely to have MAE than those in the age group of 18–39 years.
Discussion In this study, the prevalence of MAEs was found to be 46.1%.
Among the total medication errors in intervention, missed
dose and wrong dose accounted for 95.8% and 4.2%, respec-
tively. Multivariate binary logistic analyses of factors showed
that patients in the age group of 60–79 years (AOR = 2.17,
95% CI = 1.53–8.78) and 80–101 years (AOR = 1.52, 95%
CI = 1.19–5.58) were the determinants of MAE.
The rate of MAEs was found to be lower in this study
than that conducted at the Jimma University Specialized Hos-
pital (JUSH), Southwest Ethiopia, where 51.8% MAEs was
reported.11 The plausible justification for the difference might
be the difference in study setting. This study was conducted at
the surgical, gynecology and medical wards, whereas the study
from JUSH was conducted in the intensive care unit (ICU),
where the number of drugs given per patient was more as com-
pared to that administered to patients admitted in the medical
wards of ARH because IV administration is highly followed
for patients admitted to the ICU in comparison to other wards.
Besides, a much lower rate of MAE was found in our
study as compared to that in a prospective observational study
conducted at a tertiary care hospital, HospSel, Malaysia,
where the rate of MAE was 88.6%. The reason for this dif-
ference could be due to the high number (ten or more) of IV
drugs prepared and administered at that point of time and
the lack of staff nurses (three or less) at the particular ward
of the tertiary care hospital.15
The rate of MAEs in our study was higher than that in
the findings reported from an observational study conducted
Table 1 Age and sex distribution of patients (N=134)
Variables Frequency (%)
Sex Male 76 (56.7) Female 58 (43.3) Age (years) 18–39 28 (20.9) 49–59 58 (43.3) 60–79 33 (24.6) 80–101 15 (11.2)
Table 2 Characteristics and IV medication usage of patients
Variables Frequency (%)
Admission ward Medical ward 73 (4.5) Surgical ward 35 (26.1) Gynecology ward 26 (19.4) Regimen taken Simple 68 (50.7) Complex 66 (49.3) Number of drugs Two drugs 67 (50.0) Three drugs 43 (32.1) Four drugs 17 (12.7) Five drugs 7 (5.2)
Abbreviation: IV, intravenous.
Table 3 Comorbidities
Comorbidities Frequency (%)
DM 5 (3.7) HIV/AIDS 4 (3) TB 9 (6.7) Cardiac disease 11 (8.2) Hypertension 2 (1.5) Cancer 10 (7.5) Renal and liver disease 12 (9) Infection and abscess 37 (27.6) Accident 5 (3.7) Others 39 (29.1)
Abbreviations: AIDS, acquired immunodeficiency syndrome; DM, diabetes mellitus; HIV, human immunodeficiency virus; TB, tuberculosis.
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Fekadu et al
at three large teaching hospitals in the UK and Germany,
which showed 93 (34%) administration errors from 278
IV interventions observed.19 This might be due to the less
knowledge, skill and attitude of the health care providers
and the difference in provision of health care services to
the patients in ARH, as compared to those of UK and Ger-
man hospitals. The other plausible reason could be due to
the involvement of drug supply and pharmacy services in
medication administration process in the three large teach-
ing hospitals which resulted in lower frequency of MAE,19
as compared to our study in which there was no pharmacist
involved in IV administration.
In this study, missed dose was found to be the common
type of administration error. The prevalence of missed dose
was much higher than that reported in JUSH (18.3%). This
might be due to the difference in study setting. The study
from JUSH was conducted at the ICU, wherein patients are
kept under close supervision as compared to those in other
wards.11 Poor availability of medications and poor logistic
system of the hospital might also account for the health care
professionals missing the medication doses, which could
ultimately increase the prevalence of missed dose.
Multivariate binary logistic analyses of factors showed
that patients in the age group of 60–79 years (AOR = 2.166,
CI = 1.532–8.799) and 80–101 years (AOR = 1.52, CI =
1.198–5.584) are determinants of MAEs. Patients in the
age group of 60–79 years were two times more likely to
have MAEs than patients aged 18–39. Moreover, patients in
the age group of 80–101 years were 1.5 times more likely
to have MAEs than patients aged 18–39 years. These find-
ings strengthens the fact that elderly people under chronic
medication and with insufficient control of their medication
level are one of the risk groups for MAE.20,21
Limitations This study has some limitations. As this is a cross-sectional
study, it might lead to recall bias. Further, the study was
conducted at a single center with a small sample size, which
might limit the generalization of the findings.
Conclusion This study reports a high prevalence of MAEs, of which missed
dose was the most common type of error. In addition, it was
found that MAEs were influenced by a patient’s age. These find-
ings emphasize that health care providers could pay due atten-
tion to the risks of MAEs and the factors associated with them.
Acknowledgments We would like to acknowledge Mekelle University for cooperat-
ing with us to conduct the study. Our deepest gratitude also goes
to the staff of Ayder Referral Hospital who helped us in collect-
ing data. The authors received no specific funding for this work.
TF and EE are assistant lecturers in Mekelle University.
MT is a microbiologist in Aksum University. SWA is a clini-
cal pharmacist and lecturer in Mekelle University.
Author contributions TF was involved in the conception and design of the study,
developed data collection tools and analyzed data. SWA,
MT and EE were involved in manuscript writing, analysis
and editing. All authors contributed toward data analysis,
drafting and revising the paper and agree to be accountable
for all aspects of the work.
Disclosure The authors report no conflicts of interest in this work.
References 1. Glavin RJ. Drug errors: consequences, mechanisms, and avoidance. Br.
J Anaesth. 2010;105(1):76–82. 2. Alsulami Z, Conroy S, Choonara I. Medication errors in the Middle East
countries: a systematic review of the literature. Eur J Clin Pharmacol. 2013;69(4):995–1008.
3. Anselmi ML, Peduzzi M, Dos Santos CB. Errors in the administration of intravenous medication in Brazilian hospitals. J Clin Nurs. 2007; 16(10):1840–1841.
4. Cayo L. Compatibility of commonly used IV drugs. Pharm Pract News Spec Ed. 2013;39–46.
5. Zeiter B, Bellers S, Kraemer I. Risk categorization of standardized continuous injection/-infusion solutions at the university medical center Mainz. Eur J Hosp Pharm. 2014;20:58–60.
6. Foinard AM, Simon N, Barthelemy C, Lannoy D, Decaudin B, Odou P. Drug incompatibilities: a problem in clinical practice. J Clin Pharm. 2013;5:34–43.
Table 4 Multiple logistic regression analysis of different variables with IV medication administration error in medical, surgical and gynecology wards of ARH from March to April 2015
Variables Medication administration errors COR (95% CI) AOR (95% CI)
Yes (%) No (%)
Age categories (years) 18–39 12 (42.9) 16 (57.1) 1 1 40–59 12 (20.7) 46 (79.3) 2.875 (1.077–7.674) 4.501 (0.300–15.578) 60–79 12 (36.4) 21 (63.6) 1.312 (0.47–3.681) 2.166 (1.533–8.799) 80–101 6 (40.0) 9 (60.0) 1.125 (1.02–4.029) 1.52 (1.198–5.584)
Abbreviations: AOR, adjusted odds ratio; ARH, Ayder Referral Hospital; CI, confidence interval; COR, crude odds ratio; IV, intravenous.
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7. Kunle R, Godwin AA, Kehinde O, Abraham D. Medication administra- tion error in anaesthetic practice, IOSR-JPBS. 2014;9(6):62–67.
8. Gikic M, Di Paolo ER, Pannatier A, Cotting J. Evaluation of physico- chemical incompatibilities during parenteral drug administration in a pediatric intensive care unit. Pharm World Sci. 2000;22(3):88–91.
9. Tissot E, Cornette C, Demoly P, Jacquet M, Barale F, Capellier G. Medication errors at the administration stage in an intensive care unit. Intensive Care Med. 1998;25(4):354–355.
10. Cousins DH, Sabatier B, Begue D, Schmitt C, Hoppe-Tichy T. Medi- cation errors in intravenous drug preparation and administration: a multicenter audit in the UK, Germany and France. Qual Saf Health Care. 2005;14(3):190–195.
11. Agalu A, Ayele Y, Bedada W, Woldie M. Medication administration errors in an intensive care unit in Ethiopia. Int Arch Med. 2012;5(1): 1–6.
12. McBride-Henry K, Foureur M. Medication administration errors: understanding the issues. Aust J Advanced Nur. 2006;23(3):33–36.
13. Vijayakumar A, Sharon EV, Teena J, Nobil S, Nazeer I. A clinical study on drug-related problems associated with intravenous drug administra- tion. J Basic Clin Pharm. 2014;5(2):49–51.
14. Llewellyn RL, Gordon PC, Reed AR. Drug administration errors-time for national action. S Afr Med J. 2011;101(5):93–98.
15. Ong WM, Subasyini S. Medication errors in intravenous drug prepara- tion and administration. Med J Malaysia. 2013;68(1):52–56.
16. Mansouri A, Ahmadvand A, Hadjibabaie M, Kargar M, Javadi M, Gholami K. Types and severity of medication errors in Iran; a review of the current literature. Daru. 2013;21(1):49–55.
17. Demehin AI, Babalola OO, Erhun WO. Pharmacists and nurses percep- tion of medication errors in a Nigerian University teaching hospital. Int J Health Res. 2008;2(1):51–61.
18. Negash G, Kebede Y, Hawaze S. Medication errors in the adult emer- gency unit of a tertiary care teaching hospital in Addis Ababa. Arch Pharma Prac. 2013;4(4):8–10.
19. Wirtz V, Taxis K, Barber ND. An observational study of intravenous medication errors in the United Kingdom and in Germany. Pharm World Sci. 2003;25(3):104–111.
20. Zakarov S, Tomson N, Peclova D. medication errors – an ending problem for children and elderly patient. Ups J Med Sci. 2012;117(3):309–307.
21. Szcepura A, Wild D, Nelson S. Medication administration errors for older people in long term residential care. BMC Geriatr. 2011;11:82.
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