Incidence and types of medication errors in the management of inpatients with chronic cardiac failure at Muhimbili national hospital Dar es Salaam

Abstract

Background: Chronic cardiac failure (CCF) is one of the major causes of high morbidity and mortality in Tanzania. Patients with CCF often have other diseases and require adequate multiple drug treatment, which is important for optimum prognosis. Medication error (ME) is a common problem facing hospitals both in developed and developing countries. The likelihood of ME to occur during the management of CCF is high due to high number of medicines, which must be taken at the same time and this may lead to poor treatment outcome. Aim of the study: The main aim of the study was to determine the types and frequencies of medication errors among patients with CCF admitted at Muhimbili National Hospital (MNH). Methodology: This was a prospective observational study that included 100 adult male and female patients with the diagnosis of CCF at medical wards at MNH. Observations were made on admission, post admission, during hospital stay and on discharge. Information was extracted from eligible patients‟ medical records, drug charts, laboratory test results and personal interview with patients. The obtained information was recorded in case report form (CRF). After reviewing and recording data from medical records, the investigator examined drug treatment prescribed by the intern, resident or specialist and noted the type of ME committed. Any new changes by another prescriber during the hospital stay were also examined. Upon receiving laboratory results, the investigator re-examined the cases for potential drug and abnormal electrolyte interaction. On discharging, the investigator examined prescriptions and also interviewed patients on types of non pharmacological advices given to them by hospital staff. Specially designed check list, patients‟ interviews and drug charts were used to determine drug administration errors. The ability of a block pharmacist to detect prescription errors was determined from medication issued for each patient according to patient file. xiii Results: During a follow up of 201 person days, 71 patients were observed with medication error (incidence rate, 35 per 100 person days of observation). Most of medication errors were due to prescription errors (80.2%), followed by dispensing error (16%) and lastly by drug administration error (4%). Most frequency of ME were observed during hospital stay (40%), followed by admission (25%). Among commission errors potential drug and drug interaction, 81 (22.7%) and potential drug and abnormal electrolyte interactions 80 (22.4%) were the most common. Potential drug and abnormal electrolyte interaction was the major error undetected by block pharmacist contributing to 45%, followed by inappropriate starting dose (23.1%) and drug of choice appropriate to the condition not written (23.7%). The mean duration of hospital stay was shorter for those without medication error (mean days 6.75 95%CI 5.1 8.45) compared with those with medication error and those with errors (mean days 11.2 95%CI 8.87 13.5). Patients discharged with symptom had more ME (93.1) compared to those without symptoms (58%) and the association was significant (P = 0.001). Conclusion: From the study, it can be concluded that the incidence of medication error is fairly high. Controlling for such errors may lead to improvement in patient care. The pattern of ME suggests that prescription errors were the major type of error. Of these prescription errors, errors leading to drug and drug interactions and drug with abnormal electrolyte interactions are the most common. Clinicians at MNH need to consider laboratory results while treating these patients. Producing laboratory results on time may be necessary to avoid these interactions.