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Frequency and Determinants of Drug Administration Errors in the ICU

van den Bemt and colleagues from The Netherlands conducted a study to identify both the frequency and the determinants of drug administration errors in the intensive care unit (ICU). Administration errors were detected in two Dutch hospitals using the disguised-observation technique (observation of medication administrations by nurses, without revealing the aim of this observation to the nurses). The drug administrations to patients in the ICUs of the hospitals were observed during 5 consecutive days. A total of 233 medications for 24 patients were observed to be administered (whether ordered or not) or omitted. When wrong time errors were included, 104 administrations with at least 1 error were observed (frequency, 44.6%); when they were excluded, 77 administrations with at least 1 error were observed (frequency, 33.0%). When wrong time errors were included, day of the week (Monday: odds ratio [OR], 2.69; 95% confidence interval [CI95], 1.42 to 5.10), time of day (6 to 10 pm: OR, 0.28; CI95, 0.10 to 0.78), and drug class (gastrointestinal: OR, 2.94; CIgj, 1.48 to 5.85; blood: OR, 0.12; CI95, 0.03 to 0.54; and cardiovascular: OR, 0.38; CI95, 0.16 to 0.90) were associated with the occurrence of errors. When wrong time errors were excluded, day of the week (Monday: OR, 3.14; CI95, 1.66 to 5.94), drug class (gastrointestinal: OR, 3.47; CI95,1.76 to 6.82; blood: OR, 0.21; CI95,0.05 to 0.91; and respiratory: OR, 0.22; CI95, 0.08 to 0.60), and route of administration (oral by gastric tube: OR, 5.60; CI95, 1.70 to 18.49) were associated with the occurrence of errors.