METHODS: This prospective study utilised the direct observation technique where the preparation and administration of 222 intravenous medications were observed in the EDs of two hospitals in Malaysia. Information on medication preparation, administration and other procedures were recorded. Error rates were calculated and multivariable logistic regression was conducted to identify factors contributing to intravenous MAEs.
RESULTS: MAEs were detected in 83.3% (185/222) of the observed medications affecting 86.7% (124/143) patients. Among these, a total of 240 MAEs were identified, with the most common being wrong rate of administration (55.8%), wrong preparation technique (20.8%) and omission error (11.7%). Alimentary tract and metabolism medications accounted for the highest proportion of MAEs (52.0%), followed by anti-infective medications (21.7%) and nervous system medications (15.4%). Excluding wrong time errors reduced the error rate to 80.2% (178/222). Non-verbal orders and inadequate or absence of labelling were significantly associated with MAEs, while factors such as the complexity of preparations, working shift, experience and high-alert medications showed no significant associations.
CONCLUSION: The study highlighted a high prevalence of intravenous MAEs in EDs. Non-verbal orders and inadequacy in labelling of medications were significant contributing factors to MAEs in the ED. Implementing an admixture labelling policy, comprehensive training programs, strict enforcement of existing guidelines and protocols through regular audits, establishing non-punitive error reporting system, and technological solutions where financially feasible are crucial for mitigating these errors to promote patient safety.