Perioperative medication errors-are these avoidable?

Abstract

Perioperative drug errors are under reported in our country but these can be a tool for assessment of quality of care to patients undergoing surgery. A medication error is defined as an error in drug administration irrespective of presence or absence of adverse consequences. Every patient is entitled to the five rights of medication namely the right patient, the right drug, the right dose, the right timing of drug and the right route. In perioperative settings, the time for dispensing to administration of drugs is merely few seconds or sometimes few minutes. The anaesthetist often has to multitask like monitoring of patient, paper work, tracking the progress of surgery and administering multiple medications simultaneously. The whole process of preparation, mixing and administration of drugs while continuous care under stressful situations often creates numerous opportunities for reducing attentiveness to drugs being withdrawn, eventually making OT’s a potential area for high risk of adverse events (47.7-50.3%). Highly stressful situations, handling of multiple issues, fatigue and inexperience contribute to risk. The use of infusion pumps, target controlled infusion pumps have often caused errors because of miscalculation, malfunction or operator insufficiency. The reported incidence of medication error in anaesthetic practice is between 0.34% to 0.73%. Majority of errors was noted at induction, maintenance and a very small number was reported at recovery. The chances of errors was higher in ASA grade III than ASA grade I and II (0.81% vs. 0.28% reporting incidence). Around 61.5% errors were due to substitution and incorrect dose calculations. In a study evaluating the ability of anaesthesiologists to correctly calculate the infusion dose for children, only 15% could provide correct calculations. The extent of drug errors varied from drug concentrations 50 times too low up to 56 times too high. Errors arising out of wrong dose preparations were found to be significantly high.