Prevalence and causes of medication transcription errors among hospitalized patients: An observational study and survey of nurses at a faith-based hospital in Cameroon
Medication errors are a leading cause of death globally; with the burden on resource-limited countries more than double that in high-income countries. Errors can occur at all stages of the medication use process; however, there is limited information on medication transcription errors (MTEs) among hospitalized patients in Africa. This study sought to determine the prevalence and types of MTEs and to assess nurses’ perceptions of the likely causes of MTEs within the pediatric and general wards at a faith-based hospital in Cameroon. A prospective chart review of medication orders transcribed for patients admitted from April 1 to April 30, 2021, was conducted. Data analyzed included patient demographics, prevalence and types of MTEs, medication classes involved in MTEs, and nurse’s perceptions of the causes of MTEs. A total of 578 medication orders were reviewed for 75 patients, of whom 40 (53%) were female, and 30 were admitted to the pediatric ward. The results revealed that 38 MTEs were recorded, with 47% occurring on the medication administration sheet and dispensing cards. The most frequent MTEs were the omission of new and stop medication orders, involved in 28.9% and 26% of all MTEs, respectively. Antibacterials for systemic use were involved in the majority (55.3%) of MTEs. Illegible prescriptions (90.7%), distractions (87.0%), and high workload (77.8%) were ascribed as the most likely causes of MTEs. In conclusion, MTEs are common and pose a potential risk of patient harm in hospitalized patients. The adoption of a computerized provider order entry system could eliminate illegible prescriptions, reduce transcription processes, and alleviate workload, thereby improving patient safety.
Ali, S., Aboheimed, N.I., Al-Zaagi, I.A., & Al-Dossari, D.S. (2017). Analysis of medication errors at a large tertiary care hospital in Saudi Arabia: A retrospective analysis. International Journal of Clinical Pharmacy, 39(5):1004-1007. https://doi.org/10.1007/s11096-017-0514-7
Armutlu, M., Foley, M.L., Surette, J., Belzile, E., & McCusker, J. (2008). Survey of nursing perceptions of medication administration practices, perceived sources of errors and reporting behaviours. Healthcare Quarterly (Toronto, Ont), 11(3 Spec No):58-65. https://doi.org/10.12927/hcq.2008.19651
Benoit, E., Eckert, P., Theytaz, C., Joris-Frasseren, M., Faouzi, M., & Beney, J. (2012). Streamlining the medication process improves safety in the intensive care unit. Acta Anaesthesiologica Scandinavica, 56(8):966-975. https://doi.org/10.1111/j.1399-6576.2012.02707.x
Callen, J., McIntosh, J., & Li, J. (2010). Accuracy of medication documentation in hospital discharge summaries: A retrospective analysis of medication transcription errors in manual and electronic discharge summaries. International Journal of Medical Informatics, 79(1):58-64. https://doi.org/10.1016/j.ijmedinf.2009.09.002
Dedefo, M.G., Mitike, A.H., & Angamo, M.T. (2016). Incidence and determinants of medication errors and adverse drug events among hospitalized children in West Ethiopia. BMC Pediatrics, 16(1):81. https://doi.org/10.1186/s12887-016-0619-5
Elliott, M., & Liu, Y. (2010). The nine rights of medication administration : An overview. British Journal of Nursing, 19(5):300-305. https://doi.org/10.12968/bjon.2010.19.5.47064
Hartel, M.J., Staub, L.P., Röder, C., & Eggli, S. (2011). High incidence of medication documentation errors in a Swiss university hospital due to the handwritten prescription process. BMC Health Services Research, 11:199. https://doi.org/10.1186/1472-6963-11-199
Jennane, N., Madani, N., Oulderrkhis, R., Abidi, K., Dendane, T., Zeggwagh, A.A., et al. (2011). Incidence of medication errors in a Moroccan medical intensive care unit. International Archives of Medicine, 4(1):32. https://doi.org/10.1186/1755-7682-4-32
Kong, H., West, S., & States, U. (2014). World medical association declaration of Helsinki: Ethical principles for medical research involving human subjects. The Journal of the American College of Dentists, 81(3):14-18. https://doi.org/10.1093/acprofoso/9780199241323.003.0025
Lane, S.J., Troyer, J.L., Dienemann, J.A., Laditka, S.B., & Blanchette, C.M. (2014). Effects of skilled nursing facility structure and process factors on medication errors during nursing home admission. Health Care Management Review, 39(4):340-351. https://doi.org/10.1097/HMR.0000000000000000
Lloyd, M. (2020). Comparison of pharmacy technicians’ and doctors’ medication transcribing errors at hospital discharge. European Journal of Hospital Pharmacy, 27(1):9-13. https://doi.org/10.1136/ejhpharm-2018-001538
Mahmoud, M.A., Ibrahim, A.A.M., & Alolayan, S.O. (2020). Medication safety issues in four lower middle-income countries of northern and Eastern Africa: Challenges and recommendations. Systematic Reviews in Pharmacy, 11(11):482-486.
McComas, J., Riingen, M., & Kim, S.C. (2014). Impact of an electronic medication administration record on medication administration efficiency and errors. CIN-Computers Informatics Nursing, 32(12):589-595. https://doi.org/10.1097/CIN.0000000000000116
Mekonnen, A.B., Alhawassi, T.M., McLachlan, A.J., & Brien JE. (2018). Adverse drug events and medication errors in African hospitals: A systematic review. Drugs-Real World Outcomes, 5(1):1-24. https://doi.org/10.1007/s40801-017-0125-6
Pichon, R., Zelger, G.L., Wacker, P., Vodoz, A.L., & Humbert, J. (2002). Analysis and quantification of prescribing and transcription errors in a paediatric oncology service. Pharmacy World and Science, 24(1):12-15. https://doi.org/10.1023/A:1014814713203
Ratnapala, U.S., Shazar, H., Pathirathna, H., Halahakoon, D., Hanwellage, K., Liyanage, C., et al. (2022). Medication transcription errors at a tertiary healthcare facility in Uva province, Sri Lanka: A retrospective study. Ceylon Medical Journal, 67(4):184-188. https://doi.org/10.4038/cmj.v67i4.9748
Shawahna, R., Abbas, A., & Ghanem, A. (2019). Medication transcription errors in hospitalized patient settings: A consensual study in the Palestinian nursing practice. BMC Health Services Research, 19(1):644. https://doi.org/10.1186/s12913-019-4485-3
Shehata, Z.H.A., Sabri, N.A., & Elmelegy, A.A. (2016). Descriptive analysis of medication errors reported to the Egyptian national online reporting system during six months. Journal of the American Medical Informatics Association, 23(2):366-374. https://doi.org/10.1093/jamia/ocv096
South, D.A., Skelley, J.W., Dang, M., & Woolley, T. (2015). Near-miss transcription errors: A comparison of reporting rates between a novel error-reporting mechanism and a current formal reporting system. Hospital Pharmacy, 50(2):118-124. https://doi.org/10.1310/hpj5002-118
World Health Organization. (2017). Medication without Harm- Global Patienti Safety Challenge on Medication Safety. Geneva: World Health Organization.