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The Impact of Dedicated Medication Nurses on the Medication Administration Error Rate
A Randomized Controlled Trial
Nancy L. Greengold, MD, MBA;
Rita Shane, PharmD;
Philip Schneider, RPh;
Elizabeth Flynn, PhD;
Janet Elashoff, PhD;
Cheryl L. Hoying, PhD, RN;
Kenneth Barker, PhD, RPh;
Linda Burnes Bolton, DrPH, RN
Arch Intern Med. 2003;163:2359-2367.
Background Concerns about hospital medication safety mount as the pace of new drug releases accelerates.
Methods We performed a randomized study at 2 hospitals (A and B) to examine whether the medication administration error rate could be decreased by having "dedicated" nurses focus exclusively on administering drugs. "Medication nurses," after receiving a brief review course on safe medication use, were responsible solely for drug delivery for up to 18 patients each. "General nurses," who did not attend the course, provided comprehensive care, including drug delivery, for 6 patients each. A direct observation technique was used to record drug errors, process-variation errors, and total errors.
Results At both hospitals combined, the total error rate was 15.7% for medication nurses and 14.9% for general nurses (P<.84). Comparing hospitals, the total error rate for medication nurses at hospital B was significantly higher than it was at hospital A (19.7% vs 11.2%; P<.04). At hospital A, there was a significantly lower error rate for medication nurses than for general nurses in the surgical units (P<.01) but no significant differences in total errors comparing nurse types in the medical units (P<.77).
Conclusions This trial suggests that use of dedicated medication nurses does not reduce medication error rates. However, subgroup analysis indicates that medication nurses might be useful in some settings. The differences in findings at the 2 hospitals and their differences in medication-use processes reinforce the concept that medication errors are usually related to systems design issues.
From the Departments of Health Services Research (Dr Greengold) and Pharmacy Services (Dr Shane), the Biostatistics Core, Burns and Allen Research Institute (Dr Elashoff), and Clinical Care Services (Dr Burnes Bolton), Cedars-Sinai Health System, Los Angeles, Calif; David Geffen School of Medicine at UCLA (Drs Greengold and Elashoff); the University of California San Francisco School of Pharmacy (Dr Shane); the Latiolais Leadership Program, College of Pharmacy (Mr Schneider), and the Department of Nursing (Dr Hoying), The Ohio State University Medical Center, Columbus; the Center for Pharmacy Operations and Designs, Harrison School of Pharmacy, Auburn University, Auburn, Ala (Drs Flynn and Barker); and the University of California Los Angeles School of Nursing (Dr Burnes Bolton). The authors' financial disclosures are given at the end of the article.
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