Clinical review: Medication errors in critical care

Health care delivery is not infallible. Errors are common in most health care systems and are reported to be the seventh most common cause of death overall [1]. The 1999 Institute of Medicine (IOM) report, To Err is Human: Building a Safer Health System, drew public attention to the importance of patient safety [2]. This was followed with considerable interest by the medical community [3]. However, to date, there is little evidence that patient safety has improved [4]. In the intensive care unit (ICU), on average, patients experience 1.7 errors per day [5] and nearly all suffer a potentially life-threatening error at some point during their stay [6]. Medication errors account for 78% of serious medical errors in the ICU [7]. The aim of this article is to provide a basic review of medication errors in the ICU as well as strategies to prevent errors and manage their consequences.Providing a single hospitalized patient with a single dose of a single medication requires correctly executing 80 to 200 individual steps [8]. This hospital medication use process can be categorized into five broad stages: prescription, transcription, preparation, dispensation, and administration [9]. An error can occur at any point in this process. A medication error is any error in the medication process, whether there are adverse consequences or not (Table 1) [10]. Most errors occur during the administration stage (median of 53% of all errors), followed by prescription (17%), preparation (14%), and transcription (11%) [11]. The earlier in the medication process an error occurs, the more likely it is to be intercepted [12]. Administration appears to be particularly vulnerable to error because of a paucity of system checks as most medications are administered by a single nurse [13]. Nurses and pharmacists intercept up to 70% of prescription errors [14]. Preparation errors occur when there is a difference between the ordered amount or concentration of a medication and what is actually prepared