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Medication Errors in Anesthesiology

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Human errors are inevitable and a part of everyday life. Medication errors caused by anesthetists in critical care units increase morbidity and mortality rates.

Written by

Dr. Chandana. P

Medically reviewed by

Dr. Jadhav Yatish Anant

Published At November 29, 2022
Reviewed AtFebruary 23, 2024

Introduction:

Some mistakes can happen in any part of life. The first step to efficiently managing errors is understanding the cause of mistakes, subsequent incidents, and accident avoidance. The anesthetist is a member of a dynamic, complicated system. The patient, anesthetist, co-workers, and the equipment used during anesthesia.

Regardless of the difficulty of the issue, error management and prevention are mainly attainable tasks.

What Is the Extent and How to Combat the Problem?

Human mistake rates in anesthesia are also high. Even when human errors are not directly involved, it is frequently easy to identify mistakes in any system component's design, production, inspection, installation, or maintenance. Critical occurrences, accidents, and even deaths can still happen due to anesthetic and postoperative care, despite the evidence of significant advancements.

The anesthesia-related mortality and morbidity rates can be solved by identification of problem areas, analysis of root causes (people, equipment, and human-equipment interfaces), drivers for safer patient care, identification of problem areas, analysis of root causes (people, equipment, and human-equipment interfaces), drivers for safer patient care, identification of challenges to the invention of patient safety systems, and development of solutions to these obstacles.

What Are the Terminologies Used to Describe Errors in Anesthesia?

The phrases; near miss, medical error, adverse event, and patient safety, as defined by the Institute of Medicine, are used in patient safety and incident reporting systems.

  • Near Miss: A mistake that occurred but had no negative consequences.

  • Slip: An error in execution caused by improper application of routine behavior.

  • Lapse: Failure to act because of memory loss or the omission of normal conduct.

  • Medical Error: When a planned activity is not carried out as intended or when the wrong strategy is used to accomplish a goal.

  • Medication Error: Any inaccuracy in medication administration, whether or not it has unfavorable effects.

  • Adverse Drug Event (ADE): Any harm caused by drug use. Medical blunders or severe medication reactions are not always the result of the other.

  • Preventable ADE: Damage that might have been averted with adequate preparation or skillful execution of a task.

What Is the Origin of the Error?

The modeling system distinguishes failures in decision-making (mistakes) resulting from errors in decision-making and implementation (action failures - errors or lapses), which are frequently unintentional. Most errors occurred because of either a lack of expertise (16 %) or a lack of knowledge of the equipment or device (9.3 %); impatience, inattention, or carelessness accounted for 5.6 % of errors.

In operating rooms, several additional circumstances exist that contribute to the high rate of drug mistakes made when administering anesthetic. The most frequent issues affecting medical and paramedical services are a lack of staff, overtime and unusual hours, inattention, poor communication, carelessness, hurry, and weariness.

What Is the Classification of Medication Errors?

Errors in medication preparation, administration, or recording are all possible.

  1. During Drug Preparation: Identical injection vials are grouped (misidentification of injection bottles), syringes without labels, failing to read the label before administration, including date of expiry and manufacturing, inaccurate labeling, and a different concentration in the syringe (inadequate dilutions are essential for pediatric patients).

  2. Administration of the Drug: Patient identification error, incorrect dosage, especially in pediatric patients (insufficient or overdose), separate persons are used for medicine manufacturing and administration, and swap syringes. Inappropriate method of administration, administered at the wrong time, drug omission, reiteration, or replacement.

  3. Recording of the Drug Delivered: Undetected adverse incident, physician’s reluctance to acknowledge their mistakes, failing to disclose a drug mistake.

What Are the Causes of Medication Administration Errors?

  • Unsafe Behaviors: Lapses and slips, rules-based errors, and violations.

  • Local Workplace Factors: Patients, policies, treatment, ward-based tools, personality and well-being, information exchange, disturbance and distraction, experience and training, blend of workload and skill, general office atmosphere, supply and medicine storage, company culture, monitoring, and interactions in the area.

  • Organizational Choices: High-level and strategic decisions.

What Are the Possible Ways of Management of Incorrect Drug Administration?

Anesthesiologists learn how to prepare, label, and arrange medications before the commencement of a case. Errors can happen for various reasons: lack of expertise, negligence (particularly during anesthetic maintenance), improper labeling, identification, or selection, or a stressful operating room environment. Errors by anesthesiologists while administering drugs in the operating room are preventable and fatal. The anesthetist should take necessary measures to minimize the mistakes occurring during induction and to deliver anesthesia safely. Drug errors that occur cannot be reversed easily. The best possible way to ‘treat’ drug errors is to stop them from happening.

What Is the Way to Improve the Safety of Anesthesiology?

  • Systems for reporting and databases.

  • Patient safety education (graduate and continuing medical education).

  • Establishing a safety culture.

  • Control over working hours for anesthetists and improve efficiency.

  • Mandatory execution of qualifications in a realistic setting.

  • Anesthesiologists check equipment in a realistic simulation setting.

  • Improved equipment design and increased uniformity across manufacturers, such as infusion pump programming.

What Are the Ways to Prevent Errors in Anesthesiology?

  • Understand the anesthetic equipment and utilize the proper protocols to maintain it.

  • Stay updated with approved continuing medical education activities: annually, one to two valid meetings.

  • Adequate patient preoperative examination, ideally by the practitioner handling the case. Cardiac and airway assessments must be performed correctly and in sufficient detail since they are crucial.

  • Technology may boost safety and decrease errors when appropriately utilized. For example, monitors, machines, pumps, computerized physician order input, and so on can result in fewer errors and higher levels of safety.

  • Observe the signs of tiredness and exhaustion, heavy workload, and overwork.

  • Effective communication between the anesthetic team is crucial.

  • System-related mistakes must be regularly looked out for, fixed, or eliminated.

  • When administering medications or syringes to many patients, exercise caution.

Conclusion:

The anesthetist is a component of a complicated system that is affected by a wide range of factors. Anesthesiologists never make a mistake on purpose, yet mistakes are never forgivable since they might result in a loss of life. The most effective approach to ensure anesthetic failures are reduced and safety is maximized by adequate individual intelligence, continual education, research, effective communication, efficient cooperation, and authentic culture of safety encircling people and systems involved in perioperative care.

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Dr. Jadhav Yatish Anant
Dr. Jadhav Yatish Anant

Anesthesiology

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