We observed a total of 4271 drug administrations for 720
patients: 2592 administrations for 514 patients at hospital
A and 1679 for 206 patients at hospital B. The mean
age of patients differed by hospital: 72.6 years (95% CI,
71.1-74.0) for hospital A and 67.5 years (95% CI, 65.0-
70.0) for hospital B.
Only 19.8% of administrations were free of procedural
failures or clinical errors. At least 1 procedural failure occurred
in 74.4% of administrations, and 25.0% had at least
1 clinical error (Table 2). Procedural failures and clinical
errors by type are shown in Table 3 and Table 4. Not
checking the patient’s identification against their medicationchartwasthemostfrequentproceduralfailure.Inonly
41.3% (n=1762) of administrations was the identification
procedureundertaken.Wrongtimingofmedicationadministration
was the most frequent clinical error (n=688 administrations),
but only 4.1% were rated as being of major
severity.WrongIVadministrationratewasthesecondmost
frequentclinicalerror(n=207administrations),with35.7%
of these errors rated as being of major severity.
Interruptions occurred in 53.1% of all administrations.
Hospital B had significantly higher rates of interruptions
and procedural failures than did hospital A (see
Table 2 for 95% CIs)