UNLABELLED: Safety of injectable dosage forms during their preparation and administration by nurses in hospitals: a literature review Introduction and Aim: Medication errors in hospitals are still frequent and significant for patient safety and associated healthcare costs. Especially, injectable dosage forms pose the high risk. The aim of this study was to review the current literature focused on medication errors related to injectable drug forms during their preparation and administration by nurses in hospitals. METHODS: Databases Medline and Scopus were used for the literature review. Papers dealing with intravenous (i. v.), intramuscular (i. m.), or subcutaneous (s. c.) administration by nurses in hospitals using direct observation method for data collection were searched. Original papers, systematic reviews or meta-analyses published in English by the end of 2022 were included. RESULTS: A total of 334 papers were retrieved, of which 21 studies met the inclusion criteria. 17 studies were observational (8 descriptive, 9 analytical) and 4 interventional. Medication errors were very common, moreover, critical steps of the medication process and possible interventions were identified. CONCLUSION: The results showed that the process of preparing and administering injectable dosage forms is a high-risk process. In the provision of healthcare, relevant measures must be set up to maximise patient safety.

• Klíčová slova
• medication error, nursing staff, hospital, parenteral administration, intravenous administra-tion, medication error, nursing staff, hospital, parenteral administration, intravenous administra-tion.,
• MeSH
• bezpečnost pacientů MeSH
• injekce * MeSH
• lékové formy MeSH
• lidé MeSH
• medikační omyly * prevence a kontrola   statistika a číselné údaje   MeSH
• personál sesterský nemocniční MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• lékové formy MeSH

AIMS: To explore all medication administration errors (MAEs) throughout the entire process of medication administration by nurses in the inpatient setting, to describe their prevalence, and to analyse associated factors, including deviation from the good practice standards. BACKGROUND: Worldwide, MAEs are very common and regarded as a serious risk factor to inpatient safety. Nurses assume an essential role in the hospital setting during the administration of medications. DESIGN: The prospective observational study was carried out in accordance with the STROBE guidance. METHODS: This study was conducted in four regional hospitals from June to August 2021. MAEs were collected when nurses administered medications to the adult inpatients during the morning, noon, and evening medication rounds at the internal, surgical, and follow-up care departments in each hospital over three consecutive days. Direct observation by the multidisciplinary team was employed. MAEs were classified as major MAEs (from the potentially most serious and common to all drug forms), specific MAEs (specific to a drug form), and procedural MAEs (e.g., patient identification, hygiene standards, or generic drug substitution). Predictors of either major MAE or specific MAE frequency were analysed using the generalised linear model and the decision tree model. RESULTS: Overall, 58 nurses administering medication to 331 inpatients at 12 departments were observed. In total, 6356 medication administrations were observed, of which 461 comprised major MAEs, 1497 specific MAEs, and 12,045 procedural MAEs. The predictors of the occurrence of major MAEs and specific MAEs were the specific hospital, the nurse's length of practice (less than 2 years), and two procedural MAEs (the unclear prescription and the wrong strength). CONCLUSIONS: Non-adherence to the standard processes in healthcare facilities for prescribing and administering drugs increased the prevalence of severe MAEs. Determinants of MAE occurrence such as incorrect prescriptions or limited experience of nurses should be considered. IMPLICATION FOR THE PROFESSION AND PATIENT CARE: The identified determinants of MAE should be considered by hospital stakeholders in their support programs to reduce the level of burden for nurses during medication administration. PATIENT OR PUBLIC CONTRIBUTION: Neither patients nor public was not involved in the design, data collection, or dissemination plans of this study. The researchers observed nurse care delivery at medical departments acting as passive participants.

• Klíčová slova
• inpatient, medication administration, medication error, multidisciplinary team, nurse, patient safety,
• MeSH
• dospělí MeSH
• hospitalizace * statistika a číselné údaje   MeSH
• lidé středního věku MeSH
• lidé MeSH
• medikační omyly * ošetřování   statistika a číselné údaje   prevence a kontrola   MeSH
• personál sesterský nemocniční statistika a číselné údaje   MeSH
• prospektivní studie MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH

BACKGROUND: Despite efforts to improve undergraduate clinical pharmacology & therapeutics (CPT) education, prescribing errors are still made regularly. To improve CPT education and daily prescribing, it is crucial to understand how therapeutic reasoning works. Therefore, the aim of this study was to gain insight into the therapeutic reasoning process. METHODS: A narrative literature review has been performed for literature on cognitive psychology and diagnostic and therapeutic reasoning. RESULTS: Based on these insights, The European Model of Therapeutic Reasoning has been developed, building upon earlier models and insights from cognitive psychology. In this model, it can be assumed that when a diagnosis is made, a primary, automatic response as to what to prescribe arises based on pattern recognition via therapy scripts (type 1 thinking). At some point, this response may be evaluated by the reflective mind (using metacognition). If it is found to be incorrect or incomplete, an alternative response must be formulated through a slower, more analytical and deliberative process, known as type 2 thinking. Metacognition monitors the reasoning process and helps a person to form new therapy scripts after they have chosen an effective therapy. Experienced physicians have more and richer therapy scripts, mostly based on experience and enabling conditions, instead of textbook knowledge, and therefore their type 1 response is more often correct. CONCLUSION: Because of the important role of metacognition in therapeutic reasoning, more attention should be paid to metacognition in CPT education. Both trainees and teachers should be aware of the possibility to monitor and influence these cognitive processes. Further research is required to investigate the applicability of these insights and the adaptability of educational approaches to therapeutic reasoning.

• Klíčová slova
• Clinical competency, Clinical pharmacology and therapeutics, Management reasoning, Medical decision making, Medical education, Therapeutic reasoning,
• MeSH
• farmakologie klinická výchova   MeSH
• klinická rozvaha * MeSH
• klinické kompetence MeSH
• lékové předpisy normy   MeSH
• lidé MeSH
• medikační omyly prevence a kontrola   MeSH
• metakognice MeSH
• studium lékařství pregraduální MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

UNLABELLED: The aim of the study was to identify the reasons for medication administration errors, describe the barriers in their reporting and estimate the number of reported medication administration errors. BACKGROUND: Providing quality and safe healthcare is a key priority for all health systems. Medication administration error belongs to the more common mistakes committed in nursing practice. Prevention of medication administration errors must therefore be an integral part of nursing education. DESIGN: A descriptive and cross-sectional design was used for this study. METHODS: Sociological representative research was carried out using the standardized Medication Administration Error Survey. The research study involved 1205 nurses working in hospitals in the Czech Republic. Field surveys were carried out in September and October 2021. Descriptive statistics, Pearson's and Chi-square automatic interaction detection were used to analyze the data. The STROBE guideline was used. RESULTS: Among the most frequent causes of medication administration errors belong name (4.1 ± 1.4) and packaging similarity between different drugs (3.7 ± 1.4), the substitution of brand drugs by cheaper generics (3.6 ± 1.5), frequent interruptions during the preparation and administration of drugs (3.6 ± 1.5) and illegible medical records (3.5 ± 1.5). Not all medication administration errors are reported by nurses. The reasons for non-reporting of such errors include fear of being blamed for a decline in patient health (3.5 ± 1.5), fear of negative feelings from patients or family towards the nurse or legal liability (3.5 ± 1.6) and repressive responses by hospital management (3.3 ± 1.5). Most nurses (two-thirds) stated that less than 20 % of medication administration errors were reported. Older nurses reported statistically significantly fewer medication administration errors concerning non-intravenous drugs than younger nurses (p < 0.001). At the same time, nurses with more clinical experience (≥ 21 years) give significantly lower estimates of medication administration errors than nurses with less clinical practice (p < 0.001). CONCLUSION: Patient safety training should take place at all levels of nursing education. The standardized Medication Administration Error survey is useful for clinical practice managers. It allows for the identification of medication administration error causes and offers preventive and corrective measures that can be implemented. Measures to reduce medication administration errors include developing a non-punitive adverse event reporting system, introducing electronic prescriptions of medicines, involving clinical pharmacists in the pharmacotherapy process and providing nurses with regular comprehensive training.

• Klíčová slova
• Hospital incident reporting, Medication administration error, Medication error, Nurse practice patterns, Nurses, Nursing research,
• MeSH
• lidé MeSH
• medikační omyly prevence a kontrola   MeSH
• personál sesterský nemocniční * MeSH
• průřezové studie MeSH
• průzkumy a dotazníky MeSH
• řízení rizik MeSH
• zdravotní sestry * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Medication administration errors (MAE) are a worldwide issue affecting the safety of hospitalized patients. Through the early identification of potential causes, it is possible to increase the safety of medication administration (MA) in clinical nursing. The study aimed to identify potential risk factors affecting drug administration in inpatient wards in the Czech Republic. MATERIAL AND METHODS: A descriptive correlation study through a non-standardized questionnaire was used. Data were collected from September 29 to October 15, 2021, from nurses in the Czech Republic. For statistical analysis, the authors used SPSS vers. 28 (IBM Corp., Armonk, NY, USA). RESULTS: The research sample consisted of 1205 nurses. The authors found that there was a statistically significant relationship between nurse education (p = 0.05), interruptions, preparation of medicines outside the patient rooms (p < 0.001), inadequate patient identification (p < 0.01), large numbers of patients assigned per nurse (p < 0.001), use of team nursing care and administration of generic substitution and an MAE. CONCLUSIONS: The results of the study point to the weaknesses of medication administration in selected clinical departments in hospitals. The authors found that several factors, such as high patient ratio per nurse, lack of patient identification, and interruption during medication preparation of nurses, can increase the prevalence of MAE. Nurses who have completed MSc and PhD education have a lower incidence of MAE. More research is needed to identify other causes of medication administration errors. Improving the safety culture is the most critical challenge for today's healthcare industry. Education for nurses can be an effective way to reduce MAEs by enhancing their knowledge and skills, mainly focusing on increasing adherence to safe medication preparation and administration and a better understanding of medication pharmacodynamics. Med Pr. 2023;74(2):85-92.

• Klíčová slova
• drug, errors, medication administration, nursing, patient safety, safety management,
• MeSH
• korelace dat MeSH
• léčivé přípravky MeSH
• lidé MeSH
• medikační omyly * prevence a kontrola   MeSH
• průzkumy a dotazníky MeSH
• zpráva o sobě MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• léčivé přípravky MeSH

INTRODUCTION: Healthcare is inherently associated with a risk to patient health. One risk is associated with medication-related errors, which are commonly reported adverse events. By analyzing the root causes of medication errors, effective preventive measures can be proposed to reduce their likelihood. This study aimed to identify the reasons of medication administration errors, determine the number of medication administration errors reported, and describe the barriers hindering reporting. METHODOLOGY: The study used a standardized Questionnaire Medication Administration Error Survey (MAE survey) that was quantitatively analyzed. The study involved 112 nurses from four hospitals in the South Bohemian Region. RESULTS: Risk factors that increase the likelihood of medication administration errors include similarity of drug names (3.7 ± 1.3) and packaging (3.9 ± 1.5), frequent prescription changes for patients (3.2 ± 1.5), illegibility of written prescriptions (3.1 ± 1.6), a lack of clarity of medical records (2.6 ± 1.5). Only a proportion of medication administration errors are reported by nurses (16% to 21%). The reluctance of nurses to report medication administration errors is linked to fear of being blamed for the deterioration of the patients health (3.3 ± 1.7), fear of the doctors reaction to a medication administration error (2.6 ± 1.4), and repressive responses from hospital management to reported misconduct (2.9 ± 1.5). CONCLUSION: Measures to reduce the likelihood of medication administration errors include building a non-punitive system for reporting adverse events and medication errors, introducing electronic prescription systems, promoting open communication within the team, involving clinical pharmacists in the pharmacotherapy process, and regular comprehensive training of nursing staff.

• Klíčová slova
• administration of drugs, medication error, nurse, reporting of adverse events,
• MeSH
• farmaceuti MeSH
• lidé MeSH
• medikační omyly prevence a kontrola   MeSH
• nemocnice MeSH
• personál sesterský nemocniční * MeSH
• průzkumy a dotazníky MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

A medication error is one of the most common causes of patients complications or death in healthcare facilities. In the United States, 7,000 out of 9,000 patients die because of medication errors each year. Known factors are generally divided into four groups - human factor, intervention, technical factor, and system. Our study includes 17 studies from the OVID, Web of Science, Scopus, and EBSCO databases, in the range of 2015-2020. After a selection of professional publications, 2 categories were created - factors leading to medication errors and interventions to reduce medication error and testing their effectiveness. It has been found that human factor always plays a role, often supported by a poorly set-up system. The most mistakes are made in documentation, administration technique or accidental interchange of patients. The most frequently mentioned factors include nurses overload, high number of critically ill patients, interruptions in the preparation or in the administration of medications, absence of the adverse event reporting system, non-compliance with guidelines, fear, and anxiety. Another evidence of medication error is in the application of intravenous drugs, where an interchange of drugs or patients due to interruption occurs as well. Sufficient education of nurses and an adequate system of preparation and administration of drugs, for example using bar codes, are considered as an appropriate intervention.

• Klíčová slova
• Drug administration, drug preparation, factors of medication error, intervention, medication error,
• MeSH
• kritický stav MeSH
• léčivé přípravky * MeSH
• lidé MeSH
• medikační omyly * prevence a kontrola   MeSH
• poskytování zdravotní péče MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• léčivé přípravky * MeSH

INTRODUCTION: Outpatient Electronic Prescription Systems (OEPSs) are widely used in some European states, such as Denmark, Sweden and the Netherlands. The Czech OEPS (known as eRecept) was introduced in 2011, but with limited functions and voluntary usage it was not much accepted until 2018, when its usage was made compulsory not only for pharmacies, but for physicians as well. METHODS: Using data from the Czech State Institute for Drug Control (Státní ústav pro kontrolu léčiv or SÚKL in Czech) and from other sources, the system was described and data about its performance since 2013 have been obtained. RESULTS: The usage of the system was very low between 2013 and 2016, whilst moderate growth was seen in 2017. By 2018, the system has been widely adopted, although some twenty per cent of Czech physicians still do not use the system at all. DISCUSSION: A sudden rise in usage can be explained as the result of making the system compulsory starting in January 2018. Still, new features of the system are eagerly awaited and should be introduced to expand its benefits. CONCLUSION: The Czech Republic has joined the EU countries widely using the OEPS.

• Klíčová slova
• Drug prescription, Electronic prescription, Information system,
• MeSH
• elektronické předepisování normy   MeSH
• lidé MeSH
• medikační omyly prevence a kontrola   MeSH
• pacienti ambulantní statistika a číselné údaje   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

Medication errors in paediatric prescribing occur in approximately 10-15 % cases, almost half of these errors are represented by incorrect drug dosing. Maturational changes in pharmacokinetics and/or pharmacodynamics parameters of paediatric patients across different paediatric categories represent a challenge to optimal drug prescribing. Especially neonatal and infant populations along with obese children of adult size are the most vulnerable groups prone to medication errors. Clinical pharmacist focused on paediatric pharmacotherapy verification is another element ensuring safe and rational medication use across different paediatric specialities.

• Klíčová slova
• clinical pharmacy, paediatrics, pharmacotherapy,
• MeSH
• dítě MeSH
• dospělí MeSH
• farmaceuti * MeSH
• lidé MeSH
• medikační omyly * prevence a kontrola   MeSH
• obezita komplikace   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

These European Board of Anaesthesiology (EBA) recommendations for safe medication practice replace the first edition of the EBA recommendations published in 2011. They were updated because evidence from critical incident reporting systems continues to show that medication errors remain a major safety issue in anaesthesia, intensive care, emergency medicine and pain medicine, and there is an ongoing need for relevant up-to-date clinical guidance for practising anaesthesiologists. The recommendations are based on evidence wherever possible, with a focus on patient safety, and are primarily aimed at anaesthesiologists practising in Europe, although many will be applicable elsewhere. They emphasise the importance of correct labelling practice and the value of incident reporting so that lessons can be learned, risks reduced and a safety culture developed.

• MeSH
• anestezie škodlivé účinky   metody   MeSH
• anesteziologie normy   MeSH
• bezpečnost pacientů normy   MeSH
• lidé MeSH
• medikační omyly prevence a kontrola   MeSH
• péče o pacienty v kritickém stavu normy   MeSH
• řízení bezpečnosti metody   normy   MeSH
• řízení rizik metody   normy   MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• značení léčiv normy   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH