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Table 8 The total score of each cause of medication error

From: Using total quality management approach to improve patient safety by preventing medication error incidences**

 

Scorea

I)-Causes Related Prescribing Phase

 a. New staff

9

 b. Poor handwriting orders

24

 c. Verbal order

14

 d. Unapproved abbreviations

22

 e. Understaffing

14

 f. Metric system

19

 g. Lack of knowledge on the medication

7

 h. Unnecessary decimal points

16

 i. Lack of information on the patient

11

II)-Causes Related Dispensing Phase

 j. Poor assessment of order

12

 k. Outdated references

3

 l. Labeling & packaging problems

8

 m. Poor designed Work area

9

 n. Inadequate Distribution system

9

 o. Poor inventory arrangement

4

III)-Causes Related Administration Phase

 p. Failure to follow order instructions

8

 q. Workload/fatigue

15

 r. Medication unavailable

10

 s. Inadequate checking

6

 t. Extended delay of administration due to other department (Lab levels, x-ray,.)

8

 u. Incompliant Patient

11

 v. Inadequate medication device

4

 w. Lack of information

11

 x. Drug given but not documented

13

 y. Drug documented but not given

1

IV)-Causes Related Monitoring Phase

 z. Failure to recognize adverse reactions

5

 aa. Failure to report adverse reactions

4

 bb. Failure to educate patients about potential side effects

12

 cc. Failure to use appropriate clinical or laboratory data for adequate assessment of patient response to prescribed therapy

2

 dd. Inappropriate patient behavior regarding adherence to a prescribed medication regimen

13

 ee. Failure to follow established policies and procedures

15

 ff. Policies and procedure NOT established

7

  1. aScores were calculated depending on nurses answers and notes they filled in Medication Error Causes- Data Sheet presented previousely in Table 7