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Table 9 Pareto table --causes of medication error (N = 318)

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

Cause of medication error Score Percent Cumulative percent
b. Poor handwriting orders 24 7.5 7.5
d. Unapproved abbreviations 22 6.9 14.5
f. Metric system 19 6.0 20.4
h. Unnecessary decimal points 16 5.0 25.5
ee. Failure to follow established policies and procedures 15 4.7 30.2
q. Workload/fatigue 15 4.7 34.9
c. Verbal order 14 4.4 39.3
e. Understaffing 14 4.4 43.7
dd. Inappropriate patient behavior regarding adherence to a prescribed medication regimen 13 4.1 47.8
x. Drug given but not documented 13 4.1 51.9
bb. Failure to educate patients about potential side effects 12 3.8 55.7
j. Poor assessment of order 12 3.8 59.4
u. Incompliant Patient 11 3.5 62.9
i. Lack of information on the patient 11 3.5 66.4
r. Medication unavailable 10 3.1 69.5
m. Poor designed Work area 9 2.8 72.3
a. New staff 9 2.8 75.2
n. Inadequate Distribution system 9 2.8 78.0
t. Extended delay of administration due to other department (Lab levels, x-ray,.) 8 2.5 80.5
p. Failure to follow order instructions 8 2.5 83.0
l. Labeling & packaging problems 8 2.5 85.5
ff. Policies and procedure NOT established 7 2.2 87.7
g. Lack of knowledge on the medication 7 2.2 89.9
s. Inadequate checking 6 1.9 91.8
z. Failure to recognize adverse reactions 5 1.9 93.4
v. Inadequate medication device 4 1.3 95.7
o. Poor inventory arrangement 4 1.3 95.9
aa. Failure to report adverse reactions 4 1.3 97.2
k. Outdated references 3 0.9 98.1
w. Lack of information 3 0.9 99.1
cc. Failure to use appropriate clinical or laboratory data for adequate assessment of patient response to prescribed therapy 2 0.6 99.7
y. Drug documented but not given 1 0.3 100
Total 318 100